October 2, 2022

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Health & Fitness

Psilocybin as a mental health therapy? Some things to know.

Psilocybin as a mental health therapy? Some things to know.

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A few weeks ago, I mentioned to a friend that I was interested in learning more about psychedelics, especially how they might help me with depression and anxiety. That’s a broad category of plant medicines including psilocybin (“magic”) mushrooms, MDMA (ecstasy), DMT (Dimitri or the Businessman’s Trip), ketamine (“special K”) and some others.

I’d been hesitant to be open about my search, because I’m old enough to remember the warnings about “bad trips” that scramble your brain. Imagine my surprise when my friend told me he’d recently taken his first “trip,” which he described as life-changing.

I asked him — a real estate developer living in Northern California, married with kids — why he decided to try a psychedelic substance. “My work felt increasingly stale and meaningless,” he explained to me over a beer. “Despite a massive amount of reflection and coaching around how to break the rut, I felt as though I was still off track.”

He and the others who have used these medicines spoke on the condition of anonymity because most of these psychedelics are Schedule I substances, meaning they are illegal to manufacture, buy, possess or distribute.

When I confided my interest in psychedelics to a few other friends, several said they had tried the drugs and experienced several benefits: from easing anxiety to finding spiritual insights to combating depression and, among some with cancer, helping to reduce the fear of dying.

They are hardly outliers. According to a new YouGovAmerica study, “one in four Americans say they’ve tried at least one psychedelic drug,” amounting to some 72 million U.S. adults. (The study included the medicines mentioned earlier, plus LSD, mescaline and salvia.) Was I missing a beat by not getting onboard?

When I queried my psychiatrist about participating to help improve my mental health, he was supportive, with two caveats: Do it with a trained therapist or guide, and do your best to ensure that the substance is what it’s said to be.

These days, it’s hard not to see, hear or read about the use of psychedelics, whether it’s Michael Pollan’s best-selling book (and accompanying Netflix documentary) “How to Change Your Mind,” online advertisements for psychedelic spa “trips,” underground therapists (also referred to as “sitters” or “guides”) with websites promising consciousness-expanding journeys, and a DIY online ketamine program — with a medical professional tethered by videoconferencing — that you can do at home. (Ketamine was approved by the Food and Drug Administration in 1970 as an anesthetic/analgesic, which makes it legal to prescribe. For over 20 years, it has been prescribed off-label for depression, anxiety and other mental health issues. A derivative of ketamine, called esketamine — sold as Spravato — was approved by the FDA in 2019 specifically for depression.)

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Recent clinical trials and studies, which have garnered big headlines, have shown efficacy in treating a variety of conditions, such as depression, addiction, obsessive-compulsive disorder and post-traumatic stress disorder. And an increasing number of studies are underway.

Intrigued but cautious, I wanted to know: How should I approach this in a smart and safe way? I started by interviewing Rick Doblin, founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). He reminded me that, other than ketamine, none of these generally illegal psychedelics are approved by the FDA, so he would talk only about “minimizing risks.”

“I don’t want people to think that this is like going on a carnival ride,” he said. “There’s always a risk.”

Matthew Johnson, a psychiatry professor at the Johns Hopkins Center for Psychedelic and Consciousness Research who has conducted numerous studies on psychedelics, also spoke to the issue of safety. To that point, Hopkins’s clinical trials screen out those with schizophrenia, bipolar disorder or severe heart disease.

I mentioned that, like millions of Americans, I’m taking an antidepressant (an SSRI or selective serotonin reuptake inhibitor), which he explained would probably mute the effect of psilocybin or MDMA. To partake of psychedelics, he told me I’d want to taper off the SSRI first, which is best done with medical supervision (and which I’ve had trouble with in the past).

I wasn’t suicidal, until suddenly, terrifyingly I was

I also have heart disease, so he cautioned me to speak with my cardiologist (who texted me that he knows nothing about the use of psychedelics). In other words, these drugs are not for everyone.

Johnson reiterated that despite public testimonials about the positive therapeutic effects of psychedelic usage, “there are dangers, and it is illegal.” Was he trying to discourage me? “I’m don’t encourage anyone to do this on their own,” he said

After researching this column, I’m not interested in taking this journey on my own. But assuming I’d have a guide or therapist, where would I start?

Doblin suggested that anyone with a “clinical indication” (such as depression, PTSD or anxiety), should go to ClinicalTrials.gov to find and possibly participate in nearby studies. Recently, when I checked the database for “psilocybin” studies in the United States, 67 trials came up. All are being conducted at well-known academic medical centers, which means the studies are done with pure drugs, approved by the FDA and licensed by the Drug Enforcement Administration, which means the trials have regulatory approval.

What about people without a clinical indication, but who are on a spiritual quest? Here are the considerations I gleaned:

Set and setting: Over and over I heard this phrase, which refers to finding a healthy mind-set and a relatively safe environment. For obvious reasons, Johnson called the rooftop of a tall building a bad idea, as is being around cars or sharp objects. Robert Mitchell, who has practiced psychedelic therapy and administered plant medicines for 30 years and has treated “hundreds of clients,” said “the most important thing is that you feel safe, comfortable and will not be disturbed.” Based in Los Angeles, he said he often has clients rent a cabin in the Santa Monica mountains, which serves as a “sacred space.”

Find an experienced, trusted therapist: If you’re seeking a psychedelic guide, word of mouth may be helpful. My friend, the real estate developer, said “for a first timer, I feel resolute in advising that others find a guide, ideally referred by someone you trust.” Hopkins’s Johnson urges people not to take one of these psychedelic medications alone; although there are still risks, it’s less risky when someone is there who has knowledge of the identity of the substance and the dose. (He said this can be especially critical for psilocybin mushrooms, which are known to have a great variation in their potency.) New programs are available, such as the Psychedelic-Assisted Therapies and Research Certificate Program at the California Institute of Integral Studies, intended to serve the growing need for skilled psychedelic therapists to meet demand.

Ask questions ahead of time: Many therapists include a preparation session before any journey or treatment begins. Questions to discuss in the prep session include a discussion of the therapist’s background and expertise, your intention in taking a psychedelic medicine (and which one), your personal health history, how they might handle a problem that arises (such as a medical side effect or a “bad” trip), the sourcing of the medicine, and, of course, the fee. A Colorado woman gave me this advice, “I would make sure to work with a therapist who has experience and a clear protocol for using psychedelics, including pre-journey discussions and post-journey integration appointments.”

Know what you’re ingesting: Doblin said there’s one DEA-licensed facility in the United States: Drug Detection Laboratories. It accepts anonymous samples of illegal drugs and will analyze them and post the results online. (You send it in with a specific code and pay a fee for the analysis.) Barring that, you’ll want to talk with potential guides about the source of their substances. Mitchell told me he knows where his psilocybin mushrooms are farmed and can vouch for their purity. In the end, one friend who had two psilocybin sessions said he “had to rely on the guide and the trust engendered.” That’s always going to be imperfect.

Do your homework: MAPS is an educational nonprofit group whose first phase 3 study — on the effective use of psilocybin for severe cases of PTSD — was published last year in Nature Medicine, a top peer-reviewed journal. The organization publishes information about the functions, uses and legality of psychedelics. It offers an introductory course, Psychedelic Fundamentals. Another resource is the “MAPS Code of Ethics for Psychedelic Psychotherapy,” which discusses psychological and physical risks.

So will I be taking a psychedelic journey?

I’m reading everything I can get my hands on and talking to everyone I can about their experiences. I’m also remembering the legal issues. Yes, Pollan and others are trying psychedelics and writing about their experiences — and not being arrested or having their careers derailed or apparently suffering ill effects — but that shouldn’t be taken as carte blanche for the rest of us.

I’ll check back in here in a few months, so stay tuned.

https://www.washingtonpost.com/health/2022/09/05/psilocybin-mental-health-psychedelics/