The Health Trip
In an era of precision medicine and Big Pharma, some doctors who are seeking to help patients cope with mental illness are going counterculture.
Doctors are embracing LSD and magic mushrooms as treatment options for depression, addiction, and PTSD.
FOR DECADES, mental health experts have amassed anecdotal evidence that psychedelics could help people with intractable diseases like addiction, depression, and PTSD. Scientists at the Johns Hopkins Center for Psychedelic and Consciousness Research in Baltimore, which opened in the fall, plan to test these drugs rigorously so that one day they could be prescribed. We talked with two of the center’s founding members, Alan Davis and Albert Garcia-romeu, who are seeking out
mental health and addiction treatments,
to find out more about their research and how they plan to change our lives.
MJ: A lot of your focus is on psilocybin— the psychedelic agent in magic mushrooms. How does it help people suffering from depression or addiction?
DAVIS: There are a couple of ways we believe it works. First is the experience itself. People who take psilocybin report having a deeply positive, mystical experience that seems to help them alter their perspective on their situation. More specifically, people with depression tend to feel isolated and disconnected from their daily lives. The experience of taking psilocybin makes them feel an intense interconnection that stays with them after the experience is over. People also report gaining insight on their depression, like they suddenly have an awareness of what they want to change in their life to help them move forward. That awareness, coupled with this mystical-like experience, serves as the catalyst for change. ALBERT GARCIA-ROMEU: It helps people change their perspective, which is really useful for someone who is depressed or dealing with addiction. On the physical side, psilocybin disrupts patterns in the brain—patterns of negative thinking that become entrenched over time.
How does it do that?
GARCIA-ROMEU: In a nutshell, psilocybin and other psychedelics like LSD bind to serotonin 2A receptors, creating mood-altering effects and changes in brain function. We know psilocybin decreases amygdala blood f low in people with depression, which is associated with better antidepressant effects. This is important because depressive symptoms seem to be associated with over-reactivity in the amygdala. Keep in mind that the data for psilocybin brain mechanisms in depression is very limited, from fewer than 20 people total. We are only starting to scratch the surface of how this works.
When people hear psychedelics, they picture mushrooms growing in the back of their college roommate’s closet—not the stuff of scientific rigor.
GARCIA-ROMEU: Honestly, it’s closer to a dorm room than a science lab. Our study setting looks like a therapist’s office: sofa, chairs, soft lighting. The most clinical item is a blood pressure monitor, which we use to keep track of physiological measures at 30- to 60-minute intervals throughout the sessions. One of the strongest predictors of a challenging experience or “bad trip” can be an overly cold and clinical setting, so we do our best to make it a place that feels warm and safe. Volunteers usually spend around eight hours here before any drug is administered, with the two people who monitor them after they’ve taken the drug.
Where do you get the drugs?
DAVIS: The psilocybin is made for us by an academic chemist and put into a capsule that’s taken orally. This isn’t microdosing. A dose is moderate to high—more than recreational doses in a festival environment, for example.
How are the results looking?
DAVIS: We just wrapped up the main portion of the depression study, and now we’re doing follow-ups and preparing the data for publication. We had 24 participants—all studies here are done on people, not animals. Preliminary f indings show approximately half of the participants had complete remission of depression at one month after the intervention of psilocybin plus psychotherapy, which is very promising.
When will potential treatments be available to the public?
DAVIS: We expect the full study to be published this coming year. After that, it can take several years before the treatments are approved by the FDA and made available to the public.
What has been the biggest challenge you’ve encountered in your research?
DAVIS: Funding. The government hasn’t been backing this kind of work. So to get $17 million in private money [donors include entrepreneur Tim
Ferriss, Wordpress co-founder Matt Mullenweg, and the Steven & Alexandra Cohen Foundation]—that goes a long way to getting the quality of studies we need to move the therapeutic research forward.
A psychedelic experience lasts a few hours, but depression can haunt a person for years. How can a single dose of psilocybin have such a lasting effect?
DAVIS: A couple of days after use, the person experiences a halo effect. Their mood improves, and they may be more open to suggestion. We use that time to help them make lifestyle changes to alter their outlook. It’s not like the person just takes psilocybin, and that’s it. We still use a full therapy approach, and we’re optimistic this may lead to greatly improved outcomes in people who have not found success in traditional treatment in the past.
So it’s 10 years from now, and psilocybin has been approved for medical use. How will it work, practically speaking? Will a person get a prescription for psilocybin?
GARCIA-ROMEU: That is probably one of the greatest misconceptions around this work. This is not a taketwo-and-call-me-in-the-morning type of treatment. Nor is this like cannabis dispensaries where patients pick up the medication and take it at home, unsupervised. Psychedelics have the potential for much more intense and unpredictable psychoactive effects, so it’s best to administer them under carefully controlled conditions, in conjunction with intensive psychological support. Probably the best parallel in current medical care would be getting general anesthesia before surgery— this only happens at a medical facility under the careful supervision of a specially trained doctor and support staff.
Even so, this sounds life-changing for some people.
DAVIS: Absolutely. We see a future where we can actually heal these problems instead of simply trying to reduce symptoms. Our results point to a potential neurological and psychological basis from which we can understand this healing potential, and that could revolutionize our understanding of what “treatment” actually means. No longer would we be trying to help people get by, but they might actually heal and then thrive.
ONE MISCONCEPTION AROUND THIS WORK: THIS IS NOT A TAKETWO-AND-CALL-MEIN-THE-MORNING TYPE OF TREATMENT.