Psychedelic Therapy and your brain

We are in the midst of a mental health crisis. One in five New Zealanders will experience mental illness or significant mental distress at some point in their life. Prescriptions for antidepressants have nearly doubled in England over the past decade. Suicide rates are heartbreakingly high — a 2018 report estimates around 20,000 New Zealanders attempt to kill themselves each year. Billions of dollars have been pledged toward treatment options that are only sometimes successful, and not generalisable to the wide range of mental illnesses that exist. However, recent research investigating the therapeutic potential of psychedelic medicines has shown significant promise towards lessening this crisis. 

You might think “Psychedelics? Why would illegal substances that have been around for so long be useful for treating mental illnesses?”. Well, research into these compounds actually began in the 1950s and 60s at which time hundreds of scientific papers were published demonstrating the potential benefits of psilocybin (found in “magic mushrooms”), LSD (“acid”), and mescaline, in depressive, anxious, obsessive, and addictive disorders. Unfortunately, research came to a halt in 1967 as a result of widespread and misguided recreational use, which led to the criminalisation of these compounds under schedule I of the UN Convention on Drugs. Only recently has psychiatry seen a resurgence in the interest and use of these compounds in mental health treatment, in what has been aptly called the ‘psychedelic renaissance’. Studies are increasingly being sanctioned by governments across the world, in addition to psychedelic research centres (that have recently opened up in places such as the UK—Imperial College, London—and the US—Johns Hopkins University, Baltimore). 

Current Research 

Research in the 2010’s has primarily focused on treating alcohol addiction, depression, and death-related anxiety in terminally ill cancer patients, using double-blind randomised controlled trials. For example, a particular study in which psilocybin was administered to patients with life threatening cancer found that 82% of its participants reported increased life satisfaction or well-being up to six months post treatment. Patients also reported that the experience helped them come to terms with their own mortality. Another study looking at psilocybin therapy to treat alcoholism found that relative to baseline, participants’ percentage of heavy drinking days substantially decreased, and this was sustained at least 36 weeks post-treatment. A recent literature review found positive and enduring effects of psychedelic therapy on depression measures across several different studies. Interestingly, the more mystical a participant’s experience is rated appears to correlate with reduction in depression at 6-month follow up. Further, even in healthy patients, psilocybin and LSD treatments have been shown to increase general well-being. Researchers at Imperial College London have recently completed a trial comparing traditional depression treatments (SSRIs) to psilocybin therapy, and are in the process of writing up the results. Although they can’t give much away yet, the study’s leading researcher has said that “preliminary analysis indicates game-changing results”. In the future, researchers are geared up (excuse the pun) to next look at how psychedelics might help those with anorexia, Alzheimer’s, OCD, PTSD, and smoking addiction. 

How Do They Work? 

Basically, the structure of psychedelic molecules tends to resemble the structure of the serotonin molecule — a key hormone involved in regulating the emotional processes of our brain. Because of this, psychedelic molecules bind to serotonin receptors within the brain, primarily the serotonin 2A receptor (5-HT2AR) found in the cortex (i.e., the “thinking” part of the brain). This receptor is thought to be involved in brain plasticity, learning, unlearning, and change. By interfering with this receptor, psychedelic molecules cause a disruption of one’s usual neural processes with many downstream effects. An area that is significantly affected is the default mode network (DMN) which is thought to be the seat of one’s “self”, which might be overactive in mental illnesses such as depression. It is hypothesised that when psychedelics disrupt the DMN, rigid thoughts and behaviours attached to mental illnesses like depression can dissolve. Robin Carhart-Harris, head of Imperial College’s Centre for Psychedelic Research, captures this nicely in his entropic brain theory. Robin theorises that psychedelics dysregulate cortical activity, which can be thought of as increasing entropy (randomness/disorder). This leads to a collapse of normally highly organised activity in the DMN, and a revision of previously entrenched beliefs and destructive thought patterns. A helpful analogy is to think of the brain as metal, and that increasing entropy through psychedelic use is like increasing the temperature of the metal, which results in greater malleability. This malleability sets newly formed patterns in place, which remain when entropy decreases and the metal cools. 

Psychedelics work in a different way to classic depression and anxiety medication, by encouraging “active coping” in the user, radically revising their beliefs, revisiting and reintegrating past trauma, dealing with stress, and the like. On the other hand, drugs such as SSRIs promote “passive coping” in the user, by muting and tolerating negative feelings, rather than dealing directly with them. This is not to say SSRIs and other medications do not have their place in mental health treatment, but when someone does not benefit from them, psychedelic therapy might be a viable alternative. 

New Zealand Research 

In New Zealand, a trial was recently completed looking at the effect of ketamine on depression, which found that most of the volunteers’ symptoms of depression fell by 50 percent or more within a day of the session. A trial has recently been approved to look at the potential benefits of micro-dosing LSD (giving people a subperceptual dose of LSD). All of this research is being led at Auckland University by Dr Suresh Muthukumaraswamy, who played an important role in some ground-breaking psychedelic brain imaging studies at Imperial College in London. Muthukumaraswamy comments on micro-dosing, “At the moment there’s not a lot of rigorous scientific study of this, in fact, is really no rigorous scientific studies”. One purpose of the micro-dosing study is therefore to ascertain if this practice leads to long-term positive effects, as many have claimed. All psychedelic drugs are currently illegal in New Zealand, with harsh penalties for possession, use, and cultivation. However, Muthukumaraswamy states that the micro-dosing trail was approved because, “in New Zealand, you’re allowed to prescribe schedule A drugs to people,” provided the prescription is tightly controlled. Indeed, this is no small undertaking for volunteers of this study — “We’re going to be prodding them and probing them, making them do tasks, sticking electrodes all over them and putting them in scanners. We’ll be studying them for three months and they’ll have to come into our lab for pretty much five full days,” Muthukumaraswamy says. 

As an ardent psychology nerd, the psychedelic renaissance is both fascinating and very exciting, as psychedelics could hold the potential to hinder the path of ever-growing mental health crisis, as well as shine a light on the neurobiological basis of consciousness, the unconscious, and the self. Given how promising current research has been, the next few decades may bring a wealth of innovative discoveries for psychedelic therapy, applicable to mental health crises in New Zealand and across the world. I hope history has taught us a valuable lesson about the censorship of scientific research that will not result in the same mistakes of the 60s being repeated.  

DISCLAIMER: it is important to stress that the above findings were obtained under well-controlled and supportive therapeutic settings. Participants are heavily screened before partaking, and meet with therapists before, during, and after the experience to foster trust and integration. As such, it may not be wise to take a psychedelic drug yourself outside of a therapeutic setting and expect that your mental illness will be cured. Psychedelics carry significant legal and psychological risk when used improperly, so it is essential that research on the safe use of these substances continues.  

If you are interested in following this research and/or learning more about it, here are some resources: 

By Estelle Miller 

Thanks to Asher Soryl for his contributions to this article.