Psychedelics and Psychedelic Therapy
There’s no standard definition of psychedelic therapy in the United States yet, but it’s being explored at the federal level.
(Note: Recreational and illegal psychedelic use without any clinical supervision is not considered psychedelic therapy, and is not recommended by medical experts.)
Classic and Non-Classic Psychedelics
Challenges for Psychedelic Therapy in the U.S.
Though research suggests some psychedelics have potential healing benefits, scientists, lawmakers, and healthcare organizations are still unclear on their efficacy and safety for healthcare purposes.
And, because of the decades-long hiatus in psychedelic research in the United States, it’s essential that enthusiasm for these substances doesn’t outpace scientific findings. “We still have a lot to learn and a lot of work to do to make up for lost time,” says Charles Grob, MD, an investigator at the Lundquist Institute in Los Angeles and a professor of psychiatry and biobehavioral sciences and pediatrics at the David Geffen School of Medicine at UCLA.
In other words, we need more research to fully understand the risks and benefits of psychedelic therapy across populations, for specific health concerns, and at specific dosages (e.g., microdosing and hallucinogenic).
Working With a Licensed Therapist
Often, psychedelic therapy may be used as a complementary approach to support your already established mental health therapy goals. If you’re seeking psychedelic-assisted therapy (outside of clinical trials) — currently, that’s ketamine and, in a couple of states, psilocybin — it’s important to explore that option under the care of a knowledgeable licensed therapist, an integrative doctor, or a psychiatrist to mitigate potential health risks.
“Psychedelic-assisted therapy (means) that there is a competent, experienced facilitator who will screen the individual ahead of time to make sure they’re an appropriate candidate for treatment and (the patient) will then be prepared for the experience over the course of a few sessions,” says Dr. Grob.
Potential Health Benefits of Psychedelic-Assisted Therapy
Most types of psychedelic drugs are still in clinical trial stages (if at all), and have not yet been studied among broad populations or applications. With that in mind, here are some possible uses that current research has identified for psychedelic therapy in mental health care, as well as its limitations.
1. May Help Address Treatment-Resistant Depression
The FDA has approved ketamine (in the form of a nasal spray called Spravato, chemical name esketamine) for treatment-resistant depression, which is why you might notice ketamine-therapy clinics popping up in your area.
When paired with other conventional psychotherapies, ketamine may offer additional benefits, says Mailae Halstead, a licensed therapist with Behavioral Wellness Clinic in Tolland, Connecticut, who specializes in ketamine-assisted therapy and psychedelic integration.
2. May Be Effective for PTSD
Other than ketamine, psychedelic substances “have not met the very rigorous standards of passing multiple phase 3 trials, which is what’s needed for FDA approval,” says Matthew Johnson, PhD, the Susan Hill Ward Professor in Psychedelics and Consciousness and a professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore.
Using MDMA (3,4-methylenedioxymethamphetamine, known as ecstasy) to treat PTSD was the closest to clinical approval, but the FDA has requested additional phase 3 trials to further study safety and efficacy, which could take several years.
The authors found that MDMA was linked to decreased symptoms of depression, and that treatment was generally safe and well tolerated, even in participants with comorbidities (like depression, history of alcohol and substance use disorders, and childhood trauma). They suggested that MDMA may open a “window of tolerance,” wherein people might process trauma in an emotionally supported way, with less shame and more self-compassion.
Again, more advanced clinical trials in larger groups are necessary to better understand MDMA’s possible benefits for PTSD, and to potentially move FDA approval forward.
3. May Help People With Addictions
One theory on psilocybin’s potential efficacy for addiction treatment? It may amplify the effectiveness of traditional psychotherapy or recovery programs to bring about behavior changes. “People are often stuck in a narrow or suboptimal state of being, but psilocybin (may) shake people out of it — at least temporarily — and that can be powerful,” says Johnson, in his opinion.
4. May Decrease Distress Related to Life-Threatening Illness
At this point, research is early and ongoing, and larger, more diverse studies are needed to better understand the potential efficacy of psychedelic therapy in assisting those with life-threatening illnesses.
5. May Assist in Eating Disorder Recovery
Treating eating disorders can be challenging, but there’s emerging research that suggests psychedelic therapy may be helpful for the recovery process.
