A psychedelic renaissance is happening in the world of psychiatry. LSD, ayahuasca and psilocybin (the active ingredient in magic mushrooms) are being intensively investigated, as restrictions on research finally begin to loosen after 50 years. The results of these investigations are astounding. They show that psychedelics have a range of fascinating and wide-reaching effects on the brain—and enormous potential as safe and effective therapeutic tools for treating mental illness.
In the UK, this work has been pioneered by the Beckley Foundation, working in collaboration with many labs around the world. The Beckley Foundation was founded in 1998 by Amanda Feilding, and for most of its life has been tenaciously battering down the doors of research regulation. Until about five years ago, the legal framework regulating scientific and medical research prevented experimentation with psychedelic substances. But, all of a sudden, this has begun to give way.
Last year, our team at Imperial College London, headed up by David Nutt and Robin Carhart-Harris, carried out the world’s first brain-imaging study with LSD. Using functional magnetic resonance imaging (fMRI), we showed that LSD caused a profound shift in how regions of the brain communicate with each other. Normally, different regions of the brain tend to operate in distinct ‘networks’ that communicate tightly with one another. The visual network, for example, unifies a number of visual regions that together create our visual experience. However, LSD provokes regions to begin communicating more widely with areas outside their usual networks, in a process known as network desegregation. Correspondingly, communication within networks decreases—this is called network disintegration. Effects like these are thought to relate to a number of psychedelic phenomena, such as synaesthesia, where one sense is experienced as another.
This is especially interesting in the case of one important neural network, the Default Mode Network (DMN). The DMN is most active when the brain is not engaged in a more important task, and it is responsible for regulating and controlling the activity in many other networks. It involves regions that are involved in representing the self, long-term goals and autobiographic memories. As a result, it’s a strong candidate for being the seat of the ‘ego’, or our sense of self. Support for this idea comes from the impact of LSD: as the DMN disintegrates, so too does the strength of the ego. In fact, we found that ‘ego-dissolution’—the loss of selfhood commonly experienced in psychedelic states—correlated with the disruption caused to the DMN.
This discovery has potential therapeutic benefits for mental health. One idea that is agreed upon in psychoanalysis and psychiatry, and even Buddhist practice, is that the ego is the source of most, if not all, of our emotional distress. Quieting down the ego, and relaxing its obsessive control over the mind, is a key therapeutic goal for many treatments. Psychedelic therapy, it seems, may offer an extraordinarily easy, safe, and reliable means to this end.
This theory has been given strong support by our collaborators in Barcelona, led by Jordi Riba, who have been exploring the effects of the Amazonian shamanic brew ayahuasca. Ayahuasca ceremonies are becoming popular worldwide for their ability to provoke personal insights and long-term shifts in mental health. Riba’s team have been able to use techniques and questionnaires designed to measure the effects of mindfulness meditation to show that an ayahuasca experience bears a strong resemblance to a meditative state. The experience enables people to relax introspective thoughts and enhances their awareness of immediate sensory experience. It promotes a mental ability known as “decentering”, where one experiences one’s own thoughts at a slight remove, so doesn’t get as emotionally bound up in them.
These traits, as mindfulness research has already shown, are invaluable for therapy. Recognising and letting go of patterns of introspective thought is a powerful technique for the alleviation of psychological disorders such as depression, OCD, anxiety, anorexia, and many other common conditions. Decentring can allow patients in therapy to confront negative thoughts or traumatic memories whilst retaining enough detachment to prevent them doing further harm.
This link to therapy isn’t just a theoretical one: we have been conducting clinical trials to demonstrate the direct power of psychedelics to treat clinical conditions. At Imperial, we gave therapy consisting of two doses of psilocybin, separated by a week, to patients with treatment-resistant depression. For depression to be classed as ‘treatment-resistant’, the patient must have already not responded to two courses of treatment—most commonly SSRI anti-depressants. Typically, this group is unlikely to respond to any further treatments. So it’s all the more remarkable that after just two sessions of psilocybin, 67% of patients were in full remission from depression, a level that was maintained at 42% six months later.
To put these results into context, it should be pointed out that all other treatments for depression—whether prescription drugs or talking therapies—take several weeks to achieve their full effect. Psilocybin made a beneficial impact immediately. Other treatments need to be applied continuously to keep working, either in the form of repeated dosing or repeated practice. Not so with psilocybin—even with no extra treatment, 42% were benefitting after six months. And the results that might be achieved with occasional follow-up doses could be even greater. Most importantly, the size of the effect is simply far greater than for any other known treatment for depression, and that’s not taking into account that these patients were already not responding to other treatments.
Although this experiment used psilocybin, it’s likely that similar results would be found in LSD and ayahuasca. All these psychedelics achieve their effects through similar pathways in the brain, namely by imitating a global neurotransmitter, serotonin, and selectively disrupting the brain’s serotonergic system. And all our research seems to converge on a central cluster of therapeutic processes: habitual patterns of thought are disrupted and novel ideas explored; the ego’s grip on the mind is weakened; painful emotions and memories come into view for exploration, but kept at a safe distance.
Our network’s slogan for this approach to therapy is “in and through.” Rejecting the current psychiatric tendency to blunt unpleasant symptoms with drugs and coping techniques, we advocate exploring and coming to terms with the painful components of ourselves that lie beneath. In doing so, we echo approaches that have been advocated across history and cultures by psychotherapists, ayahuasca shamans, and Buddhist teachers alike.
You may be wondering why I’ve not touched upon the obvious downsides yet. Psilocybin is a psychedelic drug that produces hallucinations. Surely users are at significant risk of hurting themselves? Or of having a ‘bad trip’ that leaves lasting mental scars? Or of doing themselves direct damage through drug toxicity?
Our research suggests that the short answer to all these concerns is ‘no’. As others have proved at far greater length than I can, psychedelics, even when used recreationally, are orders of magnitude less harmful than alcohol, tobacco, coffee, anti-depressants, steroids, chilli, Viagra, and horse riding (to name just some common comparisons). When given to patients under medical supervision, even this minuscule risk drops to essentially zero. This is even more remarkable when weighed against the common and serious side effects of traditional psychiatric medications.
The same goes for the dreaded ‘bad trip’. The most serious negative event experienced by any of our study participants to date has been ‘moderate transient anxiety’. Most have felt only positive effects. Many have had their lives revolutionised. And crucially, psychedelics simply aren’t toxic in the way that, say, alcohol or tobacco are; it is medically impossible to suffer toxic harm from an overdose. Unlike with any other prescription medication, patients of psychedelic therapy are unable to accidentally overdose; the medicine is administered directly by the therapist, and patients never need to take a dose outside of medical supervision.
So, why aren’t LSD, ayahuasca, and psilocybin already at home on every therapist’s shelf? In short, fear and misunderstanding have led to a policy of prohibition. In the case of recreational use, this has been wildly damaging: both criminalising recreational users and creating an unregulated market in which users lack the information necessary to consume psychedelics safely. But an even greater damage has been inflicted on the world of psychiatry, and, by extension, on those in need of psychiatric support. Psychiatry has been denied, for half a century, the right to use and study medicines that research suggests are both the most harmless and most powerful ever discovered. We need to take psychedelic research seriously when study after study indicates their enormous potential to alleviate the suffering of mental illness.
We already have miracle cures. It’s time to finally start using them.