When LSD was first discovered, it was distributed to academic institutions in the US and Europe to better understand the psychedelic experience and what purposes it might be used towards. From early on, it was believed that LSD and other psychedelics might be useful in understanding and treating mental health conditions. Research studies began to investigate this further, including examining specific disorders such as alcohol abuse and schizophrenia. What most people don’t realize, and what most medical schools leave out, is that there were over 1000 studies in the 1950’s and 1960’s on psychedelics. This was not a small, fringe handful of people who were interested in psychedelics. Rather, this was a major movement in the field of psychology and psychiatry that believed that psychedelics may not only be helpful in therapy and personal growth, but may also help us better understand the fundamental nature of consciousness itself.
While there were many studies in this early wave of research, most were poorly designed and therefore difficult to interpret. In other words, research back then was not as refined as it is today. In addition, early research made many mistakes that are much clearer to us now as we look back on them. For example, psychedelic sessions were often carried out in hospitals with patients restrained to their bed. Yep, terrible idea. Or, there was so much importance placed on achieving a “mystical” or “peak” experience that any negative emotions were treated as problems to be interrupted. Attempts were made to halt a psychedelic experience if it was going in a bad direction, such as by using sedating drugs. Another bad idea. Today we know that challenges are part of the territory and are often connected to large breakthroughs or emotional releases.
The history of psychedelic research is a fascinating one. Although these were not well-designed studies, they did at the very least suggest that psychedelic-assisted therapy had some potential in treating mental health problems. However, research came to a screeching halt in the early 1970’s when psychedelics were banned and made illegal. This ended this early wave of research and led to an era of prohibition where not much was done. This has really changed in the recent past, especially the last five years when research has once again proliferated in this area.
The most evidence we have from recent placebo-controlled clinical trials is in two areas. First, MDMA-assisted therapy for PTSD was granted breakthrough therapy status from the FDA and will likely be the first FDA-approved psychedelic medicine. Phase-3 trials have been completed and early results are very promising, showing that 67% of participants no longer met criteria for PTSD after completing treatment (Mitchell, 2021). This strong data is particularly impressive as many of the participants in this study were people who have not been helped by traditional therapy or medication. While there are still some hurdles to cross, it is estimated that FDA approval for MDMA-assisted therapy may be as soon as 2024.
Second, psilocybin-assisted therapy for treatment-resistant depression is the second area with the most research. Some of the results suggest that having a mystical experience or, interestingly, having challenging moments in a dosing session, may be correlated with better outcomes (Griffiths et al., 2016). Here, the research is a few years behind MDMA and estimates for FDA-approval are 2025 and beyond.
Ketamine infusions have also been shown to be helpful with treating depression, though research also suggests that some participants relapse back into depression in long-term studies (Katalinic, Somogyi, & Mitchell, 2013). Ketamine infusions are different than psychedelic-assisted therapy in that the subjective experience is not valued and there is no therapy offered to accompany the ketamine administration. Ketamine-assisted therapy, however, is a use of ketamine that is similar to MDMA- and psilocybin-assisted therapy, but has not been as well-researched yet but is a currently available option.
Other studies have looked at the mental health benefits of ceremonial ayahuasca use which has been associated with positive mental health outcomes. LSD has also made a comeback and has been involved in more recent studies, though is likely not as preferred due to the longer timeline of its effects. On the other extreme of the length of duration is DMT and 5-meo-DMT which is a powerful, short-acting psychedelic that is currently being studied for potential clinical applications. And there are currently dozens of trials with MDMA and psilocybin for a range of problems including social anxiety, OCD, eating disorders, substance abuse, cluster headaches, and fibromyalgia amongst many others. Several studies are also focused on group administration of psychedelics. Group administration is not only associated with some cost savings, but also potentially confers additional social and therapeutic benefits for participants.
Most of the early clinical research has been focused on outcomes. Basically, that means symptoms are measured before and after treatment to show any potential effect. This is different from research on the mechanisms of action. For example, if depression decreases after psilocybin-assisted therapy, that doesn’t tell us anything about what processes involved in that treatment were effective. It’s the difference between whether a treatment works and how a treatment works.
Well, we can look at this question from multiple angles. From a neuroscience perspective, psychedelics may work by increasing neuroplasticity and creating new connections between various brain regions. This is hypothesized to be helpful for individuals with rigid neural networks associated with problems like rumination, worry, and addiction. From a psychological perspective, psychedelics may increase psychological flexibility, or the ability to accept difficult thoughts and emotions in the pursuit of a values-based life. From a spiritual perspective, psychedelics may induce a mystical experience that includes an increased sense of connection with a reality beyond our ordinary day-to-day lives.
In short, we don’t fully know yet why psychedelics may be therapeutic. Some scientists today believe that psychedelic experiences may increase our understanding of neuroscience, psychology, and psychiatry, and therefore how mental health problems may be best conceptualized. For now, it is an area that yields exciting new developments each month as we learn more and more about how psychedelics interact with our body, mind, and spirit.