Psilocybin as a mental health therapy? Some things to know.
I’d been hesitant to be open about my search, because I’m old enough to remember the warnings about “bad trips” that scramble your brain. Imagine my surprise when my friend told me he’d recently taken his first “trip,” which he described as life-changing.
I asked him — a real estate developer living in Northern California, married with kids — why he decided to try a psychedelic substance. “My work felt increasingly stale and meaningless,” he explained to me over a beer. “Despite a massive amount of reflection and coaching around how to break the rut, I felt as though I was still off track.”
He and the others who have used these medicines spoke on the condition of anonymity because most of these psychedelics are Schedule I substances, meaning they are illegal to manufacture, buy, possess or distribute.
When I confided my interest in psychedelics to a few other friends, several said they had tried the drugs and experienced several benefits: from easing anxiety to finding spiritual insights to combating depression and, among some with cancer, helping to reduce the fear of dying.
They are hardly outliers. According to a new YouGovAmerica study, “one in four Americans say they’ve tried at least one psychedelic drug,” amounting to some 72 million U.S. adults. (The study included the medicines mentioned earlier, plus LSD, mescaline and salvia.) Was I missing a beat by not getting onboard?
When I queried my psychiatrist about participating to help improve my mental health, he was supportive, with two caveats: Do it with a trained therapist or guide, and do your best to ensure that the substance is what it’s said to be.
These days, it’s hard not to see, hear or read about the use of psychedelics, whether it’s Michael Pollan’s best-selling book (and accompanying Netflix documentary) “How to Change Your Mind,” online advertisements for psychedelic spa “trips,” underground therapists (also referred to as “sitters” or “guides”) with websites promising consciousness-expanding journeys, and a DIY online ketamine program — with a medical professional tethered by videoconferencing — that you can do at home. (Ketamine was approved by the Food and Drug Administration in 1970 as an anesthetic/analgesic, which makes it legal to prescribe. For over 20 years, it has been prescribed off-label for depression, anxiety and other mental health issues. A derivative of ketamine, called esketamine — sold as Spravato — was approved by the FDA in 2019 specifically for depression.)
Recent clinical trials and studies, which have garnered big headlines, have shown efficacy in treating a variety of conditions, such as depression, addiction, obsessive-compulsive disorder and post-traumatic stress disorder. And an increasing number of studies are underway.
Intrigued but cautious, I wanted to know: How should I approach this in a smart and safe way? I started by interviewing Rick Doblin, founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). He reminded me that, other than ketamine, none of these generally illegal psychedelics are approved by the FDA, so he would talk only about “minimizing risks.”
“I don’t want people to think that this is like going on a carnival ride,” he said. “There’s always a risk.”
Matthew Johnson, a psychiatry professor at the Johns Hopkins Center for Psychedelic and Consciousness Research who has conducted numerous studies on psychedelics, also spoke to the issue of safety. To that point, Hopkins’s clinical trials screen out those with schizophrenia, bipolar disorder or severe heart disease.
I mentioned that, like millions of Americans, I’m taking an antidepressant (an SSRI or selective serotonin reuptake inhibitor), which he explained would probably mute the effect of psilocybin or MDMA. To partake of psychedelics, he told me I’d want to taper off the SSRI first, which is best done with medical supervision (and which I’ve had trouble with in the past).
I also have heart disease, so he cautioned me to speak with my cardiologist (who texted me that he knows nothing about the use of psychedelics). In other words, these drugs are not for everyone.
Johnson reiterated that despite public testimonials about the positive therapeutic effects of psychedelic usage, “there are dangers, and it is illegal.” Was he trying to discourage me? “I’m don’t encourage anyone to do…
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