Psychedelics

If you're seeking information about psychedelics, either for yourself or a loved one, you likely have many questions. What exactly are these substances? Are they dangerous? Could they potentially help with mental health conditions? This guide aims to provide clear, evidence-based information about psychedelics and their emerging role in mental health treatment.

Psychedelics have a complex history, often misunderstood and overshadowed by cultural stigma and legal restrictions. However, recent scientific research has sparked renewed interest in their potential therapeutic benefits. This guide will help you navigate this complex topic with compassion and factual information.

What Are Psychedelics?

Psychedelics (also called hallucinogens) are a class of substances that alter perception, mood, and cognitive processes. They can cause profound changes in consciousness, including sensory experiences that may seem mystical or transcendent [1].

The term "psychedelic" comes from Greek words meaning "mind-manifesting," reflecting these substances' ability to bring subconscious thoughts, feelings, and memories into conscious awareness. This property is partly why researchers are interested in their therapeutic potential.

There are two main categories of psychedelics:

Classic Psychedelics include substances that primarily work by affecting serotonin receptors in the brain, specifically the 5-HT2A receptor. These include psilocybin (found in certain mushrooms), LSD (lysergic acid diethylamide), DMT (dimethyltryptamine, found in ayahuasca), and mescaline (found in peyote and other cacti).

Dissociative Psychedelics work differently, primarily affecting glutamate and NMDA receptors. These include ketamine, PCP (phencyclidine), and Salvia divinorum.

Some psychedelics have been used in indigenous cultural and healing practices for thousands of years, while others were discovered or synthesized in laboratories within the last century [2].

Effects and Experiences

The effects of psychedelics vary considerably based on the specific substance, dosage, individual factors (personality, expectations, past experiences), setting (environment, social context), and purpose of use (recreational vs. therapeutic).

Common effects of psychedelics may include perceptual changes such as enhanced sensory experiences, visual and auditory alterations, and synesthesia (crossing of sensory modalities, like "seeing" sounds or "hearing" colors). Emotional effects often include intensified emotions, mood elevation, emotional breakthroughs, or occasionally challenging emotional experiences.

Cognitive effects typically involve changes in thought patterns, enhanced creativity, altered perspective, introspection, and insights that feel meaningful. Many people report mystical-type experiences characterized by feelings of unity, transcendence of time and space, deeply felt positive mood, sacredness, and ineffability (difficulty putting the experience into words).

Physical effects, depending on the substance, may include changes in heart rate, blood pressure, pupil dilation, body temperature, and occasionally nausea.

A psychedelic experience typically lasts between 4-12 hours, depending on the substance, though ketamine experiences are usually shorter (1-2 hours). The experience often includes an onset phase, peak effects, and a gradual return to ordinary consciousness [3].

Psychedelics and Mental Health: Emerging Research

Recent research has revitalized scientific interest in psychedelics' potential to address various mental health conditions. Johns Hopkins University has established the Center for Psychedelic and Consciousness Research, supported by $55 million in funding to expand research on psychedelics for illness and wellness.

Depression and Anxiety

Multiple studies have shown promising results using psilocybin-assisted therapy for depression, particularly treatment-resistant depression. A small study at Johns Hopkins Medicine found that two doses of psilocybin, given with supportive psychotherapy, produced rapid and large reductions in depressive symptoms, with most participants showing improvement and half achieving remission through the four-week follow-up [3].

For anxiety, particularly end-of-life anxiety in patients with terminal illnesses, psilocybin therapy has shown potential to reduce anxiety and improve quality of life.

Substance Use Disorders

Research suggests psychedelics might help with addiction treatment. Johns Hopkins Medicine has received a grant from the National Institutes of Health to explore psilocybin's potential impacts on tobacco addiction. Additionally, an online survey of over 300 people with Alcohol Use Disorder reported reducing or abstaining from alcohol use after taking psychedelics [3].

PTSD and Trauma

MDMA (3,4-methylenedioxymethamphetamine), sometimes considered adjacent to classic psychedelics, has shown remarkable results in clinical trials for PTSD. While not yet FDA-approved, research suggests MDMA-assisted therapy may significantly reduce PTSD symptoms.

Other Potential Applications

Preliminary research is exploring psychedelics' potential for:

• Obsessive-compulsive disorder

• Eating disorders

• Chronic pain conditions

• Cluster headaches

• End-of-life distress

It's important to note that these findings, while promising, are still preliminary. Most studies have small sample sizes, and more extensive clinical trials are ongoing [4].

How Psychedelics May Work Therapeutically

Researchers are still uncovering how psychedelics produce therapeutic effects, but several mechanisms have been identified:

Neurobiological Effects

Psychedelics appear to temporarily alter brain function in several ways:

• Increased connectivity between brain regions that don't typically communicate

• Reduced activity in the default mode network, a brain system associated with self-referential thinking

• Enhanced neuroplasticity, potentially helping the brain form new connections

Brain scans after psilocybin use have shown that the claustrum (an area believed responsible for setting attention and switching tasks) was less active, which researchers say ties in with typical effects like feelings of being connected to everything and reduced sense of self or ego [3].

Psychological Mechanisms

Beyond brain changes, several psychological processes may contribute to therapeutic benefits:

• Increased psychological flexibility

• Enhanced emotional processing

• Reduced avoidance of difficult thoughts or feelings

• Meaningful insights and perspective shifts

• Mystical-type experiences that can catalyze behavioral change

Unlike many psychiatric medications that must be taken daily, psychedelic therapy typically involves just one or a few sessions, suggesting that the experiences themselves—not just the chemical effects—are crucial to their therapeutic action [2].

Risks and Safety Considerations

Despite promising research, psychedelics carry certain risks that must be carefully considered. Some perceived harms of psychedelics – such as the belief that they lead to addiction and are neurotoxic – have been largely refuted by research. Other risks, like psychotic episodes or overdose, are rare and typically only reported in individual cases [6].

Psychological Risks

The primary risks of psychedelics are psychological. These include challenging or distressing experiences during sessions (sometimes called "bad trips"), anxiety, fear, or panic during the experience, and rarely, prolonged psychological distress after use. There is also potential for triggering or worsening of underlying mental health conditions, particularly psychotic disorders.

Older studies have demonstrated that in persons with schizophrenia or schizotypal features, psychedelics may acutely worsen symptoms of psychosis, in rare cases for up to weeks or months [5].

Physical Risks

Physical risks vary by substance but may include temporary increases in heart rate and blood pressure, rarely, heart rhythm abnormalities with certain substances, potential drug interactions (especially with medications that affect serotonin), and risk of injury if proper supervision isn't maintained.

Legal Risks

Most psychedelics remain classified as Schedule I controlled substances in the United States, meaning they're illegal outside of approved research contexts. Currently, international drug control scheduling classifications and popular misconceptions about the relative risks and harms of psychedelic drugs make research involving humans difficult [6].

Contraindications

Based on current knowledge, psychedelics are generally not recommended for people with personal or family history of psychotic disorders like schizophrenia, bipolar disorder with manic episodes, certain heart conditions, pregnancy or breastfeeding, or certain medications that may interact adversely.

Medical vs. Non-Medical Use

It's crucial to distinguish between medical/therapeutic and non-medical use of psychedelics:

Medical/Therapeutic Use

In clinical settings, psychedelics are administered:

• With careful screening and preparation

• In controlled, supportive environments

• With precise dosing of pure substances

• With professional guidance before, during, and after sessions

• As part of a structured therapeutic program

Clinical protocols for contemporary psychedelic studies incorporate common elements to minimize risks and maximize potential therapeutic benefit, including fully informed consent, sessions in comfortable healthcare facilities, and a two-person therapist team in attendance throughout the drug's action [6].

Non-Medical Use

Non-medical use typically lacks these safeguards and may involve:

• Unknown substance purity and potency

• Lack of screening for contraindications

• Absence of professional support

• Variable settings that may increase risk

• Potential legal consequences

If a person is going to seek their own psychedelic experience, harm-reduction practices may include counseling about known specific medical and psychiatric risks, addressing potential drug-drug interactions, and referral to online resources for safe practices [9].

Current Treatment Approaches

Psychedelic-Assisted Therapy

The most promising approach combines psychedelic substances with structured psychotherapy:

Preparation Sessions: Before taking the psychedelic, patients attend multiple therapy sessions to build rapport, set intentions, and prepare for the experience.

Psychedelic Session(s): The patient receives the substance in a comfortable, supportive environment with trained facilitators present. The session typically lasts 6-8 hours, during which the patient may wear eyeshades and listen to music.

Integration Sessions: Following the psychedelic experience, patients attend additional therapy sessions to process insights, make meaning of the experience, and apply them to daily life.

This approach is being studied in clinical trials but is not yet widely available outside research settings.

Ketamine Treatment

Ketamine, particularly in the form of esketamine (Spravato), has FDA approval for treatment-resistant depression. It's currently the only psychedelic-like substance legally available for mental health treatment outside research contexts.

Ketamine treatment approaches include:

• Intravenous ketamine infusions, typically administered in a series

• Intranasal esketamine, administered under supervision in certified facilities

• Ketamine-assisted psychotherapy, combining the medicine with therapy sessions

Unlike classic psychedelics, ketamine treatments often require multiple sessions over time rather than just one or two experiences [5].

Supporting Someone Using Psychedelic Therapy

If a loved one is considering or undergoing psychedelic therapy, here are ways to provide support:

Before Treatment

Listen without judgment to their reasons for interest, help them research reputable programs or clinical trials, encourage thorough screening and discussion with healthcare providers, and support their preparation process.

After Treatment

Create space for them to share as much or as little as they wish, recognize that integration is an ongoing process, avoid dismissing or over-analyzing their experiences, support positive changes they wish to make, and be patient as they process their experience.

Remember that psychedelic experiences can be deeply meaningful and sometimes difficult to articulate. Your supportive presence may be more valuable than understanding every aspect of their experience.

Finding Professional Help

If you're interested in psychedelic therapy, here are some pathways to explore:

Clinical Trials

Research studies offer one legal way to access psychedelic therapy. ClinicalTrials.gov lists current studies recruiting participants, and research institutions like Johns Hopkins, NYU, and MAPS conduct ongoing trials. Participants typically receive treatment at no cost if they qualify.

Ketamine Treatment

As mentioned, ketamine is currently legally available. You can speak with a psychiatrist about whether ketamine might be appropriate, research ketamine clinics that offer therapeutic support (not just the medicine), and check if insurance might cover FDA-approved esketamine (coverage varies widely).

Integration Therapists

Even without access to psychedelics, specialized therapists can help. Integration therapists are trained to help process psychedelic experiences and can provide preparation and integration support around experiences that happen elsewhere. Organizations like MAPS maintain directories of psychedelic-informed therapists.

Cautions About Underground Therapy

Some people seek treatment outside legal channels. If considering this route, be aware that quality, safety, and ethics vary enormously, there's little recourse if problems arise, substances may not be what they claim to be, and legal risks exist for all involved.

If a patient is going to seek out their own psychedelic experience, the Multidisciplinary Association for Psychedelic Studies has a resource page on psychedelic integration that may be useful for education as well as other psychotherapeutic information and guidance [7].

The Future of Psychedelic Medicine

Regulatory Changes

In an evaluation of safety and abuse research on psilocybin, Johns Hopkins researchers suggest that if it clears phase III clinical trials, psilocybin should be re-categorized from a schedule I drug to a schedule IV drug, but with tighter control [4].

Several jurisdictions have already changed their approach. Oregon has legalized psilocybin for therapeutic use under supervision, Colorado has decriminalized personal use of certain natural psychedelics, and various municipalities have deprioritized enforcement of laws against plant psychedelics.

Ongoing Research

Major research initiatives continue to expand our understanding through more rigorous clinical trials with larger sample sizes, studies examining which patients benefit most, research on optimal therapeutic protocols, and investigations of microdosing (using very small amounts).

Ethical Considerations

As psychedelic medicine emerges, important ethical questions are being addressed regarding ensuring equitable access to treatment, respecting indigenous traditions that have used these substances, preventing commercialization from dominating therapeutic values, and balancing enthusiasm with scientific rigor.

There is significant concern about diversity in psychedelic research, with Indigenous people and people of color underrepresented as researchers, therapists, and study participants, despite psychedelics being part of spiritual practices and cultures of Indigenous people throughout the world [7].

Related Conditions and Resources

• Depression: Many studies focus on psychedelics for depression

• Anxiety Disorders: Promising research on psychedelics for anxiety

• PTSD: MDMA shows potential for trauma treatment

• Addiction: Psychedelics being studied for substance use disorders

Getting Started Today

If you're interested in learning more about psychedelic therapy, consider speaking with a mental health professional about your interest, researching reputable organizations like MAPS, the Johns Hopkins Center for Psychedelic Research, or the Usona Institute, and exploring whether any clinical trials might be appropriate for your situation. You might also find a psychedelic-informed therapist for consultation or use our treatment center locator to find specialized care near you.

Remember that while research is promising, psychedelic therapy remains in development. Traditional mental health treatments, including therapy and medication, remain important options with more established evidence bases.

References

[1] National Institute on Drug Abuse. (2023). Hallucinogens DrugFacts. https://www.nida.nih.gov/publications/drugfacts/hallucinogens

[2] American Psychiatric Association. (2023). What Are Hallucinogens? https://www.psychiatry.org/patients-families/hallucinogens/what-are-hallucinogens

[3] Johns Hopkins Medicine. (2023). Psychedelics Research and Psilocybin Therapy. https://www.hopkinsmedicine.org/psychiatry/research/psychedelics-research

[4] Johnson, M. W., et al. (2018). The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act. Neuropharmacology, 142, 143-166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067249/

[5] Reiff, C. M., et al. (2020). Psychedelics and Psychedelic-Assisted Psychotherapy. American Journal of Psychiatry, 177(5), 391-410. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010035

[6] Tupper, K. W., et al. (2015). Psychedelic medicine: a re-emerging therapeutic paradigm. Canadian Medical Association Journal, 187(14), 1054-1059. https://www.cmaj.ca/content/187/14/1054

[7] Agin-Liebes, G., et al. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal, 18, 40. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00489-1