Picture this: You walk into a small, dimly lit room and lay on a bed beside a clinician. After talking you through what’s going to happen, they hand you an eye mask, then administer a controlled dose of the psychedelic compound, psilocybin.
As suddenly as the drug takes effect, the world as you knew it starts to dissolve - the chains of old thought patterns finally loosen.
While it might sound intense, this scenario could be a future reality for those living with treatment resistant mental illness, including depression and post traumatic stress disorder (PTSD).
In recent years, psychedelic-assisted therapies have become one of the most fascinating and fast-accelerating areas of psychiatric research, driven by an ever-growing body of exciting new evidence.
The current mental health crisis has also created an urgency for new, more effective treatment options, with over a billion people currently living with mental health disorders, according to the World Health Organization (WHO).
“Unfortunately, in mental health, and specifically in psychiatry, we haven't really had any new treatments for several decades,” Dr Liliana Galindo, an assistant professor at the University of Cambridge’s psychiatry department, told Euronews Health.
“What psychedelics are bringing is the opportunity to have or to present new treatments for people that don't respond to the usual treatments.”
Psychedelics are a class of psychoactive substances that can powerfully alter people's perceptions and moods by binding to serotonin receptors. Popular examples include psilocybin, DMT, phenethylamines (MDMA) and lysergamides (LSD).
While they all share similar consciousness-expanding qualities, each compound varies in its intensity, duration, and overall effect, with different ones being tested for different conditions.
So far, psilocybin, an active ingredient in magic mushrooms, has generated the most promising results.
“For treating depression, psilocybin, specifically the COMP360 (a synthetic formulation of psilocybin developed by Compass Pathways), has already finished phase three of its clinical trials. We are expecting that [Compass] is going to file the FDA (Food and Drug Administration) application soon,” Galindo said.
“Potentially, this could be the very first psychedelic treatment that will be legal and approved.”
How do psychedelic-assisted therapies work?
Up until now, mental health treatments have relied on two evidence-based methods: talk therapies and medications such as antidepressants.
These are proven to be effective, with patients receiving a combination of the two 25-27% more likely to respond positively, according to statistics by the National Institutes of Health.
But for those that don’t respond, other avenues of help remain limited.
“Many mental health conditions have some symptoms that are common, like rigid cognitions. So, for example, when people are depressed, they start to have really negative thoughts, and these negative thoughts are going to affect how they see themselves, how they see the world, and of course, how they are going to feel about it. And after several years of being depressed, it's really difficult to take a step outside of those pessimistic thoughts, or frequent fears and even suicidal ideations,” Galindo explained.
For these cases, psychedelic medications could be the answer, with Galindo noting their effectiveness at disrupting cognitive ruts and rewiring how the brain processes trauma.
“I really like an analogy I saw once [about psychedelic medications] that it's like when you're skiing. You usually go for a certain pathway, right? And because the pathway has a specific mark, it is really difficult to actually go outside of it. But somehow, what psilocybin allows, is like having fresh snow that will make it easier to actually explore different pathways.”
Numerous studies back this, with a recent one by Imperial College London - considered a world leader in psychedelic research - reporting that even a single dose of psilocybin can prompt anatomical changes in the brain.
Other psychoactive compounds such as MDMA have been shown to work a little differently by enhancing feelings of empathy, connectivity and openness, which could be effective at treating PTSD.
“It facilitates a period of time where people [with PTSD] can revisit their memories and somehow be able to rethink, to reframe, to change the narrative and to process their trauma,” she said.
“This is the reason psychedelics are bringing such a big revolution to mental health, because they're aiming to treat the core rather than only the symptoms.”
Social stigmas and legal issues
A major hurdle to mainstream approval, however, remains their status as illegal drugs in most countries.
“Unfortunately, even if we have clear evidence for their therapeutic potential, they are still illegal. For example, here in the UK, they're still classified A, meaning that in order to conduct any study, we need to apply for a special home office licence. This is not only expensive, but takes a long time, and so is definitely affecting the amount of research that could be happening in the field,” Galindo said.
Another issue is the stigmas surrounding these drugs, and their primary associations with party culture and potentially dangerous outcomes.
Galindo emphasises that these concerns are why the controlled setting of psychedelic-assisted therapies is so important.
“You need to take care of all the different details of the environment, like the sound, the lights. And of course, the entire time [the patient] is supported by a trained therapist or a member of the staff that is there to be able to support during that process,” she said.
“These drugs are really powerful tools, but of course, if for any reason they are not given in the right setting, this could come with more side effects.”
While more research is required to better understand who will benefit and who won’t, Galindo hopes that, one day, these treatments can become an accessible option for everyone.
“Rather than staying in a private setting, they should be available for the people who need it the most, not only for the ones that can pay.”
