Lying on a comfy bed with eyes closed in a darkened room, surrounded by soft mood lighting and calming music while a trusted person next to you whispers encouraging phrases sounds like the ultimate way to relax. Throw 25mgs of psilocybin into the mix, and it’s a different scenario entirely.
25mgs is about what you would get in 5gs of magic mushrooms. That’s about five times more than you might take for a casual recreational experience. Lying in a room with two psychologists present, an individual spends roughly 8 hours blasted into an alternate dimension, exploring their deepest self, re-living past traumas, and finding incomparable beauty and the strength to live life anew.
This is how psychedelic therapy works.
“A psilocybin experience is like a deep-sea dive. So, the idea of diving down into those deep waters and how dark and murky it can be,” explains Dr Ros Watts, lead clinical psychologist at Imperial College London.
“People have psilocybin and they feel these things. Trauma that’s been repressed and held onto gets released and the transformational moment is where someone can suddenly release some pent up tears that they haven’t cried for 20 years, or someone can suddenly experience joy, or beauty, or something else that they haven’t felt for ages, or suddenly they feel a sense of forgiveness for something or love for something or hear a piece of music and it touches them,” she says.
She’s speaking on the new BBC documentary, The Psychedelic Drug Trial: A Cure for Depression. Released on BBC Earth on Thursday, 9 December, the show follows several of the participants who undergo one of the most groundbreaking trials in psychedelic research.
The trial is designed to pit the effectiveness of one of the leading and best-tolerated antidepressants, escitalopram, against a course of psychedelic therapy. 59 individuals have been selected for having long-term, treatment-resistant depression, and are given either a course of escitalopram over six weeks or two sessions with magic mushrooms. What’s being tested here is which one will work better.
Depression is one of the leading mental health issues on the planet, with over 300 million people around the world suffering in some form. It’s also one of the most difficult to treat, with up to 30% of people not having any relief from various kinds of treatment. For those people, there is seemingly no hope.
That is, until, psychedelics re-entered the scene after decades of prohibition. Now, the once highly stigmatised and still very much illegal drugs are being touted across the globe as breakthrough medications that could very well save the lives of millions of people.
The trial is led by Professor David Nutt of Imperial College London. He’s a long time drug-reform advocate and ardent adherent of science and rationality. His outspokenness over the illogical nature of prohibition once got him fired from the government of UK Prime Minister Tony Blair for saying that taking MDMA was safer than horse-riding. The evidence he cited was work into the comparative dangers of drugs that he created under instruction from that same government.
Speaking in an interview with The Latch, Nutt explains that if psychedelics were created today, governments around the world would be clamouring to distribute them.
“We’ve got the capacity to be on the cusp of real change if we want to be,” he said.
“But there is still the enormous burden of history and the resistance of the bureaucrats and the anxiety that people have to make any change to the [UN] international convention [on Narcotic Drugs]”.
He describes the war on drugs, the legacy of the Richard Nixon administration, and the fact that the anti-Vietnam war protests were blamed on LSD as “historical baggage that we carry with us all the time” that prevents real change from happening.
“Mark Twain said ‘how easy it is to make a man believe a lie, and how hard it is to persuade him he was lied to’,” he said, laughing.
Research like Nutt’s is exactly the type of work that Australia’s Therapeutic Goods Administration has said that they would need to see more of in order to broaden access to psilocybin. Currently, the medicines regulator is considering whether or not to reschedule MDMA and psilocybin from Schedule 9 to Schedule 8, allowing doctors and psychologists easier access to these drugs for research and treatments. Nutt himself is however convinced.
“I’m ready. I mean, look, these were medicines in the 1960s. There were 1000 clinical papers published on them, quite a few with psilocybin. Psilocybin was sold as a medicine, I mean, we know they’re medicines, we don’t need any more data,” Nutt said.
“Our data is basically showing people that if you do the studies according to current standards they still work which is not surprising. And they don’t just work, they work better than anything we’ve got in psychiatry.
“We don’t need more evidence, we just need people to understand that these should be made available so we can actually really do what we would call effectiveness studies. There’s no doubt that these drugs work, the question is, how are we going to transform healthcare?
The research into psychedelic therapy has been compelling for a long time but one of the key criticisms of the broader psychedelic movement, and, in particular, the psychedelic startup space in the US and Canada (yes, that’s a thing) is that people with depression end up latching onto psychedelics as a cure. As they currently can’t legally access the treatment, or, if they can or do by other means and it doesn’t work for them, the risk of disappointment and despair is great.
Although the documentary tempers its titular claims of psychedelics as a “cure” by highlighting the fact that it doesn’t work for everyone, Nutt cautions that psychedelics could need to be part of routine medical treatment for some people.
“People who have what you might call a trigger event for their depression, they do very very well,” he said.
“Now, the people who don’t do so well, the people who relapse, are the ones who have had depression since childhood. In those, I think depression becomes a sort of base state of the brain, it becomes the usual way in which they think about things. That concept of a cure for them may not be valid but we can, at the very least make them feel a lot better for a period. The problem now is that we can’t re-administer because the drugs are illegal. If we could give people with chronic depression two to three treatments a year, we might be to keep their depression at bay for many years”.
“These people reasonably believe that they can benefit but they’re not allowed access because it’s an illegal drug. That is the worst of all possible worlds. What possible benefit could accrue to society by perpetuating that process? You’re not stopping recreational use, because this is a medicine and it would be prescribed, so what conceivable benefit can accrue in stopping people who have had a benefit and are now disabled from getting access to it?”
If the drugs work as well as Nutt has demonstrated that they do, millions of people around the world and going to want and need access. Fair and equitable treatment for all is a big concern in the psychedelic space but Nutt believes they can be made available to most people and that the cost/benefit analysis of governments not capitalising on the opportunity would be far worse.
“Psilocybin treatment can be offered for about £6,000 [about $11,000],” he said.
“That’s the same cost for about a week in a hospital bed. So if you can keep people with depression out of hospital for a few weeks, you’ve paid for the course of psilocybin for a lifetime”.
Nutt currently believes that the debate over whether or not psychedelic therapy works is settled. All that remains now is convincing the politicians to abandon the ‘tough on drugs rhetoric’ and start training psychologists and psychiatrists to deliver treatment. Doing that could very well be our answer to the rising mental health crisis around the world.
“It will take time. I accept that politicians are going to be sceptical, but I think that scepticism will be overturned in time.”
You can watch The Psychedelic Drug Trial: A Cure for Depression on BBC Earth from Thursday.