What Is the Role of Psychedelics in Mental Healthcare?

If you’ve been hearing a lot about psychedelics in mental healthcare but are not sure exactly what that means, read on to learn more.

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In case you missed it, psychedelic drugs aren’t just for concert goers anymore. A recent executive order from the president aimed at advancing research into psychedelic therapies (particularly ibogaine, a naturally occurring psychedelic substance) is bringing renewed attention to this emerging field in psychiatry. When used responsibly in a clinical setting with a professional, psychedelics may treat mental health symptoms that otherwise go unaddressed. 

As the country’s mental health crisis continues to grow, the need for more solutions is undeniable, and sometimes, to come up with new solutions, we need to think outside the box. Treating mental health conditions with psychedelics is doing just that. The executive order is also granting at least $50 million to advance the use of psychedelics for treating serious mental illness. 

But what exactly does that mean for us now, and how do psychedelic substances actually improve mental health? Read on to learn more about how psychedelic therapy is being used to target depressive symptoms and other complex conditions.

Why use psychedelics in mental healthcare?

Substance use and mental health treatment involving psychedelics offers a completely different way to treat mental health conditions, offering promise for those who are struggling. While traditional treatments (like a combination of talk therapy and psychiatric medications) do work for many people, countless others are left without full relief from symptoms. 

For example, 30% of people with depression have treatment-resistant depression, which is generally defined as trying two different antidepressants and still not getting relief. Additionally, around 33% of people with anxiety disorders are treatment-resistant, and up to 33% of people with post-traumatic stress disorder (PTSD) are treatment-resistant, too. 

That means that millions of people struggling with mental illnesses are still suffering, despite traditional treatment.

“The burden of depression and anxiety on well-being and functional status is profound and continues to motivate clinicians and neuroscientists to develop novel therapeutics, particularly across the COVID-19 pandemic and subsequent mental health crisis,” says Dr. Tuesday Burns, M.D., board-certified psychiatrist and Charlie Health Medical Director. “There has never been a greater need to increase access and treatment options for mental health.”

Enter: an impressive growing body of research exploring psychedelic-assisted therapy as a potential breakthrough for people who haven’t found relief through traditional substance use or mental health treatment modalities.

How psychedelics can help mental health

Psychedelics work in unique ways in the brain to potentially help treat mental health conditions.

While traditional psychiatric medications such as antidepressants like SSRIs and SNRIs work by impacting levels of chemical messengers in the brain, research suggests that one of the ways psychedelics work is to increase neuroplasticity, or the brain’s ability to change and form “new neural connections.”

Some of the psychedelics that have been studied are:

• Psilocybin
• Lysergic acid diethylamide (LSD)
• 3,4-Methylenedioxymethamphetamine (MDMA)
• Ibogaine
• Ketamine
  

When the brain is in this more flexible state post-psychedelic dose, it may be easier for someone to make positive changes and shed old maladaptive thought patterns and behaviors, researchers explain. Not to mention, a single dose of a psychedelic might lead to effects that last for months after. Some research shows that psilocybin treatment may even have lasting effects for a year after for depression. 

“We’ve got years of data collection looking at the use of psychedelic-assisted therapy in treating PTSD, depression, and substance use disorders,” Dr. Burns says. “The confluence of evidence-based psychotherapy with psychedelics has offered promising data around response and remission of depression and anxiety that had otherwise been resistant to classical medications such as SSRIs or other antidepressants.”

How psychedelic-assisted treatment works

Psychedelic treatment doesn’t just involve taking a dose of a drug, “tripping,” and then being good to go. There are major differences that set the therapeutic use apart from recreational use. The treatment process typically includes:

1. Preparation sessions 

These are where you develop a relationship with the therapist, learn about what to expect when you take the psychedelic, and set an intention for what you want to get out of the experience.

2. Dosing sessions 

In these sessions you take the drug in the provider’s office and are closely monitored. You might wear an eye mask and listen to relaxing music to help you turn your focus inward. You may or may not talk with your therapist during the “trip.” Depending on the drug you take, the trip may last up to eight hours, and you’ll be under their care for that whole time.

3. Integration settings 

You’ll meet with your therapist in the days to weeks after your dosing session to integrate what you learned during the trip and create positive changes thanks to the neuroplasticity created by the drug.

Note: This is typically how the process goes in research settings. Psychedelics are not FDA-approved, and this type of treatment is not widely available. The exception is ketamine, which is commonly available through IV infusions at specialty clinics in the US. However, this is not FDA-approved. A ketamine derivative called esketamine (branded as a nasal spray called Spravato) is FDA-approved for treatment-resistant depression.

The importance of therapy alongside psychedelics

Any psychedelic will not be a magic bullet to cure a mental health condition — especially not on its own. A “trip” on a psychedelic can lead to breakthroughs, “ego-death,” or profound spiritual experiences, but it isn’t a cure. The real magic is what happens afterward, thanks to the newfound neuroplasticity and the brain’s ability to change for the better.

“Therapy is of paramount importance with these interventions,” Dr. Burns says. “Time and time again, neuroscience research has shown that biologic interventions with psychotherapy far exceed the effects of medications or therapy alone.” 

Therapy after taking psychedelics can also increase the chances of positive change lasting. “When patients have a positive response to psychedelic treatment, it will be important to maintain the effects with evidence-based care,” Dr. Burns says. “As with any intervention, durability of response relies on maintenance of healthy behaviors, routines, and thought patterns.”

Additionally, no one (especially with a serious mental health condition) should use psychedelic drugs without supervision from a professional.  Dr. Burns warns that unsupervised use of psychedelics can be “quite dangerous.” It may lead to “bad trips” or even worsening symptoms without proper professional support. 

Who shouldn’t try psychedelic-assisted therapy?

While psychedelics do hold great promise for treating people with mental health disorders like treatment-resistant depression, PTSD, or a substance use disorder, they aren’t a good fit for everyone.

“We caution folks experiencing acute suicidality and psychosis against the use of psychedelics given the risk for decompensation,” Dr. Burns says. Folks struggling with acute crisis or safety in general also should not use psychedelics, she adds. 

Because of these risks, careful screening and ongoing monitoring are essential before, during, and after any form of psychedelic-assisted treatment.  “This is also why all interventions should be conducted under the close supervision of a collaborative mental health team,” Dr. Burns says. 

What does the recent executive order mean for us right now?

The executive order marks an exciting step in the right direction for innovation. However, Dr. Burns says the executive order hasn’t changed anything in the clinical realm yet. 

In other words, psychedelic-assisted therapy is still not widely available or FDA-approved for widespread use yet. Rather, psychedelic-assisted therapy is limited to specialized clinics and research settings conducting psychedelic studies. 

The executive order might help accelerate research and maybe even reduce barriers to care over time, but it doesn’t mean these treatments are accessible to the general public now. “We highly recommend that patients who have been suffering with treatment-resistant symptoms be referred to trials that offer psychedelic-assisted therapy,” Dr. Burns says. 

Various universities and hospitals are conducting psychedelic studies and recruiting for clinical trials involving psychedelics and mental health, including: 

• University of California, San Francisco
• John Hopkins School of Medicine
• New York University Grossman School of Medicine
• Washington University in St. Louis
• And more

If you’re currently under the care of a mental health professional (such as a therapist or a psychiatric provider), ask them if they think you might be a good fit for a psychedelics clinical trial. Ultimately, we have a long way before any of these treatments become as widely available as traditional psychiatric medications — but we’re on the right track.

How Charlie Health can Help

If you or a loved one is struggling with your mental health, Charlie Health can help. Charlie Health is a virtual behavioral health provider delivering high-acuity treatment for kids, teens, and adults facing serious mental health disorders and substance use disorders. Our innovative treatment model combines clinical expertise, group connection, and measurement-based care to support long-term healing. With the right support, managing your mental health and relationships is possible. Fill out the form below to start healing today.