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Psychedelics could shake up mental health treatment – but will require a mindset shift

At the Psychiatry and Mental Health session at HBI 2022 we heard from Adrienne Rivlin (partner at strategy consultancy LEK) about how psychedelic therapy promises to radically transform the mental health sector. But how ready is the sector (not to mention society) for the shift in mindset that this will require?

Currently there are dozens of on-going clinical trials testing how a wide range of mental health conditions, including depression, addiction, OCD, PTSD and end-of-life existential distress, can be treated with psychotropic drugs such as psilocybin (magic mushrooms), MDMA (ecstasy) and ayahuasca. 

The studies show some very promising results that could open up a whole new avenue of treatment. For example, a 2021 study at Imperial college comparing psilocybin with Escitalopram, a selective serotonin re-uptake inhibitor antidepressant (SSRI), for depression found that six weeks after treatment, 70% of those in the psilocybin group saw their symptoms decrease by 50% or more, whilst only 48% in the SSRI group did. And, 58% of those in the psilocybin group saw a large enough decrease in their symptoms to be considered in remission six weeks after treatment, as compared to 28% of patients in the SSRI group.

Results such as these have encouraged investors: hundreds of millions of dollars are already being poured into the nascent sector, in both Europe and North America. Currently most of the money is going into drug development, but some mental health providers are also starting to invest in the accompanying infrastructure that will be required for treating patients with psychedelics, such as special psychedelic clinics and digital tools which can be used to deliver the accompanying therapy.

The treatment model is very different from the current standard treatments for mental health: instead of taking an antidepressant every day to alleviate the worst symptoms of depression, patients have one or two intensive sessions lasting six to eight hours tripping on a psychedelic such as psilocybin, with the supervision of a therapist who helps them through the experience. Then in the days, weeks and months following the trip, the patient may receive follow-up therapy sessions, to help them make sense of, or ‘integrate’, the experience.

And – although Rivlin pointed out there is some debate on this – the benefit many experience appears to come not so much from the drug itself, but from the experience the drugs induce, which can be transformational. Many of those involved in the trials rate the experience as one of the most meaningful of their lives, and those that do are more likely to experience the long-term mental health benefits. 

This type of treatment sits awkwardly, therefore, with how we are used to treating patients in modern medicine. Rather than working via physiological processes which the patient has little control over, the effectiveness of this type of treatment appears to depend largely on how the patient responds, psychologically, to it. 

This makes it closer to standard (non psychedelic-aided) forms of psychotherapy, as well as spiritual, religious and alternative forms of therapy such as meditation, yoga, hypnosis and shamanistic rituals, than standard pharmacological medicines such as antidepressants. But psychedelic therapy has the added issue of involving the use of vision-inducing drugs which, ever since they were banned in the 1960s, have been widely viewed as dangerous and subversive. 

So even if governments are willing to allow these medicines to be licensed (Rivlin expects this could happen as soon as two to four years from now!), psychiatrists and the wider community of mental health professionals will have to be won over as well. And clinicians and regulators set in a particular mindset can be hard to shift. But the positive results from the scientific studies speak for themselves, and should outweigh any overhanging stigma or bias – bias against the drugs themselves, but also against this radically different approach to treating patients.

We would welcome your thoughts on this story. Email your views to Martin De Benito Gellner or call 0207 183 3779.