Turn on, tune in and drop out. Those were the infamous words of American psychologist Timothy Leary, the world’s leading campaigner for psychedelic drug research and use. He became synonymous with counterculture in the 1960s, was the most famous proponent of the therapeutic and spiritual benefits of LSD (lysergic acid diethylamide also known as acid). He died almost three decades ago, but now it looks like the ‘vision splendid’ he foretold, about the immense benefits of psychedelic-assisted therapy, is upon us. The legacy of the age of Aquarius has arrived!
From 1 July, 2023 the TGA (Therapeutic Goods Administration) will be rescheduling psilocybin and MDMA (methylenedioxymethamphetamine also known as ecstasy) in the Poisons Standard, a record of decisions on the classification of medicines and chemicals. In short this means that psychiatrists who are given approval from the TGA will be able to prescribe psilocybin (derived from ‘magic mushrooms’) for treatment-resistant depression and MDMA for PTSD (posttraumatic stress disorder).
Psilocybin-assisted therapy has yielded remarkable clinical results for depression and anxiety in numerous trials at leading universities internationally. Psilocybin-assisted therapy can lead to remission in 60-80 per cent of cases of anxiety and depression, whereas current existing treatments lead to remission in a maximum of 35-42 per cent of cases. (Griffiths et al., 2016; Ross, 2016; Carhart-Harris, 2016).
Struggling to find treatments
Over 2.2 million Australians have been diagnosed with mental health conditions including anxiety and depression, with diagnosis of the latter being on the increase. Clinicians are struggling to find treatments that work. With almost double the positive results of existing clinical treatment, psychedelic-assisted therapy has created a ripple of excitement in the therapeutic community.
Benjamin Gilmour, local paramedic and graduate of MMI’s Certificate in Psychedelic-Assisted Therapy (CPAT), completed a six-month course which included 90 hours under the supervision of psychologists. The course was speculative, as no one is really sure how things are going to operate once TGA approvals are in place.
But Mr Gilmour, like many others in the health sector, is excited about the therapy’s potential.
‘I was motivated by my desire to find more effective lasting treatments for patients with depression, anxiety, and PTSD,’ he said.
‘When it comes to mental health, the conventional medical system has been less than satisfactory for many. As a paramedic it seemed like a revolving door. I see the same patients with depression, anxiety and PTSD over and over again. Antidepressant SSRIs (selective serotonin reuptake inhibitors) can be effective for some people to an extent, but these patients would commonly describe a lack of joy in their lives. They felt numb to the enjoyment of life. And suicide remains a huge issue in this country.
‘In almost all the studies thus far, psychedelics have shown to be very effective in breaking people out of repetitive and rigid ways of thinking. Some of the benefits include: increased empathy for others; compassion for self; profound and novel insights about one’s character, or life, or the world; feelings of deep connectedness with others; a sense of meaningfulness; and, in the best-case scenario people can have a profound ‘mystical’ experience.
‘So far the results from psychedelic studies have been truly remarkable,’ said Mr Gilmour. ‘About 122 psychedelic and MDMA research trials have recently been completed or are currently active.’
Psychedelic-assisted therapy typically involves the ingestion of a classical psychedelic, such as psilocybin found in magic mushrooms, combined with integration therapy in the days and weeks afterwards. A common therapeutic approach during the actual psychedelic sessions Mr Gilmour says is ‘non-directive’.
More than just a ‘trip’
‘With psilocybin in particular, [the therapeutic approach] is attentive but usually silent, supporting the emerging process, offering assistance and guidance if needed, with little analysis of the material,’ explained Benjamin Gilmour.
The analysis happens later. The model used in trials, which will be replicated to the clinical setting overseen by psychiatrists, will involve three distinct phases:
- Preparation therapy.
- The psychedelic experience.
- Integration therapy.
‘The therapy element of this approach is absolutely essential for both effectiveness and safety,’ says Mr Gilmour. ‘In other words, just taking a psychedelic alone without adequate prep or integration is not only a missed opportunity, but can result in harm.’
So who is the most suitable person to participate in the therapy?
‘People who have been diagnosed with, or feel they have, unprocessed trauma, grief, PTSD, or anxiety. However, so far the TGA has only approved use for treatment-resistant depression and PTSD. Even so, there is also great benefit for people outside of mental illness, for the resolution of an existential crisis, for example, or for creative stimulation,’ said Mr Gilmour.
‘But it’s my personal view that psychedelics are not for recreational use, or a magic way of getting what you want, like making your rich, or for taking lightly. These are powerful and sacred plant medicines here to help us evolve, to raise our consciousness, bring us in tune with our higher selves and with nature. They are not here to galvanise the ego, but rather dissolve it,’ concludes Mr Gilmour.
With the TGA’s decision to reschedule psilocybin and MDMA from 1 July 2023, psychologists are looking into how to practise with these treatments.
‘The question even the TGA and the college of psychiatrists are trying to work out is how this is going to work,’ said Mr Gilmour.
‘Psychiatrists generally have a pharmacological approach to mental health and leave the psychotherapeutic aspects to psychologists and psychotherapists. What the TGA and the college have recognised is that psychedelic medicines cannot be used in the same way that antidepressants are used. They are not take-home meds. They are actually vehicles for psychotherapy. They must be used in conjunction with a psychotherapeutic plan,’ he said.
‘The problem is we only have a couple of hundred clinicians trained so far in Australia, less than half of them actual therapists. The rest are registered social workers, nurses, paramedics and so on. The college of psychiatrists or the Human Research Ethics Committees (HRECs) will have to decide on the make-up of the therapy teams and what required training will look like.’
The psychedelic community believes that integration is a vital component of psychedelic therapy. ‘Integration is a process of actively making sense of, or working through, translating and processing the content of a psychedelic experience,’ says Mr Gilmour.
‘I have to say that, while there are some really great underground psychedelic facilitators, integration has been largely lacking in that space. Many of us know people who have done a bunch of psychedelics and are walking around completely confused and sometimes quite unwell. That’s usually because integration has been neglected.
‘These individuals are carrying around a huge load of dredged up material from their subconscious, often very traumatic stuff, and have had no support to make sense of it. This is not a reflection on the psychedelic, rather a reflection of lack of integration. And this is why, in my view, the clinical model is so valuable.’
To date, the biological mechanisms underlying the complex psychoactive effects of psychedelic drugs remain poorly understood. While the acute presentation of a psilocybin-intoxicated individual closely resembles psychosis, hallucinogens such as psilocybin are not thought to precipitate a new psychotic illness, but rather may unmask a psychotic disorder in those who are susceptible.
Ironically, some 60 years ago, counterculture may have opened the door to a medicine that has the potential for profound impact on the improved mental health of many in our community. Maybe come 1 July we may finally understand Leary’s therapeutic directive.
I’m staying tuned in.