Psychedelic therapy for depression: hope or hype? - with Alex Riley

[Music] first i'd like to say how honored them to be here at the royal institution um it really is privileged to discuss some of the things from the story some of the studies that are in the book um and also some of the stuff that hasn't really made it into the book either because they didn't have space or time or studies that have been published recently um and because this is the wrong institution i'd like to start with a short demonstration so this is going to involve everyone here unfortunately but it can be very easy all i'd like you to do is to close your eyes for a few seconds so ignore me okay and open them again and close them again okay you can open them again now that's probably the most boring demonstration in the royal institutions history so congratulations now what happened is actually quite interesting but you didn't see it so in your brain there are these electrical rhythms uh we're not really sure what they do but there's some theories of them being involved in consciousness but the one i'd like to speak about today are alpha waves now this is a study from the 1930s and it kind of shows what i just did so i got you to shut your eyes and these alpha waves in the back of your head here which is where your visual cortex is started to increase in amplitude like a richter scale for earthquakes and when i got you to open your eyes they stopped again they went down to almost no movement whatsoever then shot again these alpha waves increase in amplitude and what these alpha waves are thought to do is essentially turn off or act as a blocking signal for the visual cortex so like i said it's at the back of your head you kind of think that the visual cortex would be near your eyes but it isn't because evolution is messy and it doesn't make sense a lot of the time and so these blocking signals uh essentially one of the theories is they stop you from seeing when you have your eyes shut so i think i'm going to leave it there for now but that's kind of an insight into one of the theories of how psychedelics might work in the treatment of depression so remember alpha waves blocking signals and i'd like to start the main bulk of the talk by talking about a fisherman so this fisherman he lives in natal which is on the northeastern coast of brazil and in his 60s he retired from being a fisherman and he fell into quite a deep depression so he reached out for antidepressants he was given two different types of antidepressants so probably an ssri and then another type of antidepressant that's a bit older maybe something like a tricyclic antidepressant or a maoi which they're just different classes of antidepressants uh i didn't respond he didn't respond to either treatment and not only did he have the mental symptoms of depression such as low mood suicide or suicidal ideation uh just lack of interest in much one's pleasurable activities he also had physical symptoms his gut his belly became very rigid um and this is quite common in quite severe forms of depression uh the ancient greeks loved it they sort of had a whole um theory about it they called it the gassy disease actually this this form of melancholia as they called it and this fisherman being in natal he lives near a brain institute and this brain institute was running a clinical trial it was trying to understand uh one of the latest treatments for depression which is ayahuasca which has been used for centuries maybe thousands of years in religious settings and by indigenous populations in in south america so ayahuasca is a mixture it's a concoction it's a tea made from it it can vary but there are usually two different types of plants so we have banisteriopsis carpe which is a vine often called the soul vine this is the main ingredient that has been used for for much longer than the second ingredient and this vine contains harmine which is a psychoactive substance in itself but what it does into in ayahuasca is that it blocks dmt and that's in the second ingredient which is from this plant that's part of the coffee family which is psychotria viridis now it blocks dmt from being broken down i mean um and so otherwise dmt would just kind of be broken down in the gut and you wouldn't have a long lasting psychedelic trip which is what ayahuasca is famous for so boiling these two plants together for hours some some people do it for days some people add different ingredients into the mix and have their own sort of brew and this is what it looks like so it's looks very unappetizing and it is it's very bitter it's got a sour taste it's brown for one and um this creates as you might imagine as this is a talk on psychedelics quite vivid psyche like trips and this is just one image that you know is kind of trying to represent it obviously doesn't come anywhere near to representing these experiences and in the religious ceremonies that are uh that take place in brazil the the word that they use is mira soys which means seeings and so these trips aren't just seen as hallucinations they're seen as just as real as anything here so anything that we're seeing now with our eyes open they really think that the the visions that they see under the influence of these of these drugs is just as real as anything else that hits your retina so this fisherman was enrolled in a trial to kind of test out this idea of whether these these drugs can whether it's tea can help relieve depression and this trial was sorry this trial was run by draulio raucho and his phd student fernando pauliano fonshas and it's the first randomized controlled trial into a psychedelic iv depression it's published in 2019 um along with the fishermen we have 28 other people who were from low income settings in natal in the surrounding region of natal they had no experience with ayahuasca so they hadn't had or any other psychedelics they didn't really know how it would go they didn't know what they might see and a lot of the people were well all of them who were so-called treatment resistant they hadn't responded to at least two different types of antidepressants but some people had much more treatment resistance some of them didn't respond to many drugs they had lists of antidepressants that they hadn't responded to some even had electroconvulsive therapy and hadn't responded to that so these are really really sick people and this is what the fishermen wrote after he was part of this trial you know what doctor your tea of the indians ayahuasca just relieved me from something that i had for years i woke up thinking that i want to go to the ocean um and in this this sort of this vision he he went to the ocean uh looked out over the over the sea and he felt this great sort of release this sort of and relief as well from him from his symptoms and it kind of dawned on him that maybe the reason he was so depressed was because he had taken away the life that he once had the life that um he basically been a fisherman all his life and maybe he was only at peace when he was by the sea or on the sea um and that was just one vision that the that came from this trial some of them were a bit darker uh and harder to sort of deal with one patient she she saw her sister so i was taking all the dreams she saw her sister who had died a few years ago in this beautiful meadow so these wildflowers were popping up everywhere and she saw her sister in this vision and her sister walked towards her and said um you don't need to worry about me like i'm fine you know i've moved on you need to live your own life uh and so she took away from this this this mirror soyuz this seeing that yes she had to move on so she she couldn't still deal with the the trauma that she had suffered from losing her sister another example um a woman who had really struggled with suicide had attempted suicide and she saw herself in this coffin um and she was still alive in the coffin in this vision and she saw her mother outside banging on the top of this coffin and she couldn't tell her that she was still alive and what she took from that is basically an insight into what would have happened if she had killed herself that she would have been so missed that her mother loved her and so these are really powerful therapeutic sort of visions that these people are having and it's not just qualitative they said to quantify you know how these people responded to this ayahuasca treatment and so this is one of the graphs from the paper you see ayahuasca in red here uh and the placebo which is everything but the the the psychoactive substance you have all of the treatment in terms of patient care and going to the hospital setting and having you know all of the sort of things that go around and the testing and stuff but you don't have ayahuasca so you can see on the left so it's a standardized scale for depression based on a number of symptoms and uh behaviors that people have along the bottom you have from baseline so before the trial started to day seven you can see a significant drop so i've added some lines in to kind of help you figure out what these numbers mean you can see severe depression and moderate and mild these are just you know cut-off points they're not exact figures um bioalaska from baseline to day one sees this dramatic fall you also see a fall in placebo as you would expect because these people are you know having a treatment and they they feel good about even just people taking an interest in them but over time placebo starts to rise again and ayahuasca stays quite low and in the asterisks there show the statistical significance so um that is significant uh throughout these these seven days and at day seven it's gained significance uh so it's very unlikely that was due to chance um but we've also got to bear in mind that this is a trial with 29 patients which is a very small sample size so it's still it's a promising early indication that these drugs do have a fast acting effect on some very depressed people and so yeah it's it's it's promising but then when we look past seven days so this is a graph from uh a paper that they published two years afterwards this was just last year we see placebo in black and ayahuasca in white we see a date day seven just before the orange line that i've put in there that there is still that significance but then day 14 and then through to months months to month six we kind of lose that significant effect that the two places aren't um that different now you notice that month four they do look very different but by that point there are so few people in the trial i think there are probably about nine in each group still coming back to be checked on that we can't really say you know whether that's due to just the variability in these patients or actually a true effect of being given ayahuasca or the placebo so it's promising you know a fast-acting antidepressant that might work for a week or potentially more and this isn't the only trial that's being done so we have trials looking into psilocybin and i'd like to go through some of the work that's been done closer to home in london so this is from the imperial college group led by robin carhart harris and this didn't test psilocybin which is the active molecule in magic mushrooms against a placebo they tested it against an existing antidepressant so escitalopram which is an ssri and again you see uh kind of a favor a favorable outlook for psilocybin where it's in red it kind of goes down um the the depression rating scale on the left-hand side and over 42 days it remains marginally below escitalopram so again very promising but this was again a trial with 59 patients so i think 30 were given psilocybin 29 we're given escitalopram so we can't really say a lot about the these data points and you actually notice that some of the the range there so by these vertical lines you can see for some people escitalopram is actually better than psilocybin so there's a lot of variability going on with such small sample sizes so be good to kind of replicate this and really move into the hundreds of patients rather than just uh 30 in each group which is obviously very difficult to do i understand that you know these are schedule one drugs um and the cost of giving it to hundreds of people with depression is you know not what a lot of funders want to do um but i'd like to just say something about not just the the statistics but also how these trials are created so and this is true for ayahuascis and psilocybin so if you look back at how the patients are actually selected for these trials they um some of them are selected from local doctors offices some from hospitals but they're also selected by self-selection so they they see advertisements on social media um and they apply for this uh for this trial which is which is you know fine that's what it happens quite a lot but there's an element there that we need to discuss when we're talking about these studies is um they might be primed to respond to psilocybin because they've seen this this advertisement on social media they probably have an interest in these drugs they might you know want to uh see what it's like to be on psilocybin i mean a lot of people are kind of talking about it in the media um and in in other circles and so i just kind of put that sort of caution into into this talk to kind of think maybe we would expect more from people who were kind of given psilocybin and kind of had this experience that they might have been looking for compared to people who went onto this trial applied for it and then were put on escitalopram which is probably the drug they came off in order to be on the trial so i think there's a sort of uh a bias here that favors psilocybin and kind of it might um sort of put escotalopan down which is you know quite amazing the esoterm um was found not to be uh statistically significant uh significantly different from psilocybin so that's one caveat that i have um and the other thing i'd like to talk about which also influences this is hype so um i'll put a definition up there for you and with a little tweak um so we we you know we hear about psychedelics and their amazing effects in in a range of mental illnesses and you know their ability to understand consciousness and spirituality and ego dissolution and all these different terms um but i just want to kind of discuss maybe the harms that we might be doing by adding hype to things that we don't really understand this from a personal perspective you know being someone who has suffered from depression for a long time we're talking about patients who are looking for hope we're looking we're talking about patients who have failed to respond to many different treatments and we need to be careful in how we present these studies to the general public because you know if you create this idea that these drugs are going to be really effective and then they turn out to not work uh for a partic for for someone then i think that feeling of hopelessness can be uh quite dangerous so i'd like to give you a few examples of hype and this comes from the media but more worryingly it also comes from within the psychedelic community itself um so this is uh following the psilocybin paper i just showed you so robin carhart harris the lead author he wrote in the guardian while we suspected that psilocybin might perform well compared to the ssri escitalopram we are not expected to perform as well as it did that's something that uh is a little bit um difficult when you're kind of talking about a phase two very small trial i think it's kind of adding to this hype that these drugs are really much better than the standard treatments and we don't actually know that yet and then this feeds into the people who read the guardian which are far outnumber the people who are reading the new england journal of medicine which is where the paper was published and this can influence how the trials are actually going to go because if you kind of say that these drugs are better than ssris before you start another trial people might take that into the trial and respond which if you're looking for positive results then you know fair enough but if you're looking for the accuracy and kind of looking out for the patients that you're aiming to treat in the future i think that it could be a problem and it's not limited to uh just these words as well it's also he kind of used statistics in in the pa in this guardian article um that actually weren't part of the of the paper i'd like to explain how some basic sort of elements of science and how they work so before you do a clinical trial you need to have a pre-report so you need to kind of put in place what you're going to do how you're going to test it and then so that kind of prevents people from just doing the study and then looking for whatever they want afterwards they can do as many analyses as possible and then they can find the analysis which best fits their hypothesis it's a standard element of of uh of clinical trials it was introduced i think in 2005. um but part of this paper wasn't included in what carhart harris published in the guardian and his analysis made it seem more favorable towards psilocybin i think it was 33 percent uh response rate to escotalopram was what he talked about but in the paper is 48 and he used a different health questionnaire that they added after the pre-report was published and that's worrying but then just yesterday they published a study that actually included a health questionnaire that wasn't included in this pre-report so again it makes me quite uncomfortable that these things are going on because it's kind of the basis of science is is to just include what you said you would include and i worry that that's not happening right now um and i have some sympathy because those those those uh questionnaires did show a better impact for psilocybin versus essay teleprom but then how far does that manipulation go if we accept it now um so these are things i'd like to be part of the psychic discussion if we are to kind of push these drugs into into mental health care which i'm not against i think they definitely have a place in men's healthcare and it doesn't stop there this is in the guardian again from carol routledge from the small farm which is actually working with the imperial college group to study dmt so this is before they started a trial on dmt in the treatment of depression so she writes the psychedelic drug breaks up all of the ruminative thought processes in your brain it literally undoes what has been done by either the stress you've been through or the depressive thoughts you have now that seems pretty conclusive that we know what these drugs do and we know that they basically reverse depression which this sounds like a cure uh and this is before they started a trial into dmt so it's kind of a big sort of press release to kind of show what this this trial is trying to do um and so yeah i think this sort of this sort of um hype should be reduced when we're talking about developing new treatments in mental health care so moving on i'd like to discuss a few theories of how psychedelics work how they might work and starting with the default mode network which some of you may have heard of it's discussed quite a lot so this uh study from 2019 shows uh the brain so you've got these big red circles at the front of the brain here so this is the prefrontal cortex these are the main areas of the default mode network that is a network in the brain that is essentially activated when you're not really doing anything you're not actively involved in the task and so it involves many different parts of the brain as you can see here so the big red bits the slightly smaller orange bits although the dos dorsal prefrontal cortex and then into the [Music] singular cortex in the middle of the brain and so the idea with psychedelics and one of the theories is that it kind of shuts down this this network so this sort of this network has been has been associated with depression with sort of internal thought uh thinking too much about you know yourself and circulates um break that internal thought process which has been linked to the default mode network um a few problems or a few sort of things that i should should talk about is we've found both uh increase and decreased uh activity in the default world network when we're studying depression and also when we're talking about different psychedelics so i think it's quite easy to just label these theories onto it onto a kind of a network in the brain but i think a lot of what the default mode network does we don't really understand as yet but it's an interesting theory and links to that since the paper i was talking about was published yesterday and as well as testing people with psilocybin against escitalopram the imperial group they took brain scans of around 40 people from who who had taken psilocybin and included some older trials as well into this group and essentially they found that psychedelics create or sort of disrupt more modular parts of the brain that have been associated with depression so think of depression as very tightly controlled like you have parts of the brain that are sort of stuck and rigid and what they kind of found was psilocybin can free people with depression from that sort of very modular brain network or brain sort of pattern and so they write psilocybin seems to increase the brain's ability to visit a broader state space and so the theory is that by going through this broader state space in the brain you're able to kind of come out of this very ruminative depressive episode and along with psychotherapy you can kind of kind of get back into touch with parts of your brain that might have become you know just separated from one another again it's uh yeah i like that theory and it's um yeah really interesting work uh the mystical part of psychedelics so there have been correlations with just how powerful a person's experience is on these drugs so you know we talk about ego dissolution so this kind of this sort of dissolving of yourself that you don't feel like you have a body that you can kind of be one with the ecosystem or the the world around you um and there are other sort of terms that can define a mystical experience such as um being unable to describe it in words or in ineff ability um and then there's this transcendence through time and space so all of these combined into mystical experience and both with ayahuasca and psilocybin there have been associations between how strong this response is and how well people do afterwards so how um well these these drugs help people uh come out of a depression and also there's the sort of the neurons themselves in the brain so as well as antidepressants and ketamine psilocybin ayahuasca have been shown to aid in the regrowth of connections in the brain that might have been damaged by stress and depression so these dendrites these sort of little spindly uh like fingers that are coming out from the main body of this neuron here um they one of the theory guys is that these reconnect and allow you to have more sort of uh diversity in your sort of responses to uh to life stresses and it could be one of the ways that it's reversing what stress does to the brain but again it's a theory and it'll require further testing and the one that i started off with which is these alpha waves um and so one of the theories that draulio aroujo the the lead author from um from natal his theory is that these drugs actually affect um so on under ayahuasca they do sort of uh make these other waves go away in the bucky or in the back of your brain in your visual cortex so and what happens when you don't have alpha waves you can see and even when you have your eyes shut what do you see and his theory uh is that when you have your eyes closed is you see your thoughts so you can see your wishes your wants and all of these things kind of come into this beautiful or scary horrifying vista and that can be the reason for your recovery because if you see something you might be more likely to believe it and this leads me back to the fisherman from natal so um like i said all the patients in this trial hadn't had ayahuasca before they were naive to ayahuasca and unbeknownst to him he still hadn't taken ayahuasca after the trial so he'd actually be given the placebo and this is what they did they created a concoction that was similar in colour similar in taste and also it's simulated or it created the same gastrointestinal distress that ayahuasca is famous for so you feel nauseous even though people on this didn't actually throw up he was essentially tricked into thinking he was given the real thing and he had this remarkable recovery he had you know he hadn't responded to antidepressants and i'd like to read you just a little bit from the book because uh draulio's rogers sort of um responds to this i think is quite is quite important so he write what he says psychiatrists treat the placebo effect as something that's bad after the experience we had in our trials the placebo effect is one of the most beautiful things i've ever seen and then this is me taking over some patients have been depressed for decades had lists of medications that were two pages long and have been given several sessions of ect easily making the cut for a diagnosis of treatment resistant depression some of them like the retired fisherman responded beautifully to a drink that was little more than lemon juice turned brown a week after his fake ayahuasca drink the retired fisherman returned to an offray lopez university hospital in natal at a meeting with a psychiatrist he lifted up his shirt and revealed his belly it was no longer stiff as it had been when he was depressed though he'd never seen this psychiatrist before he was delighted to show her rolling his belly in and out like the undulating waves of the open ocean and so i just think that's a yeah a very powerful story of the belief that we bring into these these experiences and how with the right setting we can kind of tap into something that is uh within ourselves to heal and that leads me on to another trial that was published last year in 2021 and this looked at microdosings this is from the imperial group again and what they did was they gave people who were very experienced with psychedelics who microdosed a lot they gave them they could choose whatever they wanted to microdose on whether it was lsd or psilocybin so you'd kind of cut a tab of lsd into the tenth of a of a normal dose and you'd do the same for mushrooms you divide up your mushrooms and you know take a tenth of the dose so you don't really have the same uh powerful psychedelic experience as you would have if you took the full thing and so they did this and they had around 240 people in this trial so it's a big trial um but they switched some of the patients microdoses with a placebo and what they found was those improvements in life satisfaction mindfulness reductions in paranoia uh general well-being all these scales were showing promising results but they're shown promising results in both so people who were given the placebo and also the people who were micro dosing there was no difference between them and this is what they concluded these improvements are not due to the pharmacological action of microdosing but are rather explained by the placebo effect and again shows you know what we bring into these trials and into these drugs might be already within us uh and these drugs might be able to catalyze that reaction so by giving us these amazing visual and sometimes horrendous experiences we might be tapping into whatever the placebo effect is which isn't necessarily bad it could be something to do with how we all heal and the patient reports from this from this trial are amazing i'd like to just share two with you and you can read through them now while i just have a quick drink so you can see the top one actually mentions that they had an altered consciousness or an altered state of consciousness under this placebo and the second one which i think is fantastic is an empty pill with strong belief intentions makes nearly everything you put spirituality in into an empty pill here wow i actually think he or she put the put it into the pill they didn't put anything into the pill um so um yeah it's it's really incredible and so now i've got through uh some of the bulk of the talk i'd like to kind of take a step back so with any feature i write you know you usually set up this uh modern outlook this sort of uh really good introduction that kind of grabs the reader and then you swing back into history and sort of tell them more about the background and so i'd like to do the same here so we've started with psychedelic therapy and i'd like to swing to some historical context and then we'll swing back and return to where we started and to start with the history i think two people that i kind of go into quite some detail in the book kind of follow their lives and uh how that influenced their approaches to to mental health care so we have emma kriplin looking very relaxed and we have obviously sigmund freud looking very angry um and so emma kriplin probably less than known of the two um he is often known as the father of biological psychiatry so he set up a lab uh in munich tested sort of chemistry in people's bloods and microscopes and so this sort of the early stages of you know looking at uh the biological elements of of uh mental illness um freud famous for psychotherapy psychoanalysis but they actually started very similar in their careers so they were both anatomists in the late 19th century they were born in the same year but i actually don't i didn't find any evidence that they met and probably for good reason because it was quite clear that they didn't like each other so kriplin wrote about freud the tendency to generalization beyond measure from single observations is how he summarized his approach to science he didn't really think that he had a science uh freud and carl jung are nonsensical he liked to he just wrote very very succinctly freud then wrote not in response but just generally at one point in time cripeline belongs to the enemy camp the blackest clique of munich and so these two elements of biological psychiatry and psychotherapy were really sort of seen as they couldn't really be put together they were sort of at war with one another and this is kind of seen throughout 20th century and some of the stories that i kind of go through my book um but we also have to remember that people are complex and history isn't always that easy so freud he actually wrote about a year before he died this uh the future made teachers how to exercise by means of a particular chemical substance the amount of energy and its distribution in the apparatus of the mind it may be that there are there are others still undreamt of possibilities of therapy so he was kind of talking about some chemical that could revolutionize mental health care and this goes back to his days as a young man where he was obsessed with cocaine which is something i introduced at the start of the book he thought it could cure everything and he tried to uh well he used it he drank it he didn't you know snort it he he drank it in a sort of watery solution to sort of cure his own depression and his lack of interest in the world and his nerves as it was known then um but then he was blamed for you know causing a lot of addiction across europe as well so he kind of left that to one side and create psychoanalysis rather than being associated with uh cocaine addiction which probably could move um and then in the 1930s so i'd like to go through some biological psychiatry examples here so lobotomy here's walter freeman and his surgical sidekick uh james watts and they're looking very professional here um james watts was a very good surgeon walter freeman was uh less good at everything um and he you know damaged a lot of people's lives by thinking he could cut into their brains so kind of cutting cores out of their frontal cortex to to sort of cure them of of quite serious depressions um and by some measures of the day it worked because he was able to get people out of institutions he was able to kind of create people who are once suicidal would become very pliable and you know not and just sit around all day so by some measures he was seen as a success now we know that he did a lot of damage um and yeah so that's lobotomy and then shortly afterwards we have ect electroconvulsive therapy again with a very dark history it's been used to punish people it's been used for people who would never benefit from its effects but as i track through the book is actually one of the most effective treatments we have for very severe depressions often come with delusions and as we're all more familiar the antidepressants so these are the three major groups we have imipramine with this scary mask-like thing there that i don't know what that represents um nardil is a type of mio inhibitor and these have a fascinating history where this doctor in london was finding these reports of people having really severe headaches when they were on this drug and couldn't figure out you know why why these people were having these really horrible headaches and a few people were dying and long story short he actually found that um they were eating cheese and something in maturity specifically was reacting with these drugs and causing their blood pressure to blood pressure to skyrocket and they would burst an artery in the back of their head so and then we have prozac the ssris that sort of came about in the 1970s so these are the sort of biological psychiatry elements that we that we have and we also have psychotherapy now this photograph basically captures all of them um to some degree so cognitive behavioral therapy um as i write cognitive therapy and behavioral therapy actually didn't really like each other they thought that they were either copying one another or just inappropriate and useless and it's quite you know ironic that now we've put them together into cbt which is one of the most commonly used psychotherapies for depression interpersonal therapy as well looking at people's social environment you know who might be causing them trouble and the financial elements and poverty that's associated uh with with mental illness and so throughout the 20th century we have these sort of these two models of of how to approach people with depression and psychedelics they really um bring these two fields together uh in sort of this crash of bright colors and amazing vistas and this is a photograph from the ayahuasca trial so you can see there's some sort of elements of psychotherapy there you've got a comfy chair like freud used to use the shade's long you have the therapist sitting next to them and who's there for sort of psychological support and you also have the psychoactive drug that's given to the patient and also their brain activity is being measured at the same time so it's really a fusion of history in this one session um i'd like to go into a bit of history of how this actually this session room was actually created which involves talking about betty eisner so one of the few women in in psychedelic history and even today there are very few women working in this field and she uh in the 1950s she took lsd as part of a trial herself um and she developed a lot of what became the setting for modern psychedelic therapy so she used gramophone to play music she used a handheld mirror so people could look at themselves which a lot of people who have had experience with psychedelics uh will probably say don't do that because there's a thing called trip faith and also she used photographs from people's lives so they could kind of look at their family or the people they know and sort of maybe the psychedelics would allow the lsd would allow them to have a fresh perspective on on these people in these relationships and so she wrote um i found a montevarni record of classical selections it's good to start then chopin's first piano concerto is better than anything so i kind of write about her being this conductor of the session of this this room where she sort of took people on these journeys and used music to kind of harmonize the whole experience so it's very um really amazing sort of setting that she set up and we use a lot of that today with playlists that are created for psychological therapy people wear headphones um there are sort of candles and there's often i'm not sure there are photographs but there are things that people can interact with sort of like have a fresh perspective on um and she also as well as the setting she also came up with some of the terms or at least popularized some of the terms that we use today in in psych and psychedelic therapy so she wrote the main technique which is found effective for basic problems which presented themselves in symbolic terms such as raging fires the void dragons and vortex was to instruct the individual to move toward whatever appeared now this has been reduced thankfully to in and through which is something the imperial group use for if people come across a past trauma in these in these sessions which often happens don't back away from them you need to approach whatever your fears are and whatever comes through otherwise you know you won't get through them uh so this is really symbolic element to these to these sessions and one of the patients that i spoke to who was involved in the um earliest sort of 2015 trial of psilocybin he had been abused as a child by his father and he he saw his father there in this in this trip um and you know obviously it was terrifying but he moved towards him and he realized that he was skeletor who's obviously very scary but he's made of bones so you can just you know kick him apart and break him up and stuff and so it really sort of took away from the whole fear element of of what had happened to him uh so this is you know now part and parcel of psychedelic therapy and it started in the 1950s with betty eisner and her colleagues um moving on to the 1960s uh kind of took a turn for the worse so we have some problems that are published in the new england journal of medicine its title kind of gives it away lsd a dangerous drug and in this paper they wrote there is a dangerous toxic substance and on innocent aid like milk wheaties and orange juice has been pointed out on different occasions so one of the dangers that really came about was this enduring psychosis so people could have um psychotic episodes that were just part of the of the trip they would actually have enduring psychopsychotic episodes which could be treated with antipsychotics but it's not something that you'd um want to have when you're given given a drug and sydney cohen who i've quoted at the bottom there he was actually the supervisor of betty eisen where he tried to distance himself from her uh she had some ideas of um these visions that these drugs create being some sort of ancestral memory that we could all tap into and sydney cohen was a pharmacologist and he just thought that was you know nonsense uh and sort of separated himself from from betty is and also from himself uh earlier in 1961 he wrote that these drugs are incredibly safe and then he found reports of them being used in in the counter culture and actually causing some psychotic episodes as well as the case where a ten-year-old boy had uh eaten lsd that had been uh it's actually been soaked into uh sugar cubes and he had um yes like a psychotic episode that sort of lasted for quite a number of weeks so he wrote recently we have encountered an increasing number of untoward events in connection with lsd 25 administration so in 96 is this sort of like this pusher gets pushed back against uh these drugs and we know now that there is some risk towards you know uh psychosis with these drugs but people who have a family history of schizophrenia and bipolar are usually not uh advised to to take them and also if they're not included in any of the trials for risk for these exact risks um and these these concerns really had an impact on who was who were given the drugs so betty eisener was no longer allowed to use lsd in her sessions because it was limited to people who who were doctors who had a medical degree and she was a psychologist with a phd and so she was pretty uh disappointed and probably quite angry about that because she was really a pioneer of that time she wrote a letter to humphrey osmond who's a british doctor who worked in canada at the time he actually came up with the term psychedelic meaning mind manifesting uh so he's a big name in in the psychiatric history himself so she wrote it does get discouraging to run into the prejudice which judges more from the initials after one's name or one sex because i'm afraid this had some bearing too then by what the individual is and can do i get tired of carrying the torch and fighting the battle and it was about to get worse for for people who were interested in these drugs and the possibilities that might have for um understanding how the brain works and also mental health care because there was the uh the war on drugs oh sorry the wrong war on drugs there uh yeah so nixon you know in the late 60s he kind of banned lsd and psilocybin for any use is a schedule one drug um and so not not only psychologists but doctors weren't allowed to use it on human patients and so what happened to eisner um i think it can be described as a nosedive of a career so what started off quite promising um she moved on to other drugs such as ritalin and then ketamine and she created almost like a cult um in her group therapy sessions so from going from these single rooms where you'd have uh just one patient she kind of created um a commune of 40 to 50 people who she uh really sort of dominated um and thought that her being the top of this hierarchy was essential for their for their healing and she um yeah there are examples of where she would um ask patients to spit on her for however long it took to discharge some like past trauma or some uh some difficult relationships and then they'd wipe her face down with a towel as if that was sort of uh you know coming to terms with their problems um things became um quite sexual in her in her group therapy sessions and you know these weren't targeted at people for for uh who had mental illnesses but there were people who were posing as therapists and they were guides who were actually using similar methods and uh one of the things i'd like to kind of point out is how damaging that can be for people who do have trauma such as sexual abuse in their past um because there's recently been this sort of this news broke a few weeks ago where even in in modern mdma trials uh there's been a sexual abuse case where someone um has there's been a video posted of how how this woman megan was was treated during her mdma trial i'm not saying this is you know standard practice i'm just saying this is a hopefully an anomaly that we can kind of you know overcome and make sure it doesn't become part of of uh modern uh psychedelic uh therapy so she was um she was someone with a passive sexual abuse and her therapist um kind of was very um forward in how they kind of approached her therapy session they got into bed with her they lay on top of her they at one point put some um fabric in her mouth as if to like gag her um and she's someone with you know some pretty um destructive and painful traumas and they asked her at one point to open up her legs um which caused some real sort of um problems for her and the therapist actually had sexual relations with um her after the trial and it kind of makes you think about what consent is if we're on these drugs that are known to open you up to suggestion and sort of make you more uh malleable should we be you know having sexual relations with patients while they're still involved in the clinical trial um so these are things the dangers of psychedelics they might not be you know dangerous in terms of overdose it's very difficult to overdose on these drugs they might not be dangerous through addiction in fact they might be very effective in the treatment of addiction but the drug is just part of this treatment there's also the therapy and that needs to be rigorous and therapists need to understand you know how best to use these drugs to help people heal so that's one point i'd like to kind of make sure isn't part of of mental health care if these drugs do get accepted and while the therapists were doing their thing we have the the biochemists so this is uh dwight woolley in the 1950s um he kind of thought well serotonin looks a lot like lsd so these parts that are highlighted in bold here he kind of imagined them in his head because he was actually blind uh some people think that he could um see the the molecular structure in a different way to other people who who had sight and this allowed him to kind of make the comparison between serotonin and lsd on the right there harmine which is part of ayahuasca and as well as a psilocybin and dmt and so they all sort of look very similar to serotonin and he came up with this theory of anti-metabolites that these drugs whatever serotonin does in the brain in in uh going into receptor in in the brain um lsd blocks it it's like a key in the lock um and so he kind of thought that both schizophrenia and depression were caused by something going on with the serotonin receptors in the brain and either increasing or decreasing serotonin which is you know quite a modern take on on on mental illness it wasn't completely correct because we know that these drugs actually attach to this receptor and they don't just block serotonin they actually they're agonists of this receptor they activate it and so this is a 5h2a receptor so 5ht is a 5-hydroxytryptamine which is another way of saying serotonin so and if you block this receptor with other drugs and you give patients psilocybin or lsd they don't have a trip so everything that you experience under these drugs or everything they experience with their sort of mysticism and these amazing visions comes down to this one receptor in your brain um and this was this is franz von writer who who did this study in the late 90s and has done a lot of work since and yeah it's it's amazing to me that we can just stop the psychedelic experience with a single receptor being blocked in your brain and you can do this in mice as well and um there's a study recently here's a mouse um there's a study recently that showed if you block so do exactly the same experiment that we've done in humans and you give a mouse a psychedelic psilocybin in this case there's still some antidepressant effect there so the mouse and mice in these studies they um they were they went through a standard test that is a sort of simulation of what depression might be they're stressed for a few weeks before they're given these drugs and then they're tested to see if they go back to things that they once liked so in this case they're all male mice which is another problem in science because all mice are essentially male so we don't know much about female mice and how that relates to our own biology but so these mice uh were given uh sugary solution and uh female urine which they usually love and when they go through this stress this stress test uh they stop having any interest in this it's sort of like a part of the anhedonia that comes with depression you lose interest in things that you once liked now if you give a mouse a drug that blocks the 5 ht 2a receptor and then you give them a psychedelic they still have an antidepressant effect they'll go back to their sugar solution they'll go back to their urine that they once liked so i'm not saying this is you know uh takes away anything from the mystical experience that these drugs can provide um i just think it's interesting to kind of think that maybe it's not the be-all and end-all of psychedelics that there might be more of a richer story here that we might be able to understand and actually create drugs or treatments that are more specific that can have a even more powerful antidepressant effect because one of the things with psychedelics is how are people going to be given them especially when you need two therapists usually in an inpatient setting for eight hours then you have all of the psychotherapy afterwards to integrate the experience and you know from my own personal experience i've struggled to get six sessions of cbt on the nhs so how are we going to provide people with with these trips and what i'm kind of concerned about is is this going to become especially when people take these drugs in a clinical setting are they going to become the the treatments for the rich and not it'll be just another disparity in mental health care um i'd like to finish by where i basically started and you know this is a institution of science but we should also appreciate that these drugs come from thousands of years of human history and whatever we show with brain scans and clinical trials still doesn't really add up to this indigenous knowledge and draulio rauscho told me when i was you know talking to him about his own work in brazil it's like he doesn't like his work to be seen as a discovery it just seems that it's a translation from what was already known in indigenous populations into a new language and that language is language of science thanks for that um and thank you that's the end i'll leave you with this thought here thank you [Applause] you

Channel: The Royal Institution

Views: 39,118

Keywords: Ri, Royal Institution, royal institute, psychedelic therapy, depression treatment, mental health, magic mushrooms, psychedelic drugs affect brain, psychedelic therapy session, depression treatment therapy

Id: HV1NuxDYPW8

Length: 56min 40sec (3400 seconds)

Published: Thu Jul 21 2022