The Ins and Outs of Psychedelic-Assisted Psychotherapy
Interest is growing in the potential of psychedelic-assisted psychotherapy to improve outcomes for individuals with difficult-to-treat mental health conditions, such as treatment resistant depression, PTSD, and bipolar disorder. Clinical trials are showing promising results using this approach and a growing number of clinics and therapeutic retreats are offering access to psychedelic medicine and experiences.
To learn more about psychedelic-assisted psychotherapy, the advantages it offers and some of the conditions it could help to treat, Technology Networks spoke with Dr Reid Robison, chief medical officer of Novamind, a mental health company specialized in psychedelic medicine.
Anna MacDonald (AM): What is driving interest in psychedelic-assisted psychotherapy?
Reid Robison (RR): Covid-19 made it a challenging year for our collective mental health and made the work we do at Novamind more urgent. For a number of reasons, there’s never been a better time to be in psychiatry and mental health, at the dawn of this new era as new compounds are coming down the pipeline. We’re working on the infrastructure now. We do in-office psychedelic sessions with therapy on a daily basis with these existing compounds such as ketamine and Spravato.
There is a growing body of evidence suggesting that psychedelic compounds hold strong therapeutic potential to catalyze and accelerate the healing process for a wide array of mental health conditions. Consequently, over the past several years we have witnessed a psychedelic renaissance.
AM: Can you discuss the principles of psychedelic-assisted psychotherapy and some of the conditions it could help to treat?
RR: Psychedelic-assisted psychotherapy generally consists of three components: a preparatory session, dosing session, and integration session. The preparatory session involves screening, consent, and discussion of treatment goals. Dosing begins with intention setting and ends with a brief processing of the experience. The integration session (ideally 1-2 days after dosing) allows individuals to explore their experience and discover insights and meaning that can be incorporated into day-to-day life.
In clinical trials, MDMA is showing remarkable promise for the treatment of PTSD. Psilocybin combined with therapeutic support has led to dramatic improvements in those suffering from treatment resistant depression. Ketamine is used off-label to treat a variety of conditions including major depressive disorder, PTSD, bipolar, OCD, suicidality and chronic pain.
Though theoretical mechanisms of action of psychedelic medicines are still being investigated, a growing body of research points towards the ways psychedelics might help individuals with mental health conditions alleviate symptoms that relate to serotonergic signaling. Additionally, psychedelics’ induction of desirable brain states might accelerate therapeutic processes in individuals with mental health struggles, particularly those who aren’t finding benefit from traditional modalities.
AM: What advantages could psychedelic-assisted psychotherapy offer over conventional psychotherapy and over purely pharmacological treatments using psychedelic compounds?
RR: Currently, over a million lives are lost globally each year to suicide. This is especially tragic because depression is treatable, even if the individual can’t see a way out at the time. About one in every eight Americans takes an antidepressant medication every day. But this hasn’t lowered our depression rates.
Antidepressants currently available don’t work that well for too many people, and modern life is just making things worse. We’re evolutionarily adapted for the stone age. However, we’re living out our lives in a sedentary, indoor, screen-addicted modern age. Combined with psychotherapy, psychedelics help facilitate the processing of emotions and memories, expanding awareness and leading to accelerated growth and change.
AM: Could you tell us more about some of the types of psychedelics currently being investigated? RR: As mentioned above, MDMA is currently being investigated and showing great promise for treating PTSD. Studies of psilocybin plus psychological support are similarly showing lasting benefits for those suffering from treatment-resistant depression, as well as those encountering end-of-life anxiety. There are a couple of studies investigating the efficacy of psychedelic-assisted psychotherapy for anorexia.
AM: What hurdles need to be overcome before access to psychedelic-assisted psychotherapy becomes widely available?
RR: The way I look at that is that these tools can be effective and even life-saving in certain conditions. The challenge is opening up access to the individuals who need it. Novamind is building clinics, therapeutic retreats and research sites to help bring psychedelic medicine into everyday healthcare. We have four full service mental health clinics across Utah and more on the horizon in various stages. We’ll be moving outside of Utah and beyond, but where I am now treats individuals and families with both traditional methods and new treatment modalities as they become available. We’ve guided and held space for over 5,000 ketamine journeys. When Spravato was approved by the FDA in the spring of 2019, we made the decision to adopt it. This is the first insurance-funded psychedelic medicine. We jumped in, but there were challenges. The billing codes didn’t exist yet, it was a heavy lift administratively. It’s just a new chapter of interventional psychedelic medicine.
We’ve given over 3000 doses since then. Compare that to the next highest clinic in Utah by volume, which has maybe given a dozen or two. We’ve seen over fifteen thousand people in the state last year. When MDMA is approved, when psilocybin is approved, we already have the prescribers, the therapy teams and the facilities in place to deliver these. We can also refer them to clinical trials in the meantime as an additional treatment option through Cedar Clinical Research.
AM: Can you tell us more about Novamind’s partnership with Merck and its significance? Are you able to provide any details about MK-1942, the compound being investigated in the trial?
RR: We're proud to partner with Merck and support its innovative neuroscience work to develop a potential new drug for treatment-resistant depression. Cedar Clinical Research has unique expertise conducting clinical trials and research studies in neuropsychiatry for a variety of sponsors. This exciting research opportunity with Merck exemplifies a growing pipeline of opportunities for us to provide contract research services to leading drug developers.
Dr Reid Robison was speaking to Anna MacDonald, science writer for Technology Networks.