I have been taking antidepressants every day for 14 years – by now the fifth medication. I have had behavioural therapy and several years of depth psychological treatment. And last week after the psilocybin treatment, my daughter said to me, ‘Mum, you can laugh again.’ That just made me cry – it was also something new, to have feelings again. Psychotherapy with psilocybin showed me that my life is not over. I can change.” (Testimony of a patient in the EPIsoDE study)
TEXT Henrik Jungaberle, Direktor der MIND Foundation
Magic mushrooms, LSD, ecstasy: Many people probably associate these substances with colourful swirls of colour and people who gaze at the stars or, conversely, experience a “bad trip”. Some doctors and psychotherapists feel the same way. In the German scientific community, psychedelic substances are often ridiculed or stigmatized as dangerous. Until recently, they seemed unlikely candidates for the treatment of mental illness. Classical psychedelics such as psilocybin (the active ingredient of so-called “magic mushrooms”) and LSD alter thinking, perception, and emotions, primarily by interfering with the signal transmission in the brain through the neurotransmitter serotonin. Ketamine, esketamine, and MDMA act via other mechanisms, but are often referred to as atypical psychedelics because of their similar effects.
Use in therapy in sight
What is exciting for science and the treatment of mental disorders, however, is that psychedelics have great therapeutic potential, can alleviate the symptoms of mental patients in the long term, and may also contribute to a positive change in the progression of the disease. However, we are not talking here about recreational use or self-medication at home, but rather controlled use in combination with psychotherapy. Psilocybin has already received “breakthrough therapy” status from the US Food and Drug Administration (FDA), as has the chemical compound MDMA, also known by the non-medical term “ecstasy”. That means their chances of approval are seen as particularly promising, which is why the agency is prioritizing them, thereby speeding up the bureaucracy. In a response to the May 2022 request from the US House of Representatives, the US government also indicated that it expects to approve psilocybin for the treatment of depression and MDMA for post-traumatic stress disorder within the next two years. In light of the “mental health crisis” identified by the World Health Organization, this would be welcome news.
Admittedly, this does not mean that all questions have been answered. We are still in the early stages of research, with advanced clinical trials just getting underway.
From stagnation to renaissance
The gaps in knowledge are due to a decades-long standstill in research. In fact, scientists began using psychedelics to treat mental illnesses in the mid-20th century, not to mention the thousands of years during which psychedelic substances were traditionally used in social, religious, and healing rituals. In the 1950s, LSD found its way into experimental psychiatry, spurring worldwide research into its potential applications, such as for depression and alcoholism.
Then came the rupture: led by the United States, the United Nations adopted the International Convention on Psychotropic Substances in 1971, banning psychedelics in almost every country in the world. The fear at the time was about the role of “drugs” in the youth movement, not their use on those who were ill. Nevertheless, the convention put a temporary end to research, and it has only been regaining momentum since the 2010s. Now, more than 30 universities and numerous companies around the world are working on psychedelic therapies.
Perhaps the most important current study in the field is the EPIsoDE study, which is financed by the German Federal Ministry of Education and Research (BMBF), with funding of nearly 2.4 million euros. Led by psychiatrist and psychopharmacologist Gerhard Gründer, 144 patients are being treated at the Central Institute of Mental Health in Mannheim and the Charité Hospital in Berlin. The study is testing the classic psychedelic psilocybin in short-term psychotherapy for treatment-resistant depression. The study started in June 2021 and the results will be available in 2023.
Research continues – many questions unanswered
As with antidepressants, which are used to treat millions of people today, the action mechanisms of psychedelics are complex and not yet fully understood. Unlike antidepressants, psychedelics are not administered daily, but only once or a few times. It’s something of a psychopharmacological sensation: How can sporadic intervention in a few signalling pathways of the brain trigger such profound and, in some patients, lasting changes in their severe symptoms? And how can these effects be stabilized? It is important that patients do not try psychedelics on their own. Rather, the point is to use the psychedelic sessions to open “therapeutic windows” in psychotherapy.
“For me, the two psilocybin sessions were quite simply salvation. For me, everything was actually over, I was only alive for appearances, had shut down and planned suicide if this therapy didn‘t work out either. For the first time since my youth, I was then able to open up to a person, to understand the love-hate relationship with my father, to put aside the pressure of my self-doubt, feelings of shame and guilt. I begin to plan a future again.” (Testimony from a patient in the EPIsoDE study)
Augmented Psychotherapy Training (APT): continuing education for tomorrow‘s experts
Our non-profit organization, the MIND Foundation, offers the first scientifically-based advanced training in psychedelic therapy for the medical profession and psychotherapists: the Augmented Psychotherapy Training (APT). We are training experts in the augmentation of psychotherapy, so that we can already help patients professionally, protect them from dubious people and misguided self-medication - and prepare psychiatric care for a future in which psychedelics are also part of the toolbox.
Facts help against fear
The fact that the method of “psychedelic augmentation” is still viewed with scepticism by the public and parts of the professional community is probably due to the stigma and various fears that have persisted for a long time. There is the issue of addiction, for example. In fact, this is very unlikely. The classic psychedelics such as psilocybin, LSD, and DMT have a miniscule addictive potential - especially compared to alcohol, opiates, and cannabis. US government-sponsored studies on the use of psilocybin in the treatment for tobacco addiction and alcohol use disorder at Johns Hopkins University suggest a future role for psilocybin in the treatment of substance use disorders. Accidents, abuse, and an unhealthy relationship with psychedelics are still possible. Patients at risk for psychosis must be consistently excluded, and for many people with complex personality disorders, there is currently no hope for a possible successful treatment with psychedelics.
And the “bad trip”? Some worry that they might have bad experiences during just one “therapeutic trip.” But here, too, research already offers important insights: The therapeutic environment supports using even unpleasant feelings during treatment to ultimately improve mental health.
From the therapeutic encounter with the existential
Moreover, the use of psychedelic substances is not exclusively about treating illness, but also about the question: what can help us live a good and healthy life? This concept is called “salutogenesis.” In the Netflix series “How to change your mind,” based on the book of the same name by Michael Pollan, this becomes clear: The experience with psychedelics not only ensures that certain complaints are alleviated. It also gives people new perspectives on life - often a lasting change in goals and values. So, it should probably be called “How to change your life.”
We are convinced that psychedelics represent an innovation in psychiatry and psychotherapy and will support a paradigm shift, away from the mere treatment of diseases and towards the strengthening of mental health. In this way, what was lost through a one-sided fixation on biological psychiatry will also return to medicine: the search for the right life through the therapeutic encounter with the existential.
Programme tips
5. NOV ab 11.00, OVID Praxis, in Person, Deutsch | Englisch
Von Kopf bis Fuß auf „drugs“ eingestellt – ein Angebot zum Schnuppern und Diskutieren
MIND Foundation
4. NOV 9.30, CAMPUS, hybrid, Englisch
Green Science! Green Medicine? How the Pharmaceutical Industry can Co-create a Sustainable NOW
NUVISAN
5. NOV ab 10.00, HU Berlin, in Person, Deutsch | Englisch
Die Augen als Fenster zur Sprache, Leibniz-Zentrum Allgemeine Sprachwissenschaft, University of Potsdam
Humboldt-Universität zu Berlin
9. NOV 17.00, Pastamadre, in Person, Englisch
Cooking for the Microbiome
Max-Delbrück Zentrum für Molekulare Medizin
10. NOV 18.30, Französische Botschaft, in Person, Deutsch | Französisch
Louis Pasteur / Robert Koch: Parallele Schicksale
Französische Botschaft
Dr. sc. hum. Henrik Jungaberle is director of the MIND Foundation and one of the two executive directors of OVID. He is a researcher, science entrepreneur and author. His main interests are public health, psychedelics, and psychotherapy. He researches integration and integrity in psychoactive substance use.
