Psychedelic medicine is everywhere these days from Forbes to Goodhousekeeping Magazine. Ever since Michael Pollan wrote “How to Change Your Mind” in 2018, I have been helping individuals in my practice and my personal life digest and entertain the notion that psychedelic drugs could be the future of mental health treatment. In the past year alone, we have seen Psilocybin go head to head with the standard of care antidepressant Citalopram in The New England Journal of Medicine. Published in the esteemed journal Nature Medicine, the breakthrough Phase 3 Clinical Trial data for MDMA (3,4-methylenedioxymethamphetamine) for severe PTSD practically guarantees that the FDA will approve it in the next few years. We are at a very interesting crossroads where “illicit drugs” are demonstrating their safety, efficacy and promise as medicines when given in therapeutic settings. Used for millennia by indigenous cultures for spiritual and physical ailments, there is no doubt that hallucinogenic medications have the potential to accelerate healing and transformation. This is very exciting and offers an alternative to the idea that mental illness comes from a broken brain that can only be “fixed” by adding the missing chemical. But are we ready?
There is already a lot of stigma, fear and misinformation in the universe of mental wellness and thus the intersection with “illicit” drugs is a perfect storm. Education will need to be the cornerstone of our efforts in the years to come to allow the convergence of wisdom from many different cultures, fields of expertise and experienced practitioners who have paved the way to provide individuals with access and understanding of these treatments. Centerstage is the concept of connecting the patient with their own inner healing intelligence. The patient is encouraged to develop a relationship not only with the provider who can provide their expertise and support but also with the medicine and themselves with the goal of self awareness and getting at the root cause of mental and emotional suffering. Embracing the new toolkit for healing– including powerful plant and synthetic medicines like Ketamine, Psilocybin, MDMA, 5-MEO DMT, Ibogaine, and LSD– and the new paradigm is going to require a shift in our medical model and more broadly in the realm of culture and politics and there are still so many questions. First and foremost, providers and patients need access to these medications, most of which are still illegal.
In a recent interview, Dr. Jerrold Rosenbaum, Massachusetts General Hospital’s (MGH) former psychiatrist in chief and Professor of Psychiatry at Harvard Medical School, who is heading MGH’s new center for psychedelic research and neuroscience commented:
“Some of these substances may have some brief cardiac stimulation, but otherwise, they’re remarkably safe and non-addicting.They (psychedelics) were banned, at least in part, because in some situations they were misused, but I don’t think the misuse is the full story as to why they were banned. An example of misuse was a government agency trying to see if they could brainwash people. There were political reasons for making them Schedule 1 and illegal.”
One of the biggest challenges in the field has been the legal status of these medications. The DEA’s Schedule 1 is defined as “drugs with no currently accepted medical use and a high potential for abuse.” The research that has been published over the last decade has solidly contradicted these notions. In the face of the data and the enormity of the mental health epidemic that we now face, the DEA will likely be forced to reconsider.
I became interested in psychedelic medicine after training in General Surgery at Weill Cornell Medical School and then in Psychiatry at Stanford School of Medicine. Working at the mind body interface is the next frontier. In my private practice, Helios Wellness, traditional evidenced based interventions are effective for a good percentage of individuals and I would not discount their utility even as we move forward. Especially when you combine both psychotherapy and medications, the research shows you are more likely to achieve wellness. However, despite this, many patients become stuck or only have a partial response. In 2015, I went searching for more tools to help these folks. Matching the medicine and the approach with the individual and where they are in their journey can be complex but it is critical to getting good outcomes. That’s when I found Ketamine Assisted Psychotherapy and added it to my toolkit.
Proving its effectiveness for refractory depression and PTSD in addition to many other diagnostic categories like anxiety, OCD, and Eating Disorders, Ketamine infusions and Ketamine Assisted Psychotherapy (KAP) has quickly gained traction in the field of psychiatry through an emerging body of peer reviewed studies as well as the clinical experience of many pioneering practitioners who have witnessed the potential of this medicine. Originally discovered as an anesthetic in the 1960’s, Ketamine has been used for sedation and pain but was then observed to have potent effects on depression in clinical settings. This led to research and off label use of racemic Ketamine in the treatment of depression and PTSD as well as the eventual FDA approval of Esketamine for depression in 2019. Like many of the other traditional psychedelics and even meditation, Ketamine works on the Default Mode Network (DMN) which has become a hot topic of discussion. The DMN is thought to be the part of your brain that encodes all the stories about the self that many call the center of the ego and the seat of “the monkey mind” as it is known in Buddhist teaching. Both the phenomenology and the neurochemistry are key. Ketamine can induce mystical experiences of ego dissolution or as I like to say“ego exfoliation.” It also has direct neuroplastic effects on the brain activating a whole host of neurotransmitters necessary for feeling good as well as having immunoregulatory effects on the body. This is precisely what we need when stuck in depression, anxiety, burnout and trauma. The ability to think and feel about ourselves and the world in a different way, in addition to the ability to make new connections. My colleague Rebecca Brachman PhD who conducted basic science research on Ketamine at Columbia University in 2016 demonstrated that Ketamine “can induce persistent stress resilience and, therefore, may be useful in protecting against stress-induced disorders” in animal models. When combining an agent like Ketamine with the right kind of therapy, the experience can be transformative. We are looking at the difference between entertaining the thought that deep down we are “good enough” and actually getting the opportunity to feel it for the first time.
Not only is Ketamine the only legal psychedelic medicine for the time being, it is also the only fast acting antidepressant that is available currently. Unlike treatments for anxiety or physical pain that can work rapidly, those suffering from depression and even suicidal thoughts have had to wait 4-6 weeks at least to start feeling relief with traditional interventions. Ketamine has been used in Emergency rooms to offer immediate relief for suicidal ideation. For many of the patients I have treated over the last 6 years, it has been life changing. Although Ketamine can be addictive, it has actually been used successfully to treat addiction to Alcohol, Cocaine and Heroin and when used in a therapeutic setting, this risk can be significantly mitigated. Like any intervention, Ketamine has risks and doesn’t work for everyone. But psychedelic medicine is certainly disrupting our notions of how to best treat psychic pain and suffering and maybe even helping us to understand a bit more about the nature of human consciousness.
Jennifer Dore, MD is a board certified psychiatrist specializing in psychodynamic psychotherapy and medication management for conditions such as depression, anxiety, bipolar disorder, ADHD and addiction. She currently serves on the board of the Ketamine Research Foundation. In 2014, Dr. Jennifer Dore founded Helios Psychiatry with a mission to serve the local Bay Area community and innovate across a broad spectrum of traditional and pioneering treatments, including Ketamine-Assisted Psychotherapy. Dr. Dore has worked with hundreds of patients and published numerous research papers including, most recently, a groundbreaking study into the effects of Ketamine-Assisted Psychotherapy published in the Journal of Psychoactive Drugs.
Learn more about Helios at her website: https://www.heliospsychiatry.com/our-team#JenniferDoreMD
Jennifer Dore MD, June 17, 2021
