46 | New Scientist | 4 June 2022S
WITCHED OFF”, “short-circuited”
and “shut down”. This is how three
participants described their depression
before they took part in a clinical trial for
psychedelic-assisted psychotherapy at
Imperial College London in 2016.
Their outlook changed dramatically after
taking a high dose of psilocybin, the active
ingredient in magic mushrooms. “I was a
ball of energy bouncing around the planet,”
one recounted in an interview with Rosalind
Watts, a clinical psychologist who led the trial.
Another described the experience as akin to
defragging a computer hard drive: “I visualised
as it was all put into order, a beautiful
experience with these gold blocks going
into black drawers that would illuminate.”
Such transformations are no longer
surprising. Similar trials have established
psychedelics as a game changer when it comes
to tackling the global mental health crisis.
“There’s a huge unmet need, and psychedelics
do have radical potential,” says Watts.
Now, some scientists are creating new drugs
that remove the psychedelic experience, or
“trip”, while still offering therapeutic benefits.
But Watts and others are warning that this
approach misunderstands how psychedelic
therapy works – and that if we try to squeeze
it into a pill-popping industrial healthcare
model, its vast promise may never be realised.
They aren’t just dishing out warnings,
though. Some of the pioneers of the field
are moving beyond the simple story that
psychedelics “reset the brain” by carefully
investigating the role of the psychedelicexperience, and the therapy that accompanies
it. The aim is to establish exactly what we can’t
lose if we are to make good on the hopes raised
by psychedelic medicine’s recent successes.
In psychedelic therapy, people are given a
high dose of psychedelics under the careful
guidance of therapists, bookended by therapy.
There is no doubt that it can be an effective
treatment. Over the past decade, researchers
have demonstrated that it can relieve various
mental illnesses in people who don’t respond
to existing treatments. Small-scale clinical
trials have found that one or two doses
of psilocybin, for instance, can alleviate
symptoms of major depressive disorder,
reduce anxiety in people with cancer, enable
people who are addicted to alcohol to abstain
and release those with obsessive-compulsive
disorder from their rigid habits. In November
2021, the biggest trial to date found that a single
dose of psilocybin relieved treatment-resistant
depression for three months in a quarter of
patients. These people had tried at least two
other treatments without success.
The results speak for themselves. But
clinical trials are far from the real world of
public healthcare systems. Billions of people
struggle with depression, anxiety and various
other mental health conditions. The big
question is: if psychedelics were to become
legal treatments, could you replicate this
experience for everyone who wants it?
For David Olson, a chemist at the University
of California, Davis, the answer is to create new
drugs that offer the transformative powers of
psychedelics without the experience. These JANEL
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Hallucinogenic substances like psilocybin can
help people with serious mental health problems,
but is the psychedelic experience entirely necessary?
Thomas Lewton reports
Features