How psychedelic drugs are tackling mental illness

AT ANY given time, there’s a mere handful of people truly tapped into the Zeitgeist.

In music right now, it’s Kendrick Lamar; in fashion, Virgil Abloh; in film, it’s Dwayne Johnson. You can add author Michael Pollan to the list.

His 2006 book The Omnivore’s Dilemma was part of a seismic shift in which readers and eaters began questioning where their food came from, how it was produced and who was screwed over along the way (the farmers, the animals, the planet) in order to get it to your plate. By the time the 10th anniversary edition was released, it had sold more than two million copies. But this year, he shifted his focus from the stomach to brain with How to Change Your Mind — The New Science of Psychedelics and cemented his rep as a writer at the very edge of public consciousness. The starting point was the concept of microdosing — a red-hot trend in Silicon Valley and beyond — where the most lateral of thinkers are taking small amounts of LSD, which generate “subperceptual” effects that can improve mood, productivity and creativity. A smart drug for smart people, if you believe the hype.

Pollan characteristically built on this by replacing the microdosing with macrodosing. By which we mean he took drugs. Many, many drugs. In quantities that make people, according to The New York Times, “feel the colours and smell the sounds”. Whether or not he knew it at the time, he ever so slightly wedged open the doors of perception when it came to psychedelic drugs and their potential benefits.

In so doing, he has tapped into a burgeoning movement in which primarily recreational drugs, such as LSD, mushrooms, marijuana, ketamine and MDMA, are showing glimpses of clinical promise where conventional medications are not. It’s in the field of mental health that the results are most apparent. Which is just as well because for all the increasing openness we have about discussing this scourge, the numbers are not decreasing.

Quite the opposite.

In April this year, mental-health technology group Medibio polled 3500 Australian workers from 41 organisations across a range of industries and found that 36 per cent had depression and 33 per cent had anxiety. In contrast, the 2007 stats list anxiety at 14 per cent and depression at six per cent.

A part of this leap is undoubtedly down to the fact that people are more comfortable discussing these issues and seeking help. That’s a very good thing. However, it’s equally clear that the current approach of counselling combined with the most common medications — selective serotonin reuptake inhibitors (SSRIs) such as Lexapro — doesn’t work for everybody. Nothing does and nothing ever will, but in labs around the world, the go-to party drugs for everyone from bush-doofers to EDM aficionados are throwing up results that are beginning to overshadow their tarnished reputations.

One of these is MDMA, which was invented in 1912 by a German pharmaceutical company to help medications that control bleeding. It first entered the dance party scene in the mid-’80s and quickly became as much a part of these events as tolerating Armand Van Helden, gurning wildly and finding conversations with complete strangers to be fascinating. Manufactured under dubious circumstances at best, there are clearly risks involved with recreational use. But transfer the setting from club to clinic and a different picture emerges. Especially as a potential treatment for people with post-traumatic stress disorder (PTSD).

In a study conducted by the Multidisciplinary Association for Psychedelic Studies in the United States, 56 per cent of 107 subjects no longer qualified for PTSD after treatment with MDMA-assisted psychotherapy, measured two months following treatment. At the 12-month follow-up, 68 per cent no longer had PTSD. “Most subjects received just two to three sessions of MDMA-assisted psychotherapy. All participants had chronic, treatment-resistant PTSD, and had suffered from PTSD for an average of 17.8 years,” MAPS director of strategic communications Brad Burge says.

A separate study conducted this year by the Medical University of South Carolina on an admittedly small group of 26 first responders and military personnel concluded: “Active doses (75mg and 125mg) of MDMA with adjunctive psychotherapy in a controlled setting were effective and well-tolerated in reducing PTSD symptoms.”

There’s a bit to unpack in these qualified conclusions, most notably the terms “with adjunctive psychotherapy” and “controlled setting”. “It’s important to keep in mind that MDMA will not be a take-home drug,” Burge says. “MDMA-assisted psychotherapy is a supervised treatment — it happens in a clinic or therapist’s office, with a medical review and therapeutic supervision. This is not ‘take two and call me in the morning’. Patients would never get a prescription for MDMA to fill themselves at the local pharmacy. Unlike all other medications for PTSD, with MDMA-assisted psychotherapy, patients only take the drug two or three times over a 10-week course of psychotherapy — and research suggests that the benefits last.”

He adds that though the drug has side effects such as possible anxiety, lack of appetite, increased body temperature and nausea for the four to six hours it’s in your system, Burge says, “They are not as extreme or long-lasting as SSRIs”, which millions of Australians take daily.

“Also, nobody in the completed trials reported dependence or continued use of MDMA after participation in the trial,” Burge says.

MDMA’s benefits are, according to Burge, not restricted to the treatment of PTSD. “It has also shown promise in early research as an adjunct for psychotherapy for anxiety associated with life-threatening illness and social anxiety in autistic adults. It is now (also) being studied in alcoholism treatment as well as cognitive-behavioural conjoint therapy (aka couples therapy).” At the very least, he expects it to be approved by the US Food and Drug Administration for PTSD therapy by 2021.

Closer to home, Dr Gillinder Bedi, a senior research fellow at both The University of Melbourne and Orygen, The National Centre of Excellence in Youth Mental Health, advocates a cautious approach in the MDMA-as-therapy debate. “The slow progression of MDMA-assisted psychotherapy from the subcultural margins towards approval has been driven by the belief of those advocating for it,” she says. “Without this motivated community, MDMA would likely not have been developed as a medication. The downside of this robust advocacy base is that it can lead to rather extreme claims, such as being labelled ‘penicillin for the soul’. In addition to well-designed studies that control for experimenter bias, there is a need for researchers and clinicians outside the MDMA-advocacy community to be involved in the ongoing development of this research direction.”

Clearly there are more questions than answers right now, many of them practical. “For instance, should prescribing be limited to physicians with specific qualifications?” asks Bedi. “What training should be required for those conducting the psychotherapy? How should the drug be handled and stored by pharmacists? This suggests a need for stringent training and oversight of MDMA-assisted therapy.”

Then, there’s the proven human factor where not everyone will play by the narcotic rules. Case in point: Modafinil. A report by the University of Melbourne’s Brain, Mind and Markets Laboratory found that the anti-narcolepsy drug was the go-to helper for certain finance professionals and students who want to maintain their focus during long hours in the library or plundering the markets. Some is sourced online. Some comes from Australian doctors in a trend known as off-label prescribing. And if Modafinil — known as “Viagra for the mind” — is in demand, wait until your local GP has pure Molly at his or her disposal.

“Approval of MDMA will lead to off-label prescribing, with doctors prescribing the drug for conditions other than PTSD,” Bedi says. “This could include a range of conditions, such as depression and substance-use disorders.”

This is just one of myriad red flags. Burge says MDMA’s therapeutic acceptance has been hamstrung by several additional factors. “Recreational use and abuse has been one source of the stigma, but an even greater cause of the stigma has been the misinformation, bad science, and political posturing that policymakers have engaged in for decades,” she says.