The Current State of Psychedelic Medicine: Psilocybin and MDMA
It was a pleasure to be on Keith Fiveson’s Mindfulness Experience Podcast (listen HERE), where I discussed my experience at the recent Microdose Wonderland Psychedelics Conference in Miami. The conference was fascinating and provided an excellent overview of the medical, legal, and cultural issues surrounding psychedelic medicine today.
As psychedelic medicine becomes increasingly prevalent in my patients’ and clients’ mental health work and personal journeys, integration of this important work has become a large part of the therapy and coaching work I now do. I see psychedelics as standing at the interface of mind, body, and spirit. On the one hand, they offer a novel neurobiological mechanism to treat depression, anxiety, PTSD, OCD, and addiction. And, on the other hand, they offer an expansion of consciousness or perspective – which some may experience as a spiritual awakening – that enables people to see their world and therefore their symptoms with fresh eyes. As a psychiatrist and executive coach, I am asked about psychedelics by patients and clients on a regular basis, so I wanted to share some of what I learned at the Wonderland Psychedelics Conference here.
Paul Stamets, one of the world’s leading mycologist and psilocybin researchers, discussed a recent study on which he was a co-author where the administration of 25 – 40mg of psilocybin (a relatively high dose) resulted in decreased intimate partner violence and a reduction in heavy drinking days – elucidating the potential of this powerful medicine to reduce violence, crime, and addictive behaviors.
Paul Stamets also discussed one of the largest studies of psilocybin microdosing to date conducted by the organization Quantified Citizen using a self-report questionnaire on www.microdose.me. This study asked volunteers who microdose about their microdosing habits: How much psilocybin do they use? How often do they use it? Do they use it alone or “stacked” (i.e., with other substances, like chocolate/cocoa, niacin, and/or with another type of mushroom formulation called lion’s mane)? And what psychological and behavioral effects do they observe from their microdosing? This study also collected data from an equal number of volunteers who did not microdose to use as a control group. The results showed that people who microdose exhibited improvements in symptoms of anxiety and depression, as well as in their psychomotor skills (as measured by how many times they can tap their fingers together in one minute).
Perhaps the most important finding was that when people “stacked” their microdosed psilocybin with a low dose of niacin (which increases vascular blood flow, while psilocybin decreases it) together with the mushroom compound lion’s mane (which has been shown to improve cognition in prior studies), the positive effects of microdosing on anxiety, depression and psychomotor skills increase exponentially beyond the benefits of microdosing psilocybin alone. The mechanism through which this effect takes place likely involves increased BDNF (a nerve growth factor) and reduced inflammation, leading to enhanced neurogenesis (new neuronal growth in the brain).
According to Paul Stamets, it’s important not to microdose with psilocybin daily, but rather to take it for a few days (3-5/week) and then take at least 2 days off (this is the Stamets’ protocol) or take it for one day on and two days off (the Fadiman protocol). After doing the above protocols for about a month, it’s good to take 2-4 weeks off. These are recommendations from the experts in the field and are not yet supported by scientific data – but the research studies to confirm optimal microdosing protocols are in process. The personal, non-commercial use of psilocybin has just been legalized in Colorado, and it is likely other states will soon follow suit.
Dr. Rick Doblin spoke at this conference on the legalization process of using MDMA, or Ecstasy, in the treatment of PTSD. As of Nov. 1, 2022, the second Phase 3 trial of MAPS has been completed, showing that three MDMA treatments resulted in significant improvements for individuals suffering from PTSD: 32% of study participants were free of PTSD symptoms at 2-month follow-up; 21% showed significant clinical improvement in their PTSD symptoms; and, unfortunately, but not surprisingly, 12% were non-responders. The PTSD improvement observed with MDMA use was generally durable, meaning it held up at 7 years of follow-up in many (but not all) of the participants. The first Phase 3 trial results were published in Nature Medicine, May 2021. Science magazine called this research one of the top 10 breakthroughs of the year!
In contrast to traditional drug treatments for PTSD, which often require daily long-term use and do not result in full remission, the MAPS protocol involved 3 eight-hour MDMA treatment sessions with a trained therapist. Importantly, the MAPS study did not exclude the sickest individuals (i.e., people who are actively suicidal or who have had prior suicide attempts) as so many PTSD studies do. Per Dr. Doblin, there were no suicides in the MDMA groups in either of the Phase 3 trials, which is very promising, showing that this medication is safe and effective to use with this population.
While PTSD is the first indication for which MDMA will hopefully obtain FDA-approval in the second quarter of 2024, it’s possible that down the road this powerful “heart-opening” medicine that increases feelings of empathy and connection could be used for the resolution of humanitarian conflicts around the world. Dr. Rick Doblin discussed his powerful vision of MDMA helping us get closer to a world of “Net Zero Trauma.” Let’s hope we can indeed move in this very direction!