By Dr. Reid Robison, Chief Medical Officer
I had the good fortune of attending the Horizons Conference in NYC in December, one of the more scientifically rigorous (and longest running) psychedelic medicine conferences. With both MDMA and psilocybin moving through the drug development process and a steady stream of new and exciting developments from stakeholders in space, I’m convinced that the next couple of years will be pivotal for psychedelics. It’s inspiring to see the progress being made in this field.
Progress in MDMA research
I really appreciated the openness, transparency and thoughtfulness of MAPS and their update on the path toward MDMA approval for PTSD. After nearly two decades of tireless work led by Rick Doblin, including clinical trials, therapy training programs, and several high impact publications, the phase III MDMA study is well underway. After incredibly promising results from the first part of the phase III study (announced last year), MDMA-assisted psychotherapy is poised for approval by the FDA as a potential treatment for PTSD by the end of 2023. Equally exciting were the goals that MAPS shared of training 30,000 therapists by 2031 and treating 1 million people with PTSD by 2031.
Psilocybin for anorexia
It was great to get a sneak preview from Dr. Natalie Gukasyan about their preliminary impressions from the study for anorexia at Johns Hopkins. I often point out when I speak about eating disorders that anorexia nervosa has the highest mortality of any psychiatric illness, and there's an urgent need for new treatment options. Dr. Gukasyan noted that many individuals with anorexia experience lower-than-expected subjective effects of psilocybin. She mentioned that optimal psychedelic study design for anorexia may need more than the typical two or three dosing sessions that are written into most protocols. Not surprisingly, some individuals with anorexia may need more psychological support than is needed for other conditions—an important reminder that change takes time. These observations and ongoing studies are a great addition to our growing understanding of how psychedelics might help treat anorexia. More research to come.
Can we use psychedelics to reopen critical periods?
Another fascinating topic was Dr. Gul Dolen’s talk on psychedelics and metaplasticity. In their study, Dr. Dolen and her team set out to answer the question: “Can we use psychedelics to reopen critical periods?” A critical period—also called neuroplasticity—is a duration in which a person’s brain is more receptive to the influence of experience and external stimuli. And the answer, for both the classic psychedelics and other compounds like MDMA and ketamine, was not only fascinating, but has relevance for how we approach psychedelic therapy clinically. Different psychedelics vary dramatically in their acute subjective effects, and there’s evidence that the duration of these effects is proportional to the duration of therapeutic effects and the window of neuroplasticity.
For example, ibogaine's subjective effects last 26-72 hours, and ibogaine opens the social reward learning critical period (a period of increased brain plasticity, sensitivity to environmental stimuli, and adaptability) for >4 weeks. Compare this to other drugs, such as ketamine, and you can see a proportionality. Ketamine acts rapidly, but the effects don’t last as long. The acute subjective effects of ketamine last only .5-2 hours, and the social reward learning critical period is open for much shorter, at 48 hours. The critical period of psilocybin and MDMA is two weeks, and for LSD, it’s about three weeks.
"What I think we might have actually discovered is that psychedelics might be that master key for reopening critical periods." – Dr. Gul Dolen
As a final note, I’ll quote Dr. Matthew Johnson: "One of the reasons psychedelic therapy works so well is people are doing their own healing—there's nothing 'automatic' about it."
These drugs aren’t magic, fix-all solutions. They're powerful tools we can use to do deeper work and to become more aware of ourselves and the world we’re a part of. The process of psychedelic therapy and integration is difficult, but incredibly rewarding work that requires bravery and openness. There truly isn’t anything “automatic” or “easy” about it.
I’m extremely grateful for the contributions that have been made by so many in this field. We’ve come a long way, and I’m excited to see what we can accomplish going forward.