We’re Heading Into Pivotal Years for Psychedelics – Here’s Why

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

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Concluding thoughts

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.

How Ketamine Facilitates Healing

by Dr. Reid Robison, MD MBA

If you haven’t checked it out yet, I highly recommend Michael Pollan’s 2018 book How to Change Your Mind. It’s a deep dive into the history, research, and resurgence of psychedelics as a valid modality of psychiatric treatment.

In chapter 5, Pollan explores what brain imaging has been teaching us about the effect of psychedelics on the brain. One of the most notable findings is that psychedelics lessen the activity of a series of neurological pathways in the brain known as the Default Mode Network (DMN).

The DMN serves a multitude of functions in navigating our daily lives and plays a major role in how we define the self (our definition of who we are), very similar to what is often referred to as the “ego.”

The DMN is also often referred to by psychologists as “The great orchestrator of the brain.” Let’s explore how psychedelics, like ketamine, affect these DMN functions and discuss why these effects can facilitate healing.

Daydreaming
Where does the mind go when it is not occupied by an immediate task?

Individuals suffering from depression may default to ruminations or feelings of worthlessness. People suffering from substance abuse may default to thoughts of guilt or the urge to use. Those battling eating disorders may default to obsessions with control and relentless thoughts about body image. People suffering from anxiety may default to an unrelenting need to get things done and have everything perfect.

This list could go on and on. For individuals whose minds tend to wander to such places, psychedelic medicine may help. Ketamine and other psychedelic medications reduce the activity of the DMN, allowing the mind to daydream in a different way and form new pathways for the brain to use.

A psychedelic experience can act as welcome reprieve from the unrelenting negative thoughts that many battle every day. It allows for a chance to cognitively and emotionally interact with life in a new way, and see ourselves with a fresh perspective.

The Self
The way each of us defines ourselves is wildly complex. In our brains is the wiring for thousands and thousands of rules and definitions that make up our unique experience of self (who we are).

Embedded in our sense of self are the rules and defense mechanisms for how we deal with things like guilt, shame, grief, and trauma. Many of our defense mechanisms were written in our minds when we were very young and entirely without our awareness.

Defense mechanisms that may have protected us as children may now only serve to drive our negative self-image. In a psychedelic experience, as the DMN is dialed down, the overpowering definitions of self are softened. This allows us to see and possibly even define ourselves in a new way. The ruts and trenches of how we think about ourselves are filled in and new definitions of who we are materialize and are given a chance to flourish.

The Great Orchestrator
Our brains receive and process enormous amounts of information. As a child, this information is not filtered. Over time, however, our brains learn to create short cuts and filter out extraneous information through a process called specialization.

This process is seen in language acquisition and motor skill development, as well as an assortment of other skills essential to daily life. As a part of specialization, the DMN comes online and orchestrates the cognitive short cuts or filters that are essential to daily life.

The downside to this is that the cognitive short cuts and filters imposed by the DMN make it more difficult to see the forest from the trees, so to speak. If we are perpetually seeing ourselves or the world in a negative way, then turning down the DMN through the use of psychedelics may facilitate new insights into life and a reframing of a negative self-image into a more honest and kinder one.

Mental health problems steal peace away from us in a myriad of ways. One of the most powerful tools for combatting this is found in our perception. Many people with mental illness wish they could change their reality.

To one degree or another, we all have a list of “I could-be-if…” statements. The problem with these statements is that they often give our power away. The world is never going to be perfect, but there is more than enough joy in it to have a rich and fulfilling life regardless of circumstances.

I once heard a man in a Narcotics Anonymous meeting share that he felt addiction could be defined as the inability to accept life on life’s terms. I think this profound statement can be expanded beyond the world of addiction to the struggles of life faced by many.

Ketamine may be a viable tool that enables us to come to terms with the world as it is. By quieting the DMN and its rigid response to the world, ketamine facilitates seeing our world and the suffering in it in a new way.

Reid Robison

About the author

Reid Robison, MDA MBA is the Chief Medical Officer at Novamind. He is a board-certified psychiatrist who was named Best Psychiatrist in Utah by Salt Lake City Weekly’s Best of Utah Body & Mind 2020.

Dr. Robison is the co-founder of Cedar Psychiatry and serves as the Medical Director for the Center for Change, a leading Eating Disorder center. He was previously a coordinating investigator for the MAPS-sponsored MDMA-assisted psychotherapy study of eating disorders.

New Research Behind Ketamine’s Molecular Process

At Numinus, we’ve watched ketamine help our patients, and we’re witnessing it change the landscape of psychiatry for good. Compared to traditional medications, ketamine has rapid antidepressant effects, often evident within an hour. For people with treatment-resistant depression, ketamine has shown 50-70% response rates. And we know that here at Cedar. We’ve seen it.

Scientists are rushing to understand the molecular process that makes ketamine so fast-acting and effective. This new research from Sweden focuses on serotonin, which has long been implicated in depression. Researchers studied a specific serotonin binding site and found that after ketamine treatment, patients had an increase in serotonin 1b receptors. While this illuminates a particular aspect of the molecular mechanisms behind ketamine’s efficacy, the total process is still evolving. Concluding the study, the scientists called for more research to help us understand this powerfully therapeutic drug.

We know intimately the low clinical response rates and delayed onset of action of traditional antidepressants, and while they help for some, others need alternatives. That’s why new treatment options are vital. It’s why we stay up to date on current studies and host research of emerging neuropsychiatric treatments—it’s why our Principal Investigator and founder Reid Robison MD MBA has led over 100 clinical trials.

Call us anytime at 1-833-NUMINUS (686-4687), we’re here to help.