By Nicholas P.W. Reeves, MD
One direction of intense interest currently is the potential of certain powerful psychoactive agents such as psilocybin or MDMA to act as catalysts for powerful transformational healing in conjunction with intensive psychotherapy. MDMA and psilocybin can be powerful catalysts for psychotherapeutic healing because they help to temporarily break the subjects’ brains out of the conditioned patterns of thinking and behavior that have perpetuated their symptoms, thus enabling psychotherapy to have markedly enhanced efficacy through breaking down barriers such as deeply entrenched psychic defense-mechanisms. Famous UC Berkeley journalist Michael Pollan recently released a great book on this topic called How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression and Transcendence.
At this point, there have been tremendously exciting positive results in clinical trials using MDMA as a catalyst to augment psychotherapy for patients with PTSD. MDMA helps break the sufferers’ brains out of the abnormal patterns of neural network activity (correlate of symptoms and psychic defenses) that were established through the powerful conditioning that occurred as a result of their traumatic experiences. There have also been incredibly fascinating results from studies using psilocybin-assisted therapy to treat end-of-life anxiety/depression, treatment-resistant depression, nicotine addiction and alcohol addiction. These therapies (unlike TMS, DBS, and ketamine) are not yet legal for community clinicians to perform, and they require further study of their efficacy and safety before the FDA will grant approval. Dr. Reeves has been following this line of research very closely for many years, and at least in the case of MDMA-assisted therapy for PTSD, it seems to be getting close to the point of potential FDA approval, as Phase 3 Clinical Trials are just now beginning and the FDA has granted MDMA-assisted therapy its coveted “Breakthrough Therapy” designation.
There are currently ongoing psychedelic research studies in San Francisco and Marin, such as MDMA-assisted therapy for PTSD (UCSF) and for end-of-life anxiety/depression (Dr. Phil Wolfson in Marin), as well as psilocybin-assisted group therapy for depression related to the trauma of the 1980s AIDS epidemic in gay men (UCSF). Dr. Reeves is a close acquaintance of many of the psychiatrist-scientists conducting these studies, so please feel free to call him if you think your patient might benefit from referral to any of the mentioned clinical trials.
In summary, the field of psychiatry is undergoing exhilarating changes that are inspired by the principles of neuroscience, and several dramatically efficacious and neuroscience-informed treatments are emerging that may radically change the way psychiatry is practiced in the second half of the 21st century. There has never been a more fascinating time to be a scientifically savvy (read: nerdy) psychiatrist, and each successive generation of new psychiatrists will be able to truthfully say the same thing.