LSD, MDMA… how psychedelic drugs can treat psychiatric disorders

Will LSD, psilo­cybin – the main psy­cho­act­ive sub­stance found in hal­lu­cino­gen­ic mush­rooms – or MDMA soon become treat­ments for depres­sion, addic­tion, or obsess­ive-com­puls­ive dis­order? Psy­che­delics are a fam­ily of sub­stances that induce a state of altered con­scious­ness and per­cep­tion. These psy­cho­act­ive sub­stances act on the recept­ors for sero­ton­in, nick­named the “happy hor­mone”. Long demon­ised as dan­ger­ous, these drugs were the sub­ject of much research in the late 1940s. But their asso­ci­ation with the protest move­ments of the 1960s and 1970s led gov­ern­ments to ban them.

For sev­er­al years now, sci­entif­ic research has been tak­ing a closer look at the effects of LSD and psilo­cybin on men­tal ill­ness and addic­tion, and as a sup­port for patients at the end of their lives. Research and stud­ies are mul­tiply­ing. Psy­chi­at­rists have ana­lysed 25 stud­ies on the effect­ive­ness of LSD and psilo­cybin in psy­chi­atry, anxi­ety-depress­ive symp­toms, addict­ive dis­orders, and obsess­ive-com­puls­ive dis­order (OCD). Their con­clu­sion is clear: “Psy­che­delics are prom­ising ther­apies with rap­id and long-last­ing effic­acy, and their use appears to be gen­er­ally well-tol­er­ated”. Switzer­land, where LSD was syn­thes­ised in the 1930s, is a pion­eer in this approach. For the past three years, Pro­fess­or Daniele Zullino has been con­duct­ing psy­che­del­ic ther­apy (LSD and psilo­cybin) for patients suf­fer­ing from anxi­ety, addic­tion and/or depres­sion, at the Geneva Uni­ver­sity Hospitals.

Over the last twenty years or so, we have wit­nessed a “psy­che­del­ic renais­sance” in Switzer­land. Research had nev­er actu­ally stopped, des­pite the pro­hib­i­tion intro­duced by Pres­id­ent Nix­on in 1971. There have always been exper­i­ments with dif­fer­ent sub­stances, not­ably in Zurich and Basel. And it was in the early 2000s that two psy­chi­at­rists, Peter Gass­er and Peter Oehen, were giv­en author­isa­tion to use them as treat­ments, par­tic­u­larly for people at the end of their lives. Then, in 2014, the Fed­er­al Office of Pub­lic Health (FOPH) decided to author­ise excep­tion­al treat­ments for doc­tors who reques­ted them. Research is there­fore quite well developed, with around thirty doc­tors involved in recent years.

We treat Swiss patients who have been suf­fer­ing from depres­sion or anxi­ety dis­orders for years or even dec­ades, using a range of thera­peut­ic effects, both phar­ma­co­lo­gic­al and psy­cho­thera­peut­ic. These patients must already be under the care of ther­ap­ists but are exper­i­en­cing prob­lems with their usu­al treat­ment: this ther­apy should be a last resort, nev­er the first line of defence. More than half also come with an addic­tion prob­lem. So, these are patients for whom we hope that a moment of digress­ive think­ing, with new asso­ci­ations and the devel­op­ment of cer­tain cog­nit­ive schem­as, can kick-start the psy­cho­thera­peut­ic pro­cess. As such, it’s not phar­ma­co­ther­apy in the tra­di­tion­al sense of the term, but rather a treat­ment out­side the research pro­tocol: this is com­pas­sion­ate use.

Before the first ses­sion of LSD or psilo­cybin admin­is­tra­tion, we carry out sev­er­al assess­ment inter­views, enabling us to do a full psy­chi­at­ric invest­ig­a­tion and review the patient’s his­tory. Pre­par­at­ory ses­sions are then held to explain everything to the patient, show them around the premises and intro­duce them to the staff. We also assess the patient’s motiv­a­tions, treat­ment object­ives and expec­ted effects. On the day of treat­ment, patients arrive at 8.30 a.m. and under­go psy­cho­met­ric tests and a check of their vital signs. Thirty minutes after tak­ing the sub­stance, they go to bed in a room with a mask over their eyes and music in their ears. The psy­che­del­ic jour­ney then begins, last­ing around eight hours for psilo­cybin and twelve hours for LSD. The choice between the two sub­stances is largely left to the patient, depend­ing on the dur­a­tion of the effect and the price (CHF 130 for a stand­ard dose of 10 micro­grammes of LSD and CHF 440 for 25 mg of psilo­cybin). The effects are similar.

It’s a real innov­a­tion in psy­chi­atry, the likes of which has not been seen since the dis­cov­ery of antidepressants.

The next day, the patient returns for what is known as the integ­ra­tion ses­sion, where everything that has happened is reviewed. The patient writes down everything he or she has exper­i­enced as accur­ately as pos­sible. We dis­cuss how these exper­i­ences can be integ­rated into daily life and the psy­cho­thera­peut­ic approach. The inter­view is recor­ded, so that the patient can listen to it again alone and with his ther­ap­ist. Four weeks later, an amp­li­fic­a­tion inter­view takes place to take stock again and decide on a poten­tial new ses­sion. The treat­ment is admin­istered in one to three ses­sions – although some patients respond very well after just one or two ses­sions. How­ever, each ses­sion should ideally be spaced two to three months apart.

We have sci­entif­ic data to sup­port our approach for res­ist­ant depres­sion, for anxi­ety dis­orders linked to severe ill­nesses, for the treat­ment of alco­hol and tobacco addic­tion, and for OCD. What’s more, there have nev­er been any severe side-effects with LSD or psilo­cybin. And LSD and psilo­cybin are not addict­ive: this was made-up by Richard Nix­on’s admin­is­tra­tion in the 1970s. In order for these sub­stances to be placed on the list of nar­cot­ics, they had to be addict­ive and of no thera­peut­ic value. At the time, it was a polit­ic­al decision to com­bat protest groups linked to the Viet­nam War and the civil rights move­ment led by Afric­an-Amer­ic­ans. Oth­er­wise, oth­er sub­stances are of interest, such as DMT, the act­ive sub­stance in ayahuasca, but we don’t cur­rently have author­isa­tion to use them.

One of the most com­mon exper­i­ences that patients have is the appear­ance of cer­tain import­ant memor­ies that have been exper­i­enced in a trau­mat­ic way, but which are then put back into a new con­text, lead­ing to learn­ing sig­nals. Then, to treat OCD, pho­bi­as or claus­tro­pho­bia, we also use expos­ure: the patient is taken into a lift, and the pan­ic reac­tion does not occur because the atten­tion is focused on some­thing else. This situ­ation, which has been seen as highly anxi­ety-pro­vok­ing for years, is exper­i­enced in a com­pletely dif­fer­ent way, and a bene­fi­cial pro­cess begins.

The exper­i­ences with the most spec­tac­u­lar effects are the “chal­len­ging exper­i­ences”, i.e. dif­fi­cult exper­i­ences, memor­ies or emo­tions that resur­face in a par­tic­u­larly pain­ful way, with a cer­tain anxi­ety about facing them. These patients describe enorm­ous changes in the days that follow.

We haven’t ana­lysed all the data yet, but the impact is very pos­it­ive. After two ses­sions, half the patients are in remis­sion from their dis­orders, wheth­er addic­tion or depres­sion. Some people with dec­ades of treat­ment stop tak­ing anti­de­press­ants, patients suf­fer­ing from OCD see their symp­toms dis­ap­pear dir­ectly after one ses­sion, oth­ers treated for depres­sion come back a month later and have com­pletely stopped drink­ing and smoking without hav­ing made the decision to do so. Of course, in some cases, not much changes. But we are some­times sur­prised by the dra­mat­ic effect, and that’s very encouraging.

Research is devel­op­ing: the UK is quite act­ive, stud­ies are being car­ried out in Ger­many and pre-clin­ic­al research is tak­ing place in France, par­tic­u­larly in Ami­ens. There’s real enthu­si­asm. At con­fer­ences, psy­che­del­ic top­ics are being dis­cussed in front of packed audi­ences. This is some­thing new, because these are what we call dis­rupt­ive treat­ments – they’re not con­tinu­ous – some­thing we haven’t had until now. This is a real innov­a­tion in psy­chi­atry, the likes of which has not been seen since the early 1960s with the dis­cov­ery of anti­de­press­ants. Every­one is expect­ing a major revolution.

We’re likely to see an accel­er­a­tion in the devel­op­ment of these treat­ments, with the first psilo­cybin approvals in the United States expec­ted in one or two years’ time. There’s huge interest from start-ups: it’s going to have a snow­ball effect. In ten years’ time, it will be a well-estab­lished treat­ment, which will cer­tainly not make depres­sion or addic­tion dis­ap­pear, but which will take up a cer­tain place in the thera­peut­ic arsen­al. The big chal­lenge is to integ­rate it into cur­rent psy­cho­thera­peut­ic mod­els. But we’re at the very begin­ning of the pro­cess, because we can­’t start again from what was achieved in the 1960s: the sci­entif­ic meth­od­o­logy was­n’t the same. So, we need to see how we can com­bine psy­cho­thera­peut­ic tech­niques with the effect of these sub­stances to derive max­im­um benefit.

Interview by Sirine Azouaoui