If you haven’t yet had a conversation about psychedelics and mental health, get ready. Although many people still associate hallucinogenic drugs with Woodstock and raves, they’ve shown significant promise in treating certain mental health conditions—and in 2022, we can expect to see them taken more seriously than ever before.
The buzz around psychedelic-assisted therapy comes at a time when America is in the midst of a mental health crisis. The U.S. depression rate has tripled since the start of the COVID-19 pandemic, with nearly 33 percent of adults reporting depression symptoms, according to The Lancet Regional Health—Americas. Anxiety is on the rise as well, as are symptoms of post-traumatic stress disorder (PTSD)—particularly among health-care workers and COVID-19 survivors.
Traditionally, health-care providers have used a combination of pharmaceuticals and therapy to treat mental health conditions like above. SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed antidepressants, but studies find that commonly prescribed antidepressants don’t work or stop working for around 30 to 40 percent of people with depression.
What then? A growing number of experts consider psychedelic-assisted therapy to be a hopeful alternative. Studies on the effects of psychedelics on mental health started in the 1950s and showed early signs of promise until they were halted by President Richard Nixon amid increasing backlash against the hippie and anti-war movements of the ‘60s (both of which came to be associated with psychedelic drug use). Research in this field picked back up again in the 1990s, and there are now active clinical trials exploring therapeutic uses for several psychedelics. “I see [more discussion] of the role of psychedelics in treating mental health, where before there might not have been as much recognition,” says Natalie Lyla Ginsberg, global impact officer at the Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit research and educational organization for psychedelics founded in 1986.
One example of the growing interest in psychedelics for mental health treatment: Congresswoman Alexandra Ocasio-Cortez introduced an amendment to promote research into psychedelics’ medical benefits in July 2021. While it did not pass, it did show a change in favor—it was rejected in a 140 to 285 vote, compared to a push in 2019 that was defeated in a 91 to 331 vote. “Now I think we're just really seeing a huge shift of acceptance…even concretely, with the spread of ketamine therapy clinics,” says Ginsberg.
The push for research like this, along with an increase in pop culture references to psychedelic use—it’s made recent appearances on TV shows like The Bold Type (where the series’ main characters microdosed psilocybin) and 9 Perfect Strangers—is leading to a shift in collective acceptance and curiosity, not just among certain mental health professionals, but patients as well. “Because the studies are moving to the mainstream, [someone] who's not a Burning-Man-type is maybe going to look at these treatments,” says Mike Dow, PsyD, a therapist at Field Trip Health, a company founded in 2019 that runs five ketamine-assisted psychotherapy clinics, two of which opened in late 2021.
The push for research along with an increase in pop culture references to psychedelic use—it’s made recent appearances on TV shows like The Bold Type and 9 Perfect Strangers—is leading to a shift in collective acceptance and curiosity, not just among certain mental health professionals, but patients as well.
Currently, ketamine, which can be prescribed by a doctor, is the only psychedelic legally available to mental-health patients who aren’t involved in clinical trials. This lab-created, consciousness-altering substance got its start as an FDA-approved anesthetic in the 1970s, eventually making its way to the club scene where it was known as “special K” or “vitamin K” (and, regrettably, often used as a date-rape drug). In the late ‘90s, ketamine was named a schedule III controlled substance in the U.S.—the same category as anabolic steroids and Tylenol with codeine—but soon after, studies started to show its promise as a treatment for severe depression.
Today, buoyed by this research, ketamine-assisted therapy is being offered by a growing number of providers around the U.S., including Field Trip Health and Nue Life, which offers ketamine-assisted therapy via telemedicine and has an interactive companion app.
“What the research is showing is that many people who suffer from depression, anxiety, and PTSD have a sort of negative loop in their brain,” says Nue Life founder Juan Pablo Cappello. “[What] ketamine does—and other medicines, but unfortunately many of which are not yet legal—[is] they allow you to find new patterns of thinking and new ways to frame prior trauma and prior experiences.”
Psilocybin, the psychoactive ingredient in psychedelic mushrooms, is another substance that’s being considered for use as a mental health treatment. In 2019, Denver and Oakland, California, became the first cities to effectively decriminalize psilocybin, followed shortly by Santa Cruz, California, in 2020; Washington, D.C. in early 2021; then Seattle, Ann Arbor, Michigan, and Detroit in late 2021. Oregon was the first state to do the same, in 2020, and also to vote to legalize psilocybin for therapeutic use in supervised settings—patients are expected to have access to it in 2023.
As for more widespread legalization, “The psychedelic activists are following the same model [as cannabis legalization],” psychedelic legal consultant Noah Potter told Rolling Stone in February. And with cannabis as the example, we can expect progress towards federal legalization of psilocybin and other psychedelics to be slow-going and for initiatives to instead continue at the state and city level. “Why are you going to bang your head against the wall federally when you can start by dealing with your own local government?” Potter said.
Researchers agree that more studies are needed to draw conclusions around psilocybin’s effectiveness as a mental health treatment, but preliminary research shows promise. In April 2021, the New England Journal of Medicine published a small double-blind study with 59 participants looking at the benefits of treating depression with psilocybin. It found that while psilocybin didn’t necessarily prove superior in treating depression when compared to escitalopram (an SSRI commonly sold under the brand name Lexapro), it resulted in fewer self-reported side effects.
Even MDMA—aka Molly or Ecstacy—is being studied for its effects on mental health. In May 2021, the journal Nature Medicine published the results of a clinical trial with 131 enrolled participants that found that patients with severe PTSD who were treated with MDMA in conjunction with therapy had a significant improvement in symptoms. In fact, many experts think MDMA usage for PTSD will be FDA-approved by 2023. What’s more, advocates think this sort of governmental stamp of approval will be the watershed for federal legalization of psychedelics. “We think that once there is a body of data that is sponsored by the federal government that proves without a shadow of a doubt that there is a therapeutic application, that these are real medicines, that’s when things are really going to change in congress,” Melissa Lavasani, founder of the Plant Medicine Coalition, told Rolling Stone in the aforementioned article.
So what else does the future hold for psychedelics? For one thing, taking psychedelics could one day be the same as taking an everyday pill prescribed by your doctor. Aphrodite Health launched in June 2021 with plans to release a low-dose, FDA-approved psychedelic medicine for hormone-related mood disorders. Field Trip, meanwhile, is in the preliminary stages of developing a psilocybin-like molecule for therapeutic settings that delivers a short-term, two-to-four hour psychedelic experience—half the duration of a traditional psilocybin trip.
Researchers are also looking at new therapeutic use cases for psychedelics. End Well, a nonprofit known for large-scale public events focused on ideas and innovations around death, serious illness, and grief, talked about the future of psychedelics and end-of-life issues at a late 2021 event. Their thesis: Psychedelics have the potential to reduce fear and suffering in the face of death, in a way unlike that of any existing medication. Psychedelics also have the potential to help heal intergenerational and intersectional trauma as well as facilitate conflict resolution, says Ginsberg of MAPS. “We're very curious to use research to explore how psychedelics can assist in having the difficult conversations and dialogues that we see [some] communities really struggling [to have] right now,” she says.
It’s important to note that psychedelic-assisted therapy is likely to be accessible to only a privileged few at first. It’s currently expensive—a one-month “subscription” to Nue Life costs $1,250 while an introductory treatment session at Field Trip is $750—and experts say it’s not likely to be covered by health insurance anytime soon. Plus, psychedelic experiences generally last hours at a time, making them inaccessible to people who can’t afford to take a full day off from work or parenting duties.
"We have this real disconnect where a more affluent investor community is making tremendous progress...in terms of getting these therapies approved and embraced by the government, [and] on the other hand, that same government continues to wage this very unfair war on people of color and the urban poor.” Juan Pablo Cappello, founder of Nue Life
Then, there’s the matter of cultural appropriation. Organizations entering the therapeutic psychedelic space—particularly those who stand to profit from it—should be mindful of the Indigenous communities that have used natural psychedelic substances for ceremonies and medicine for centuries, including psilocybin, which has roots in Aztec and Mayan culture. (Aztec users called the psychedelic mushrooms teonanácatl, which means "flesh of the gods.”) “When you look at legalization in cannabis, Prop 64 in California was not inclusive of the Indigenous community. They can have weed on their reservation, they have sovereignty, but they can't participate in [intrastate] commerce,” says Danniel Swatosh, co-founder of Humble Bloom, a cannabis- and plant-medicine-focused immersive education and advocacy platform.
And just as the legalization of cannabis has led to social equity programs for those once convicted of marijuana-related felonies, there will likely be a call for psychedelic wellness providers to consider the ethics of the development of these programs alongside the continued incarceration of psychedelic drug users. “We have this real disconnect where a more affluent investor community is making tremendous progress with regulatory entities, in terms of getting these therapies approved and embraced by the government, [and] on the other hand, that same government continues to wage this very unfair war on people of color and the urban poor,” says Cappello, who emphasizes that accessibility and destigmatization of psychedelic therapies are at the heart of Nue Life.
But despite the high cost and potential controversy around psychedelic-assisted psychotherapy, those involved in the field insist that it will eventually become a legal, accessible, and mainstream form of self care. “[Field Trip founder Ronan Levy] said once that psychedelic-assisted psychotherapy will be [as common as] your twice-yearly appointment to get your teeth cleaned,” says Dr. Dow. “This is mental hygiene.”
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