How Will The Psychedelic Industry Affect SSRI Treatment In The U.S.?

7 min readMay 18, 2022

Antidepressant use in the United States has been steadily increasing since 2015. Doctors prescribed 20.5 million antidepressants between October and December 2020, compared with 19.3 million prescriptions during those same months the previous year.

According to a report from Evernorth, overall use of antidepressant medications increased 7.9 percent between 2019 and 2020. The mental health impact of the Covid pandemic and lockdowns has certainly played a role in this increase.

Antidepressants are one of the most frequently prescribed medications in the U.S. Looking at data gathered between 2015 and 2018, we can see that more than 13 percent of people aged 18 and older said they took an antidepressant in the last month.

The most common type of antidepressant medication are selective serotonin reuptake inhibitors (SSRIs). These drugs aim to treat depression by increasing levels of serotonin in the brain. They achieve this by blocking the absorption of this neurotransmitter by brain nerve cells (neurons). The result is that more serotonin than usual remains available in the synaptic space between neurons, so it can pass along further messages between the cells.

SSRIs include drugs like fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft).

Psychedelic therapy, however, tackles depression in a different way. This form of therapy features psychotherapeutic, pharmacological, and subjective aspects that make the results distinct from traditional SSRI treatment. The psychedelic industry is also growing rapidly, with laws surrounding these compounds becoming more relaxed.

The budding psychedelic industry will likely have an impact on SSRI treatment in the U.S. When psychedelics for medical use become legalized in more U.S. states, many people with depression may find they no longer need SSRIs. How this will play out, however, depends on several factors, which are worth exploring.

The Growth Of Psychedelic-Assisted Therapies In The U.S.

The main psychedelic-assisted therapy that has grown rapidly in the U.S. is ketamine-assisted therapy. (While ketamine is not considered a traditional psychedelic, it can induce psychedelic and mystical effects.)

Ketamine therapy has now become mainstream, with clinics distributed all over the country and more opening all the time.

For example, Field Trip Health says it aims to have 75 clinics in the U.S. by 2024. In 2015, there were fewer than 60 ketamine clinics. Just three years later, according to the journal Psychiatry and Clinical Neurosciences, there were more than 300.

What accounts for this rapid growth? Well, one key reason is the fact that ketamine is legal as an off-label treatment for depression. The drug has been used as an anesthetic for surgery and as a painkiller for over 50 years.

But doctors can legally prescribe it for depression, too.

There is also an impressive body of research showing its efficacy in treating major depression, treatment-resistant depression, and suicidality. This has, therefore, increased demand for the treatment, leading many clinics to pop up across the country, offering relief to those who are suffering.

Another reason for the more recent growth in ketamine clinics is that, in 2019, the Food and Drug Administration (FDA) approved esketamine (Spravato), a nasal spray form of ketamine, for treatment-resistant depression. While ketamine clinics tend to offer clients ketamine infusions, delivered intravenously, many now offer esketamine.

Clinics offering psychedelic-assisted therapy with other compounds are yet to appear. This is because other candidates, such as psilocybin, remain Schedule I drugs.

According to federal law, this means they have no recognized medical value and a high potential for abuse. The exception would be in Oregon, which in November 2020 became the first U.S. state to legalize psilocybin-assisted therapy.

More states will follow suit soon, allowing entrepreneurs and medical professionals to set up clinics offering people the psilocybin experience.

The Increase In Psychedelic Trials

The recent “psychedelic renaissance” has seen burgeoning research into the potential of psychedelics to treat conditions like:

At the start of this renaissance, it was typically institutions like Johns Hopkins University, NYU, and Imperial College London that were carrying out psychedelic trials. These institutions now have their own dedicated centers for psychedelic research and they have produced some of the most important studies on these compounds.

However, the growth of the psychedelic industry has seen companies in the space now getting involved in these types of trials. Companies carrying out studies on psilocybin and other psychedelic therapies include:

These companies have a strong financial backing, allowing them to have various clinical trials in the pipeline. Many of these trials involve the companies’ proprietary formulations of psychedelic compounds.

For example, Compass Pathways has its own formulation of synthetic psilocybin called COMP360.

Interestingly, MindMed has developed a proprietary, non-hallucinogenic molecule — named 18-MC — based on the psychedelic ibogaine. This would be used for the treatment of addiction.

There is growing interest in compounds that benefit the brain, as psychedelics do, but without giving users a psychedelic trip. Whether such compounds would be as effective remains to be seen.

But the benefits of a psychedelic minus the trip would be eliminating the possibility of a “bad trip”, lowering the risk of adverse effects on mental health, and doing away with the need for guided psychedelic sessions, which requires therapists and supervision from a medical team.

The Size Of The SSRI Industry In The U.S.

Based on the number of SSRI prescriptions given in the U.S., it is clear that the SSRI industry is huge. The market for antidepressant medications was worth $14.93 billion in 2020, and is predicted to be valued at $18.29 billion by 2027.

The increase in the percentage of people using antidepressants increased by 64 percent between 1999 and 2014. So, the SSRI industry is both highly lucrative and expanding.

How Psychedelics Would Impact The Need For SSRIs

While many people in the U.S. take SSRIs for depression, they don’t work for everyone. In these cases, the person’s depression is said to be treatment-resistant.

In addition, people with treatment-resistant depression may try several SSRIs, yet none offer remission from depression and the relief they need to feel well and function.

Even amongst people who do find SSRIs to be effective, there are downsides. These include a range of side effects, as well as withdrawal symptoms when stopping use. Also, some individuals may find the benefits to be minor.

SSRIs differ in their effectiveness, with some researchers saying there is little evidence they work better than placebo.

Taken together, these factors show that patients need more options for treating their depression. Psychedelic therapy could, for many such patients, be an effective alternative.

As well as offering relief from depression when other options fail, psychedelic therapy has the advantage of requiring only one or two sessions to enjoy relief from symptoms.

For example, as shown in the documentary Magic Medicine (2018), researchers from Imperial College London administered psilocybin to 20 patients with treatment-resistant depression. Patients received two doses: 10mg and 25mg.

Following the high dose, patients experienced benefits lasting up to five weeks. Now, while it is true that these effects tend to wane after six months, six patients in the study still experienced benefits at this point.

Considering that antidepressants need to be taken every day, the results of this trial are quite impressive. Robin Carhart-Harris, the lead researcher in the study, stated:

“Based on what we know from various brain imaging studies with psychedelics, as well as taking heed of what people say about their experiences, it may be that psychedelics do indeed ‘reset’ the brain networks associated with depression, effectively enabling them to be lifted from the depressed state.”

Psychedelic therapy, then, may provide some patients with more substantial relief from depression — as well as various other advantages — compared to SSRIs. If the benefits of psilocybin persist for months after only one or two doses, there may not be a need to take SSRIs anymore.

However, it should be underscored that many patients in these trials experience depression again and do go back on SSRIs. So psilocybin should not be thought of as a magic bullet.

What Would Legal Psychedelic Therapy Mean For Big Pharma

If psychedelic therapy becomes a popular option among patients with depression and other conditions, then Big Pharma could see a reduction in profits. After all, a lot of money is made when people take antidepressants every day.

In general, Big Pharma is sitting on the sidelines when it comes to psychedelic-based therapies. Nevertheless, interest from pharmaceutical companies is growing. After all, Spravato was developed by Johnson & Johnson.

Moreover, many of the big psychedelic companies are made up of people who have a background in the pharmaceutical industry. We are also starting to see large pharmaceutical corporations get involved in the psychedelic industry.

For example, Merck & Co., one of the largest pharmaceutical companies in the world, has teamed up with Novamind to develop a new drug for treatment-resistant depression.

The psychedelic industry was worth $4.75 billion in 2020, and is set to be valued at $10.75 billion by 2027. In light of these projections, pharmaceutical companies may lose out if they don’t enter the psychedelic space.

The psychedelic industry may not make SSRI treatment obsolete, but it will likely mean that many people on SSRIs — or those thinking of taking them — will opt for psychedelic-assisted therapy instead.

Since patients desperately need additional options to deal with mental health issues, combining a meaningful psychedelic experience with psychotherapy could be the solution that many are looking for.

Words by Sam Woolfe. Follow Sam on Twitter and Medium, or check out his personal website.