Magic Medicine
Psilocybin — the compound found in so-called ‘magic’ mushrooms — is looking so promising as a treatment for depression and addiction, that some researchers are calling it a “breakthrough” medical technology, and comparing it to the discovery of penicillin as an antibiotic almost a century ago. It could replace conventional antidepressants in the UK, USA, and Australia within five years, according to researchers in the field. This may pave the way for the medical use of psilocybin mushrooms here in South Africa, even though they remain illegal, writes Leonie Joubert.
Depression can be fatal. American novelist David Foster Wallace was one of its victims. He died of depression in September 2008.
A few years before that, he wrote something that might help us understand why someone would choose to take their life. He said that a depressed person doesn’t choose this end because they find death suddenly appealing. Someone ends their life, he wrote, in “the same way a trapped person will eventually jump from the window of a burning high-rise”. The terror of falling from a great height is easier to face than the terror of the fire’s flames.
But psilocybin, the active compound found in certain psychedelic mushroom species, is making a comeback in the field of depression treatment after nearly five decades of silence from the psychiatric community. Fast changes abroad in the political and cultural attitudes relating to the substance, which was made illegal by the United Nations in 1971, has leading medical schools at Johns Hopkins in the USA and Imperial College, London, estimating that psilocybin-assisted therapy could be mainstreamed alongside conventional therapies in the UK, USA, and Australia within fives years.
Psilocybin is still an illegal substance here in South Africa, meaning doctors and therapists can’t administer psilocybin-assisted therapy as a treatment. However Dr Mike West, a psychiatrist in private practice in Cape Town, argues that once psilocybin is licensed for medical use in another country in the world, doctors here could apply to the South African Health Products Regulatory Authority (SAHPRA, formerly the Medicines Control Council) under a Section 21 process, in order to use psilocybin as an ‘unregistered orthodox medicine’ alongside conventional treatments for depressions.
Other international developments hint at a changing zeitgeist around the use of psychedelics globally, both for medical purposes (the medicalisation route) or for people to be free to use them privately at home (the decriminalisation route, as is happening with cannabis in South Africa).
In May this year the US city of Denver voted to decriminalise psilocybin, followed a month later by Oakland, California. Now the US states of California and Oregon may also vote to end the prohibition of the substance which as far back as the 1940s was showing great promise as a medical treatment for depression, end-of-life anxiety, and alcohol dependence.
Changes are also coming at a Federal level in the USA, where the Food and Drug Administration (FDA) is fast-tracking the substance through regulatory processes after declaring it a “breakthrough medical technology” because early clinical trials show it to be more effective than “available therapy”. A leader in private psychedelic medical researcher, Rick Doblin from the Multidisciplinary Association of Psychedelic Studies (MAPS) predicts that psilocybin will be legal for medical prescription in the US within five years.
The same could be true for the United Kingdom. Dr Robin Carhart-Harris, one of the leading researchers in this field at Imperial College London, was quoted in the press recently, saying that psilocybin could “replace antidepressants in five years”. The Guardian reported recently that Australia might soon be the next country to medicalise psychedelics, with the first trials about to begin in Victoria, where St Vincents Hospital will use psilocybin to treat end-of-life anxiety in terminally ill patients.
After working in this field of medical research since 2000, Johns Hopkins University formally launched its Center for Psychedelic & Consciousness Research this September, while Imperial College London opened the Centre for Psychedelic Research earlier this year.
Meanwhile here in South Africa, a High Court bid that was due to start this November, which aimed to have psilocybin mushrooms decriminalised in much the way cannabis was last year. However, the court process has been delayed indefinitely due to changes in the legal team handling the case, according to Monica Cromhout, a Somerset West-based retiree behind the court bid. Cromhout has twice been charged with allegedly having in her possession dried psychedelic mushrooms. After her first arrest in 2014, Cromhout was given a stay of prosecution, pending the outcome of this High Court bid to decriminalise psilocybin.
Potted history of psychedelic-assisted therapy
Psilocybin is amongst a family of naturally occurring psychedelics that many traditional communities have been using for thousands of years, mostly for ceremonial and spiritual purposes. Psychedelics’ entry into the Western world came through the medical lab in the 1940s, when the psychiatric community, mostly in the United States, first started investigating their potential to help understand the nature of the mind. There were at least three decades of research using psychedelic-assisted therapy to treat conditions like depression, end-of-life anxiety, and alcoholism.
Bill Watson, one of the founders of Alcoholics Anonymous (AA) had such a positive experience with the lab-synthesised psychedelic known as “acid” or LSD (lysergic acid diethylamide, synthesised from the ergot fungus, a close relative of psilocybin mushrooms) which helped him with his own addiction, that he wanted this form of therapy used in the AA programme.
But then psychedelics escaped the lab, and made it into the recreational scene in the USA, where they became synonymous with the anti-war movement and hippie culture. The Nixon administration pressured the United Nations to declare psychedelics, including psilocybin, illicit substances under the 1971 UN Convention on Psychotropic Substances.
This shut down all the ongoing medical research, and drove psilocybin and other psychedelics into the underground, where small communities have carried on using them recreationally and therapeutically ever since, including here in South Africa.
There has been a resurgence of research in this field in the past two decades, though, with a number of internationally recognised medical research labs now running clinical trials under licence from their governments, including Johns Hopkins, New York University and University of California Los Angeles in the US, and Imperial College in the UK. Some of these clinical trials involve using psilocybin-assisted therapy for treating depression, end-of-life anxiety in cancer patients, and alcohol and nicotine dependence.
How psilocybin-assisted therapy (PAT) works
Unlike conventional anti-depressants like SSRIs which need to be taken daily for an extended period, psilocybin treatment involves occasional, supervised dosing sessions. The medical teams at universities like Johns Hopkins in the US, and Imperial College London, put participants through 12-week programmes. The first few weeks involve normal talk therapy to prepare patients for the dosing sessions. In the middle of the programme participants will have two four- to six-hour supervised psilocybin dosing sessions which bring on an intense psychedelic state in a carefully controlled, safe, supported environment. These sessions are then followed by several talk therapy sessions where patients process with the therapist what they experienced in the dosing sessions.
The clinical trials use laboratory synthesised psilocybin. The first dose amounts to the equivalent of about 2 grams of dried Psilocybe mushrooms per 70kg of body weight. The second dose amounts to about 4 grams of mushrooms, which gives a much more intense experience.
In the underground community here in South Africa, where many do shamanic-styled “journeys”, the dose is usually 5 grams of dried mushrooms.
One of the earlier trials by the Imperial College team, where a small group of people with treatment-resistant depression went through the 12-week programme, participants’ depression scores dropped immediately after the treatment, and most were still showing signs of relief up to three months after the last dosing session.
With the smoking cessation study done by the Johns Hopkins team, the psilocybin treatment looks like it is more effective for breaking the hold of nicotine than most current treatments.
What’s going on in the brain?
Two things are happening in the brain as a result of the psilocybin treatment, according to researchers, which might explain why people show positive mood and behaviour changes that last long after the substance has left the body. These benefits have been measured for many weeks, sometimes even months later.
The subjective experience during the session:
Unlike talk therapy, where a patient externalises their personal narrative and the therapist helps them test and possibly rewrite that narrative, psilocybin is a deeply internal process. The person is their own therapist. Many say it is like years therapy in one session; the insights gleaned during dosing sessions go from being intellectual knowledge, to somehow becoming imbued with meaning and emotion, and therefore become more real and help reshape a person’s personal narrative. Dr Matthew Johnson from Johns Hopkins gives a good overview of why this so-called “mystical experience” during a psilocybin session can bring about long term positive behaviour changes in this talk given at the Psychedelic Science Conference held in Oakland, California, in 2017.
Quietens the ruminating mind:
MRI brain scans done by the Imperial College team show that psilocybin operates on a part of the brain that’s associated with locked-in patterns of thinking. This kind of rumination is often associated with depression and many habitual behaviours.
Think of the mind as a snowy hill, Dr Mendel Kaelen from the Imperial College team says, describing how the substance works to “reboot” or “rewire” the brain away from unhelpful ruminative thought. Every time a person processes information, it’s like a sled running down that hill, which cuts deeper and deeper grooves into the snow. The more the brain reacts to triggering information, the deeper the grooves become, until the sled’s runners are so stuck in those grooves that it can’t respond any other way.
Kaelen describes a psilocybin session as being like putting a fresh powder of snow over the hill, allowing the sled to track a new path. Working on the plasticity of the brain, psilocybin seems to break those locked-in patterns of thinking and behaving.
Many of the participants of Johns Hopkins and Imperial Collage trials say that the conventional anti-depressants, like SSRIs, that they had previously tried seemed to only treat the symptoms of their depression. They said these medications often numbed them, or described the drugs as being like putting a plaster over a boil. A psilocybin dosing session, many said, seems to go directly to the cause of the pain, as if lancing the boil.
It seems to be this dual process of meaning-making during the psychedelic dosing session, and the plasticity of the brain’s neural response to the substance, that might explain why people going through these trials show lasting positive responses to the treatment.
Researchers warn, though, that psilocybin-assisted therapy is not a cure-all for all mood disorders, has to be administered in a supported context, and should not be used for people with psychosis or schizophrenia.
Clinical psychologist Margaret Ross from the Palliative Care and Psycho-Social Cancer Care unit at St Vincent’s Hospital Melbourne, is about to begin the first trials in Australia where her team will be using psilocybin to treat end-of-life anxiety in people with a terminal diagnosis. She compares the use of psilocybin for treating certain mental health conditions to that of radiation as treatment is for cancer: in the right circumstances, with the right person, it can cure cancer; but in the wrong circumstances and the wrong person, it can create cancer. The suggestion is that for most people, psychedelics are psychologically safe to use; for some, with certain psychiatric conditions, these substances may make the condition worse, hence the need for careful screening before administering the treatment.
Meanwhile a small but thriving underground community is practicing a more shamanic approach with psilocybin here in South Africa, regardless of the fact that it is still an illegal substance. They use it in private home settings, usually in small group contexts and with carefully structured ritual processes. They do so because they believe, to quote science writer Michael Pollan in his recent book How to change your mind: what the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence that this substance has so much potential that it shouldn’t just be used “for the treatment of sick people, but should be used for the betterment of well people, too”.
