The healing power of psychedelic compounds as spiritual tools has been recognised by many cultures for a large part of human history, from the use of ayahuasca by indigenous groups in the Western Amazon to the role of peyote and mescaline in Native American rituals. A new wave of research over the last 30 years has begun to investigate their potential for unlocking new psychological therapies in areas where standard treatments have failed. I spoke to Dr Liliana Galindo about what these compounds could mean for the future of psychiatry.
The University of Cambridge affiliated assistant professor and consultant psychiatrist is Principal Investigator of the Cambridge Psychedelic Research group. She is leading two clinical trials investigating the therapeutic potential of empathogens and neuroplastogens, bringing studies of this nature to Cambridge - and the east of England - for the first time. One of the studies includes participants with post-traumatic stress disorder (PTSD), a condition for which there is currently a real dearth of treatment options. The only pharmacological interventions (i.e. medications) on offer for PTSD at the moment are selective serotonin reuptake inhibitor (SSRI) antidepressants, such as sertraline (Zoloft) and fluoxetine (Prozac). These medications do help some patients, but generally only offer some symptomatic relief, Dr Galindo tells me. “They might help to reduce some of the anxiety, some of the insomnia” often experienced by PTSD sufferers, but “it is not treating the root, … the trauma that is behind”.
The other option is psychological intervention: therapies such as EMDR (eye movement desensitisation and reprocessing) and CBT (cognitive behavioural therapy), which focus on the reprocessing of traumatic memories. But these aren’t suitable for everyone. “For many people, any work with their trauma is so triggering that they can’t allow [themselves] to do it. Some people might not remember or recall the trauma, because it’s something that comes with a lot of pain.”
"Around 30% of those suffering from depression can be classed as ‘treatment-resistant’, meaning they do not show any response to at least two forms of treatment"
While estimates vary widely, it’s only a limited number of people with severe PTSD who experience a marked improvement, even with these interventions. The story is similar for other mental illnesses: around 30% of those suffering from depression can be classed as ‘treatment-resistant’, meaning they do not show any response to at least two forms of treatment.
Therapeutic options are limited by the paucity of medication options available. As a result of slow innovation in psychiatric pharmacology, the vast majority of psychiatric medications available today are descended from the first generation of drugs - some of which were developed more than 50 years ago, with few modifications since.
This urgent need to expand the menu of treatment options is one reason researchers are so keen to explore psychedelic and empathogen-assisted therapy (PAT): where people receive a controlled amount of a psychoactive drug in a safe clinical environment, under medical supervision while supported by a trained psychotherapist. Dr Galindo uses the analogy of surgery to explain the principle behind PAT: “When you have a physical trauma, you use an anaesthetic that will allow the surgeon to have a few hours where the person doesn’t feel the same pain. What these psychoactive substances [empathogens] are giving you is a period of hours … that will allow the person to revisit and re-process their trauma with a different perspective.”
"As a result of slow innovation in psychiatric pharmacology, the vast majority of psychiatric medications available today are descended from the first generation of drugs"
Treatment with PAT has shown almost unbelievable promise in clinical trials, with successful outcomes in treating conditions ranging from anxiety to addiction.
There are many proposed mechanisms by which psychedelics offer this protective effect. Their utility in the reprocessing of traumatic memories may in part be due to the cognitive flexibility they offer. Rigid thought patterns underlie many of the symptoms of mental illness: the cyclical negative rumination of depression and anxiety; the rigid patterns of thoughts and behaviour common to addiction, eating disorders and obsessive-compulsive disorder (OCD). Psychedelics belong to a class of compounds called neuroplastogens, which support the growth and regeneration of nerve cells to increase neuroplasticity (the ability of the nervous system to reorganise itself). Essentially, these substances create the ideal conditions for rewiring these rigid thought patterns and mapping out new neural pathways.
"Essentially, these substances create the ideal conditions for rewiring these rigid thought patterns and mapping out new neural pathways"
There are many stages to the intervention that participants in these trials will receive. The dosing sessions, where people actually receive the drug under clinical supervision, could involve up to eight hours of assisted therapy. “That means you need to have…doctors, they are with a psychotherapist supporting them…plus the research nurses that are monitoring their vital signs.” The drug is only one part of the intervention, as well. “Before this dosing session, they have a preparatory session with a trained therapist, as well as sessions afterwards, to integrate the different experiences they had”. Participants are also screened beforehand to confirm they’re eligible to be part of the study.
I ask Dr Galindo whether it’s been more difficult to obtain approvals for her research, given she’s working with restricted drugs. Under UK law, all psychedelics are classified under Schedule 1, the strictest category of regulation. Application for a Home Office licence (the permit necessary for any research involving a Schedule 1 drug) is a complex, thorough, and often lengthy process. However, Dr Galindo tells me the waiting is made easier by the knowledge they’re researching “something that could come at the end with therapeutic options for a lot of people. In the trial with PTSD, the participants that are joining…have been symptomatic for more than 10 years. And we’re speaking severe PTSD. So people who cannot work… cannot fulfil the different aspects of their lives because they are so affected by these symptoms.”
Many in the field feel this regulation is perhaps too stringent, and is compromising innovation. A 2022 letter from The Royal College of Psychiatrists called for the removal of psychedelic drugs from Schedule 1 to facilitate research, pointing to countries such as Australia and parts of the United States, where some psychedelics are already approved for therapeutic use. “We need to explore…how could the UK legislation adapt at the same pace [as] the science”.
This rigorous regulation is partly historical. Following the War on Drugs, the use of psychedelics in research was outlawed, first nationally in the United States, then globally via the 1971 United Nations Convention on Psychotropic Substances. In 1991, the first approval for psychedelic research since the 1970s was granted, rekindling interest in the subject and kickstarting a second wave of clinical trials: the so-called ‘psychedelic renaissance’. The encouraging evidence that emerged from this new wave of research has meant psychedelics are increasingly being viewed as a viable option for UK medical research to explore further.
"In 1991, the first approval for psychedelic research since the 1970s was granted, rekindling interest in the subject and kickstarting the so-called ‘psychedelic renaissance’"
Dr Galindo is hoping to expand her research to look at other psychedelic compounds; this year, her group will begin two trials to investigate the potential of psilocybin, one for generalised anxiety disorder and the other for treatment-resistant depression, and will be hosting their first Cambridge Psychedelic Research Day on 12th March.
She’s running these trials alongside working as a consultant psychiatrist, and so I ask (slightly selfishly; I’m still feeling out different career options), how she finds it balancing research and clinical practice. “It’s not straightforward!” She laughs. “Many of my questions or my ideas come from my clinical experience. I struggle to think we can find a solution if we are really far away from what we are studying.”
“The part that is beautiful, and promising, is that we really haven’t had many new treatments in psychiatry for a long time, many decades. And here we have a hope that we might be able to change a paradigm."
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