Self-Understanding Through Revelation
Dr Robin Carhart-Harris, Head of the Centre for Psychedelic Research at Imperial College London
Antidepressant medications have been prescribed to an astonishing 20% of the adult population in the UK and yet depression rates have not decreased since accurate record keeping began. Is it time for a different approach?
The prestigious New England Journal of Medicine recently published a clinical trial report comparing psychotherapy with the psychedelic (psyche revealing) drug, psilocybin, aka ‘magic mushrooms’, with a Prozac-like conventional antidepressant known as escitalopram, Cipralex or Lexapro.
This is the first time a psychedelic has been pitted against a conventional psychiatric drug treatment and the results are remarkable. A wide swath of different measures favoured the psychedelic, assessing such things as work and social functioning, anxiety, pleasure responsiveness, well-being, avoidance, suicidality and of course, depression.
The proportion of patients achieving remission at the end of the trial, meaning they no longer had depression, was twice as high in the psilocybin group than the escitalopram group, at 60 vs 30 percent. Psilocybin caused fewer cases of dry mouth, drowsiness, sexual dysfunction, emotional blunting, and anxiety than escitalopram, suggesting superior tolerability as well as effectiveness.
“My hope is that professionally delivered psychedelic therapy can meet the massive un-met need for breakthrough in mental health care."
As Covid has shown, it is easier to treat an illness if you understand it. Mental illness is the world’s number one cause of disability and depression is the largest contributor to this burden. In recent years, antidepressant medications were prescribed to an astonishing 20% of the adult population in the UK and yet depression rates have not decreased since accurate record keeping began. In my view, one reason for psychiatry’s failure to get on top of mental illness, is its failure to explain how it comes about. Oversold and all too convenient tales of chemical deficiencies or genetic determinants have taken us nowhere in terms of tangible breakthroughs for patients and their families.
My hope is that professionally delivered psychedelic therapy can meet the massive un-met need for breakthrough in mental health care. One reason I believe it can, is the manner in which it works, zoning in on and, with support, cracking open complexes of suffering contained within the body and brain. It is often said of conventional antidepressants that they merely ‘plaster over’ the root causes of suffering, whereas the defining property of psychedelic therapy is their ability to accelerate self-understanding through revelation.
Modern research is now demonstrating that symptoms associated with depression and related disorders such as post-traumatic stress disorder often emerge from a background of adversity. Viewed this way, it is arguably easier for patients, caregivers, employers and family remembers to understand symptoms of suffering and for clinicians to treat them. This process may begin with a conscious recognition of the adversity suffered, however fuzzy its nature, and then, through a combination of a psychedelic and an ideally nurturing relational context, one can work towards a goal of acceptance and relational reconnection.
It has been said that psychedelic medicine offers a brave new world for psychiatry, but in a sense, it is an old world or, rather, one that has always existed. Bravery is needed from multiple stakeholders, as well as honesty, and integrity.
After a period of some freewheeling, this new road to Eleusis may soon begin to steepen, and, as life tends to teach us, there may be no definite summit, and plenty of pitfalls. The future health and longevity of psychedelic therapy will depend, in my view, on how successfully it integrates with psychotherapy, wisdom teachings and the scientific method - as well as how successfully they integrate with each other.