Psychedelic Treatment for Depression: How to avoid a Potential Crash Landing. Part 6
Pictured above: Christopher Pittinger, M.D., Ph.D. researches the use of psychedelics at Yale.
In this 7-part series, we’ve been looking at the connection between EAPs and issues in the workplace around treating depression and other mood disorders. In the first three installments we looked at the problems caused by psychedelics – in particular a story of a depressed Alaska Airlines pilot who attempted to self-medicate using psychedelic mushrooms and ended up nearly crashing the plane he was flying in. In part 4 we looked at the history of psychedelics and how they went from being revered to reviled and back to revered again. In the 5th installment, we looked at how these drugs are used to treat a variety of mental health disorders.
In this 6th installment, I’ll outline exactly how this hallucinogenic treatment is administered. Back in May of 2023 I attended an EAP conference on the therapeutic use of psychedelics. Held in Connecticut, not far from Yale University Medical School attendees were treated to 3 presentations by researchers who were conducting clinical trials using various forms of psychedelic drugs for treating a wide variety of health problems including depression, anxiety, PTSD, addiction and even OCD.
Christopher Pittenger, M.D., started off the event by talking about how in the 1970’s, the “Controlled Substances Act,” which was the legislation that accompanied President Richard Nixon’s “war on drugs,” halted a lot of legitimate research that was being done on the therapeutic use of hallucinogens.
Two Harvard Psychologists back in the 1960’s studying psychedelics before they were banned, Drs. Timothy Leary and Richard Alpert were fired for handing these drugs to students. While most of their research has since been disregarded, two key points they first identified for using Psychedelics therapeutically were called “set and setting.” These terms refer to the mindset of the person prior to taking the psychedelic, and the setting refers to the room in which the mind-altering drugs will be administered.
When we saw pictures of the rooms where the treatment sessions took place, (see previous blog) the setting looked more like a cozy living room or bedroom than it did like a doctor’s office. There was a bed, a reclining chair, soft lighting, art on the walls, blankets, a mask, and soft music playing in the background. That was the setting. As far as mindset goes, patients need to know exactly what to expect coming into this treatment and to see if they are indeed good candidates for the treatment. That way they have the proper mindset or expectations for the experience they are about to have.
Before introducing us to this new form of therapy, Dr. Pittenger took time to point out some of shortcomings of other forms of treatment commonly used for treating depression. Prozac, he explained, only helps 40% of the population, so the failure rate is high. (Amazingly, this number is only two percentage points higher than the 38% of people who are helped by a placebo. Ironically, that little bit of difference is all you need to have your drug approved by the FDA.) And most anti-depressants Pittinger added, take up to 4-6 weeks to kick in.
And with SSRI’s (aka, antidepressants) there are side effects including drowsiness, weight-gain, and loss of libido. Not to mention the fact that for the unlucky patients who don’t respond to at least two different varieties of anti-depressants, their mood disorder is reclassified as: “treatment-resistant.” The only other option for folks falling into this category is electro-convulsive therapy or shock treatment. This form of therapy, as you can well imagine, is NOT the average person’s preferred form of treatment!
Then along comes a very convincing study that shows a very mild psychedelic called Ketamine (or its patented cousin Esketamine) is as effective or better than shock therapy at helping patients with treatment-resistant depression. While this study involved a three-week course of treatment, the process that Dr. Pittenger described was a 3-session treatment that could take place in less than a week. And this breakthrough treatment can have long-lasting effects!
At Dr. Pittenger’s office at Yale they recruit people with specific health problems including depression, anxiety, PTSD, OCD and chronic pain. There are a variety of psychedelics being studied. But LSD is not one of them. It’s way too powerful, and its effects can last for days. Psilocybin (mushrooms), Ayahuasca (tea), MDMA (ecstasy) and Ketamine are the other options in descending order of strength with Psilocybin being the strongest and Ketamine being the weakest. While Ketamine is legal with a prescription, MDMA, is expected to be approved by the FDA in August of this year and introduced into 12 treatment centers around the country in January 2025.
The next speaker, Will Culpepper was conducting actual LEGAL Ketamine-Assisted Psychotherapy or KAP. As we described in the previous blog, a KAP patient is seen typically for three sessions or more. They come in initially for a preliminary, prescreening appointment where the goal for the therapist and patient is to get to know one another, develop a rapport and establish trust. Screenings and assessments are given and any other related symptoms the patient might be experiencing are discussed.
For the treatment session itself, which can last from 3 to 4 hours, there are always two therapists in the room at all times. Typically the patient wears some sort of mask, like a “mindfold” (see below) that allows them to comfortably open their eyes and still maintain total darkness.
The first 30-45 minutes of the treatment session is dedicated to helping the patient relax and feel comfortable. A music playlist is carefully chosen that is relaxing and soothing and consists of either classical or New Age instrumental music. “Lyrics are too distracting,” the therapist reports. Sometimes a mindfulness meditation is practiced beforehand, and intentions set: What is the client’s goal for the session? An attitude of surrender and flow is encouraged. Then a lozenge of 150 milligrams of Ketamine is administered. Interestingly, dosages vary depending on the therapist’s approach, and not depending on the weight of the patient. Amounts can vary based on someone’s tolerance for the medication, how quickly they want to go into a trance state or for people who want to go deeper into the experience.
A friend of mine, who happens to be a pharmaceutical rep for the very same company that discovered LSD in the 1930’s, tried out a similar kind of Ketamine Treatment for a series of 4 separate sessions where the Ketamine was administered intravenously instead of taken as a lozenge. He said the effects of the Ketamine were quite profound. Once the “trip” began there was no way he “could think his way out of it. You are no longer in control of your thoughts,” he explained. Seeing that he had to let go of control (there was no other choice) was one of the important takeaways for him. While it wasn’t scary, he reports he experienced mind altering states like finding himself inside his mother’s womb.
Seeing his talk therapist a few days after the treatments was important to unravel the meaning of what he had experienced during the trip. One of the clinicians working at a Psychedelic Therapy research center at Johns Hopkins emphasized that the brain is apparently more malleable (or plastic) right after the dosing treatment, so there’s an opportunity to make a dramatic behavioral change that will really last once a person has an experience like this.
In the next installment we’ll look at how this therapy and a variation on it are being used to treat Veterans with PTSD.
James Porter
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