What is presented in the media is often a little less nuanced than reality, for practical reasons. In a culture where information is supposed to be easily digestible, the media is not presented with enough information to form an accurate picture. So some show the highlights from one side, and others show the highlights from the other. You end up with black-and-white stories that often polarize and contradict each other. Some read articles from Dagbladet about MDMA deaths and LSD psychoses that confirm one side. And others read hand-picked articles about how little harmful MDMA is compared to alcohol and how amazing results psilocybin has on a number of mental illnesses. Both live in a kind of bubble and many of my clients have one leg in each bubble. Psychedelic therapy is not a risky sport , but neither is it a magic pill that fixes everything at once. Here I will try to be a little more nuanced.
Psilocybin – one treatment is all it takes?
Research on psilocybin-assisted therapy has focused mainly on depression. A relevant study has been conducted at Johns Hopkins in the US and one at Imperial College in England . Both studies have very good results, well above alternative medications on the market today. In addition, there are some advantages of psilocybin over current antidepressants – they work quickly, there are fewer side effects and you don't have to take it every day. Antidepressants and psilocybin also have opposite functions in many ways, with the former reducing symptoms and the latter getting to the core of the problem instead. But there are facets of psilocybin treatment that are rarely brought to light.
One is the experiences people have through such treatments. They can be beautiful, but for many it is perhaps one of the most frightening experiences they have had in their lives. When the researchers at Johns Hopkins asked participants to rank how meaningful the experience was, 75% of whom placed it in the top five of their lives, they used that word carefully. They didn't use the words beautiful, positive, or redemptive, simply because the experiences and the period after can be quite challenging.
The other point that is rarely made is that the studies are small, so it is common to see poorer results in larger studies. Among other things, the researchers handpick their candidates from a large group of applicants, which allows them to choose exactly the candidates they believe will benefit most from this type of treatment. In addition, it has been seen that depression creeps back over time. In the study from Imperial, it is seen that almost two-thirds of the participants were depression-free after two treatments (one low and one high dose). After three months, less than half were depression-free, and it is seen in long-term follow-up (6-12 months) that the percentage is slowly decreasing and that depression returns for most. These are still good results compared to other medications/treatments and when you consider that the participants in the study have been diagnosed with clinical depression for an average of 17.8 years. But it also confirms that this is not a quick fix. And based on the research, we actually do not know how patients would respond to multiple treatments over time.
So all I can offer here are experiences from my clients and other psychedelic therapists/retreat organizers in other countries. We also see that depression returns over time for almost everyone, but often in a slightly different form. One of my clients described the phenomenon well: “I still have dark periods where I lie on the couch in the fetal position, but the difference is that I know that it’s not all and that it will pass. I didn’t before.” It seems that several treatments (2-6) are required per year over several years to achieve a significant, long-lasting effect for the majority. It is perhaps not surprising that it takes time to learn to see the world in a different way than you have done your whole life.
MDMA – are you cured in three doses?
MDMA for post-traumatic stress disorder (PTSD) has documented better long-term effects than psilocybin for depression, but these studies also differ considerably. The MDMA studies involve three high-dose treatments over three months with 36 hours of psychotherapy. This means that participants receive several hours of therapy per week over a long period in addition to the treatment days with MDMA. This is both a more intensive and expensive course of treatment than one usually goes through, and it is a very large part of the treatment. In some cases, PTSD can also be an easier "nut to crack", simply because there may be more concrete goals. Like being able to process a specific trauma.
On the one hand, I would say that the impression one gets in the media is a bit sensationalistic, simplified and exaggerated. On the other hand, I also see huge potential in using less rigid treatment protocols than what is used in research today. Research is limited by finances, stigma and government drug regulation, so researchers stick to as conservative a framework as they can until these become approved drugs. It is also important to emphasize that neither MDMA nor psilocybin are new molecules in the world, and that these are substances that have been used as medicine in underground therapy for 50 years, several of whom have published books (e.g. Leo Zeff, R. Coleman and Anne Other). In underground therapy, the treatment is adapted to the client. You often work your way through different medications in phases, sometimes in combination, to achieve the best possible results over time. And then the research comes 10-20 years later.