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Huberman Lab
Dr. Robin Carhart-Harris: The Science of Psychedelics for Mental Health
May 22, 2023
02:32:42
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Quick takeaways
- Psychedelic therapy involves an altered state of consciousness through hallucinations and intense emotions, leading to cathartic experiences and insights.
- Under the influence of psychedelics, there is an increase in global communication between brain regions, facilitating enhanced neural activity and plasticity.
- Separating the psychedelic effects from therapeutic action may overlook the unique contributions of the subjective experience and neuroplasticity induced by psychedelics.
- Psychedelics like psilocybin induce neuroplastic changes in the brain, contributing to lasting therapeutic effects observed in individuals with depression.
- Combining psychedelics like psilocybin and MDMA in therapy can provide a balance of introspection and positive experiences for individuals with specific needs.
Deep dives
Importance of the Psychedelic Experience in Therapy
During psilocybin therapy sessions, patients enter an altered state of consciousness characterized by hallucinations and intense emotions. This experience is crucial for therapeutic outcomes as it allows individuals to confront repressed memories and emotions, leading to cathartic experiences and insights. The therapy sessions involve a therapeutic rapport and a trust-building process, promoting an environment where patients can let go and be open. The psychedelic experience is distinct from traditional cognitive therapy and plays a significant role in transformative therapeutic effects.
Neural Connectivity Changes During the Psychedelic Experience
Under the influence of psychedelics, there is an increase in global communication and connectivity between different brain regions. This effect is attributed to the activation of the serotonin 2A receptor, which leads to enhanced neural activity and plasticity. These changes in connectivity are observed during the psychedelic experience and are associated with the profound subjective effects reported by individuals. Furthermore, some studies have shown that this increased connectivity persists even after the effects of the drug have worn off.
Skepticism towards Non-Psychedelic Therapeutic Approaches
There is ongoing research to develop drugs that can treat depression without inducing hallucinogenic effects. However, some skepticism exists regarding the effectiveness of such approaches. The psychedelic experience, characterized by hallucinations and emotional catharsis, is believed to be a crucial component of therapeutic outcomes. Attempts to separate the psychedelic effects from the therapeutic action may overlook the unique contributions of the subjective experience and the neuroplasticity induced by psychedelics.
Evidence of Hallucinogenic Effects and Long-Term Changes
Clinical studies using psilocybin have demonstrated increased interconnectivity between brain regions, dendritic growth, and synaptic spine growth. These neuroplastic changes are believed to contribute to the therapeutic effects of psychedelics. Evidence suggests that these changes persist beyond the acute psychedelic experience, with lasting effects observed in individuals with depression. However, the exact duration and extent of these changes require further investigation.
DMT and Ego Dissolution
DMT is a classic psychedelic that directly stimulates the serotonin 2A receptor. It is known for its brief and intense effects, often described as a rocket ship. The experience of DMT can lead to ego dissolution, which is a temporary elimination of the concept of self and a sense of interconnectedness with the world. Ego dissolution can result in a profound sense of meaning, a recognition of the molecular continuity of life, and a realization that the sense of self may be illusory or constructed by the mind. The positive aspect of ego dissolution is the feeling of interconnectedness with others and the world at large.
Combining Silasibin and MDMA Therapy
Combining silasibin and MDMA in therapy has shown potential in certain cases. Silasibin can provide deep introspection, but it can also be overwhelming and agitate defense mechanisms. On the other hand, MDMA therapy is more reliably positive and can help create a safe space for revisiting past traumas. The combination may offer advantages in cases where a balance of introspection and positive experiences is needed. The precise therapeutic effects and optimal application of this combination are still being explored.
Different Psychedelics and Duration
Psychedelics like DMT, Silasibin, and LSD have different durations of trips. DMT produces a short but intense experience, lasting only minutes. Silasibin and LSD have longer trips, lasting several hours. The varying durations are influenced by the pharmacology and potency of the compounds. The practical considerations of trip length, staffing for therapy sessions, and availability of facilities can influence the choice of psychedelic for therapeutic use.
The potential of psychedelics in therapy
Psychedelics offer a potential paradigm shift in mental health treatment as they provide a different approach compared to traditional daily medication. While not everyone may be comfortable with psychedelic therapy, it offers a unique opportunity for individuals suffering from psychiatric disorders that have not responded well to conventional treatments. Studies have shown promising results with psychedelic therapy in various difficult-to-treat disorders such as treatment-resistant depression, trauma, anorexia, fibromyalgia, addiction, OCD, Parkinson's disease, and bipolar disorder. However, the journey to licensing psychedelics as medicines is a slow process involving multiple phases of clinical trials and the scrutiny of regulatory bodies like the FDA. Organizations like MAPS are leading the way in conducting successful phase 3 trials for MDMA therapy, primarily for post-traumatic stress disorder, with potential FDA approval expected in the near future. Psilocybin therapy for treatment-resistant depression, conducted by companies like Compass, is currently in phase 3 trials, but it may take several more years for approval. The ultimate goal is to have psychedelics legally prescribed and available as an alternative treatment option alongside established medications.
The complex landscape of legality and regulation
Navigating the legal and regulatory landscape surrounding psychedelics is a challenging endeavor. At present, these substances are mostly illegal, except for specific clinical trials. Oakland, California, has decriminalized psilocybin, but it remains illegal at the federal level. The FDA plays a vital role in the licensing of psychedelics as medicines, and successful phase 3 trials are crucial for approval. MAPS, along with other research centers, is making significant progress in the therapeutic potential of psychedelics and attracting philanthropic support for further research. However, the rollout of legal access and reliable sources of psychedelics poses its own set of questions and challenges. For MDMA therapy, MAPS is likely to become the provider, but the journey to becoming a pharmaceutical company is expensive and requires careful consideration. The training and certification of providers is another aspect being addressed, as clinical psychologists and physicians contribute to offering psychedelic therapy. The future of legality and accessibility remains uncertain, but current research and growing public interest offer hope for a more open-minded approach to psychedelic therapy as a transformative solution for mental health.
31.
Neuroplasticity as a Consequence of One First Time Session With 25 Milligrams of Psilocybin
2min
55.
The Potential for Psychedelics to Be Added to the Array of Potential Treatments
5min
In this episode, my guest is Robin Carhart-Harris, PhD, distinguished professor of neurology and psychiatry at the University of California, San Francisco. He is one of leading researchers in the study of how psychedelics such as psilocybin, LSD and DMT can change the human brain and in doing so, be used to successfully treat various mental health challenges such as major depression, anorexia, obsessive-compulsive disorder (OCD) and addiction. He explains how psilocybin induces sustained changes in adaptive brain wiring and cognition. We discuss the key components of safe and effective psychedelic journeys, the role of hallucinations, the use of eye-masks to encourage people to “go internal,” and music, as well as what effective therapist support consists of before, during and after the session (also known as integration). We discuss micodosing vs. macrodosing and how researchers control for placebo effects in psychedelic research. We also discuss the current legal landscape around psychedelic therapies. Psychedelic therapies are fast emerging as powerful and soon-to-be mainstream treatments for medical health disorders, but they are not without their risks. As such, this episode ought to be of use to anyone interested in brain plasticity, mental health, psychology or neuroscience.
For the full show notes, visit hubermanlab.com.
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The Brain Body Contract
Timestamps
(00:00:00) Dr. Robin Carhart-Harris
(00:02:28) Sponsors: LMNT & Waking Up
(00:05:41) The Brain-Body Contract
(00:06:31) Origin of the Word: “Psychedelics”; Pharmacology
(00:12:05) Psychedelics & Revealing the Unconscious Mind, Psychotherapy
(00:17:32) Microdosing
(00:26:08) Psilocybin vs. Magic Mushroom Doses
(00:28:28) “Psychedelic-Therapy”, Music
(00:31:13) Sponsor: AG1
(00:36:26) Psychedelic Journey: “Trust, Let Go, Be Open”
(00:43:01) Negative Emotions, Fear & Psychedelics
(00:46:21) Global Functional Connectivity, Serotonin 2A Receptor; Subjective Experiences
(00:52:33) Pharmacology: Therapeutics without Psychedelic Effects; SSRIs
(00:58:45) Psilocybin & Depression; Long-Term Effects: Connectivity & Neuroplasticity
(01:10:26) Psilocybin Therapy & Anorexia
(01:12:56) Integration Phase & Psychedelic-Therapy; Meditation
(01:19:50) First-Time Psychedelic Use, “Entropic Brain Effect”, Neuroplasticity, Cognition
(01:30:16) Fibromyalgia & Psychedelic Treatment; MDMA Therapy & “Inner Healer”
(01:38:55) Placebo Response & Psychedelic Therapy
(01:41:39) LSD & Psychedelic-Therapy, Micro-Dose
(01:48:19) Combination Psilocybin-MDMA Therapy
(01:56:06) DMT “Rocketship” & Serotonin 2A Receptors; Ibogaine
(02:01:04) “Ego Dissolution”, Cocaine vs. Psychedelics; Relapses
(02:12:26) Psychedelics & Legal Landscape; Decriminalization
(02:17:54) MDMA, Trauma & Clinical Trials; Future Regulatory (FDA) Approval?
(02:23:25) Psilocybin & Current Clinical Trials
(02:28:41) Mental Health & Psychedelic Treatment, Safeguards, Paradigm Shift
(02:34:39) Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous, Social Media, Neural Network Newsletter
Title Card Photo Credit: Mike Blabac
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