Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers psychedelic-assisted psychotherapy with Dr Emma Hapke and Dr Daniel Rosenbaum, both of whom are psychiatrists at the University Health Network in Toronto and co-founders of UHN’s Nikean Psychedelic Psychotherapy Research Centre (in addition to being lecturers in the Department of Psychiatry at the University of Toronto).

The learning objectives for this episode are as follows:

By the end of this episode, you should be able to…

Briefly describe the history of psychedelics in psychiatry
List the four classes of psychedelic drugs and their mechanism of action
Summarize the evidence regarding psychedelic-assisted psychotherapy for various psychiatric disorders
Discuss patient selection considerations for psychedelic-assisted psychotherapy
Describe the safety, tolerability and possible side effects of psychedelic-assisted psychotherapy
Understand how a psychedelic-assisted psychotherapy session is practically carried out

Guests: Dr Emma Hapke and Dr Daniel Rosenbaum

Hosts: Dr Chase Thompson (PGY4), Dr Nikhita Singhal (PGY3), Jake Johnston (CC4), and Annie Yu (CC4)

Audio editing by: Nikhita Singhal

Show notes by: Nikhita Singhal

Interview Content:

Introduction - 0:00
Learning objectives - 02:47
Definitions/categories of psychedelics - 03:24

Classic psychedelics - 04:15
Empathogens (e.g. MDMA) - 07:15
Etymology of the term “psychedelic” - 09:30
Ketamine - 12:24
Iboga - 13:28

Brief history of psychedelic medicine - 17:51
Current evidence and ongoing trials - 27:38

MDMA and PTSD - 29:26
Psilocybin and treatment-resistant depression - 32:24
A word of caution - 34:29
End-of-life care - 38:47

Practical aspects of psychedelic-assisted psychotherapy sessions - 45:45
Safety considerations - 01:04:04
Future directions - 01:10:33
Closing comments - 01:19:07

Resources:

Books:

How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (Michael Pollan)
The Doors of Perception (Aldous Huxley)
The Human Encounter With Death (Stanislav Grof and Joan Halifax)

Brainwashed podcast series (CBC): https://www.cbc.ca/listen/cbc-podcasts/440-brainwashed
Zendo Project (psychedelic peer support): https://zendoproject.org
Nikean Psychedelic Psychotherapy Research Centre: https://www.uhn.ca/MentalHealth/Research/Nikean-Psychedelic-Psychotherapy-Research-Centre
California Institute of Integral Studies (CIIS): https://www.ciis.edu
Multidisciplinary Association for Psychedelic Studies (MAPS): https://maps.org
PsychEd Episode 27 - Serotonin Pharmacology: From SSRIs to Psychedelics with Dr Robin Carhart-Harris)
PsychEd Episode 34 - Ketamine for Treatment-Resistant Depression with Dr Sandhya Prashad

References:

Carhart-Harris R, Giribaldi B, Watts R, et al. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med. 2021;384(15):1402-1411. https://doi.org/10.1056/nejmoa2032994
Carhart-Harris R, Nutt D. Serotonin and brain function: a tale of two receptors. Journal of Psychopharmacology. 2017;31(9):1091-1120. https://doi.org/10.1177/0269881117725915
Davis AK, Barrett FS, May DG, et al. Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2021;78(5):481–489. https://doi.org/10.1001/jamapsychiatry.2020.3285
Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. dhttps://dx.doi.org/10.1177%2F0269881116675513
Griffiths RR, Johnson MW, Richards WA, et al. Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors. J Psychopharmacol. 2018;32(1):49-69. https://doi.org/10.1177/0269881117731279
Johnson MW, Hendricks PS, Barrett FS, Griffiths RR. Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. Pharmacol Ther. 2019;197:83-102. https://doi.org/10.1016/j.pharmthera.2018.11.010
Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021;27(6):1025-1033. https://doi.org/10.1038/s41591-021-01336-3
Mithoefer MC, Mithoefer AT, Feduccia AA, et al. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. Lancet Psychiatry. 2018;5(6):486-497. https://doi.org/10.1016/s2215-0366(18)30135-4
Nicholas CR, Henriquez KM, Gassman MC, et al. High dose psilocybin is associated with positive subjective effects in healthy volunteers. J Psychopharmacol. 2018;32(7):770-778. https://doi.org/10.1177/0269881118780713
Reiff CM, Richman EE, Nemeroff CB, et al. Psychedelics and Psychedelic-Assisted Psychotherapy. Am J Psychiatry. 2020;177(5):391-410. https://doi.org/10.1176/appi.ajp.2019.19010035
Rosenbaum D, Boyle AB, Rosenblum AM, Ziai S, Chasen MR, Med MP. Psychedelics for psychological and existential distress in palliative and cancer care. Curr Oncol. 2019;26(4):225-226. https://dx.doi.org/10.3747%2Fco.26.5009
Swift TC, Belser AB, Agin-Liebes G, et al. Cancer at the Dinner Table: Experiences of Psilocybin-Assisted Psychotherapy for the Treatment of Cancer-Related Distress. Journal of Humanistic Psychology. 2017;57(5):488-519. https://doi.org/10.1177/0022167817715966

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

40 | Creativity and sustainability | Colin Hornett