In this episode of the Psychedelic Medicine Podcast, Ben Malcolm, PharmD joins to discuss the research surrounding the intersection of psychedelics with pregnancy and nursing. Dr. Malcolm is a psychopharmacology consultant, psychedelic educator, founder of Spirit Pharmacist, LLC and a board member of the Psychedelic Medicine Association. Dr. Malcolm recently wrote an overview article on the existing research into psychedelics, pregnancy and breastfeeding. In this conversation, Dr. Malcolm shares the current state of research that he explored in his article, highlighting the few points where data does exist while emphasizing that there are still major unknowns. Overall, Dr. Malcolm describes how most are very conservative when it comes to psychedelic use while nursing or pregnant, though pregnancy seems to present more concerns than nursing. Dr. Malcolm also discusses ketamine and the interesting findings in patients who were given this substance as an anesthetic for cesarean sections. In conclusion, Dr. Malcolm suggests moving beyond a black and white perspective on this topic, emphasizing that there are also opportunity costs to not pursuing healing. However, in this area especially, more research is needed before clear guidelines can be developed.    In this episode: The lack of treatment options for postpartum depression Why it is likely for a fetus or infant to be exposed to psychedelics if a mother ingests them while pregnant or nursing Psychedelics and the developing brain Ritual use of ayahuasca and mushrooms among pregnant women in traditional ceremonial contexts The research into negative impacts of ecstasy use during pregnancy and the variables that confound the results The unknowns about microdosing while nursing The research into whether LSD is a teratogen The effects of psychedelics on hormones Pregnancy as an aspect of set and setting   Quotes: “Psychoactive drugs or psychotropic drugs typically end up in breastmilk more than other types of substances because they are usually more fat-soluble. Usually to get into brain tissue they have to be a little more fat-soluble than drugs that act in the periphery.” [10:15] “In the nursing period I think that there’s more potential to use psychedelics safely and without really taking much risk as far as exposing the [child], whereas in pregnancy, yeah, you just don’t really have that choice—the fetus is going to be exposed.” [24:42]   Links: Dr. Malcolm’s recent article: “Psychedelics, Pregnancy, and Breastfeeding” Spirit Pharmacist website Spirit Pharmacist on Facebook Spirit Pharmacist on Instagram Spirit Pharmacist on YouTube Psychedelic Medicine Association Porangui

In this episode of the psychedelic medicine podcast, Allison Feduccia, PhD joins to discuss the intersection of psychedelic medicine and women’s health. Dr. Feduccia is a neuropharmacologist, psychedelic researcher, and builder of virtual and in-person communities. She is cofounder of two prominent organizations, psychedelic.support and Project New Day, and is additionally a scientific advisor for Eastra. Alli has been researching psychedelics since 2004 when she first began studying MDMA and has subsequently been involved in the field through work at numerous universities, the NIH, and MAPS. In this work she seeks to spread evidence-based knowledge, connection to resources, and strategies for individuals to maximize potential therapeutic benefits of psychedelics through safe and responsible practices. In this conversation, Alli responds to questions touching on all areas of women's health and the impact psychedelics could have specifically for female patients. A major theme of the discussion is the interplay between psychedelics and hormones. While this is a topic with little in the way of scientific research, Alli shares some interesting ideas about how the neuromodulation of psychedelics could interact with endocrine systems, and how serotonin receptors within the uterus could explain certain anecdotal reports of various effects of psychedelics on menstrual pains or irregularities.  In a similar vein, Alli discusses some of the physiological effects of psychedelics, particularly in relation to blood flow, and how these non-experiential features of these compounds could actually be helpful properties for women with certain conditions. This insight leads to interesting avenues for future drug development and also stresses the importance of studying psychedelics at different doses so that the positive health effects can be isolated. Alli also talks about the potential for psychedelic healing in the context of postpartum depression, sharing an evocative family story which illustrates simply how crucial and overlooked this issue has been in healthcare. The advances in mental healthcare coming out of psychedelic research provide a promising path forward for such conditions, however.    In this episode: How psychedelics could help with premenstrual discomfort Concerns about taking psychedelic substances while pregnant Psychedelics and postpartum depression How psychedelics could impact hypoactive sexual desire disorder   Psychedelics interactions with menopause Potential role for hormones alongside set and setting for impacting the psychedelic experience   Quotes: “It may be that psychedelics could really affect women’s moods as they go through these different life stages, and help them feel better.” [4:45] “Maybe this concept of neurotransmitter modulation with our sex hormones may be a target for drug development work as well.” [23:42] “This is also pertinent to transgender women who may be using hormones. This type of modulation on mood or physiological symptoms—this could be really applicable too for helping to really have the body adjust and be more balanced to changes in hormonal fluctuations in the body.”  [26:59]   Links: Psychedelic.support website Project New Day website Eastra Health Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, PhD candidate and psychedelic science YouTuber Manesh Girn discusses his recent research on psychedelic brain action. Manesh is in the final stages of obtaining his PhD in neuroscience at McGill University and is an author on over a dozen peer-reviewed articles on psychedelics and related topics. He is also chief research officer at EntheoTech Bioscience and runs the YouTube channel the Psychedelic Scientist.  In this conversation, Manesh discusses his recent article in Trends in Cognitive Sciences titled “A complex systems perspective on psychedelic brain action.” He explains the complexity science approach used in the article, which emphasizes the brain is a holistic, interconnected system, rather than individual component networks that can be isolated. From this standpoint, Manesh critiques some simplistic explanations of the neural mechanisms of psychedelics which focus exclusively on interactions with the default mode network isolated from other brain systems. He also explains how individual some of the neural effects of psychedelics are, citing different findings from different studies and observed variations between brain scans of different people. By better understanding these individual differences, and placing these different responses into a complexity science framework, Manesh believes that more individually-tailored psychedelic therapies are possible once the systems involved are more comprehensively understood.  Manesh closes this discussion by explaining the difference between genuine complexity and sheer chaos.  Complexity, he explains, is a delicate balance of novelty and order, which is why psychedelic experiences can be both destabilizing and productive of novel insights and personal transformation.    In this episode: The research into psychedelics and the default mode network Using frameworks from complexity science in psychedelic research Measuring entropy in the brain Differences in neurological effects from taking between different studies and different individuals How a complexity science approach to neuroscience could better inform precision psychiatry   Quotes: “You can’t just look at a specific brain region or network [in psychedelic research], you’ve gotta talk about the brain as a whole, in this sense of seeing the brain as a system of interacting parts.” [4:49] “The core idea of this paper is that psychedelics put our brain into this state that is more dynamically flexible, it’s more diverse in its activity patterns, and it’s more sensitive to inputs that come in.” [14:17] “What we find in the brain imaging findings is that different studies disagree, but also if you look at individual people, they can have radically different effects on their brain—almost opposite.” [21:37]   Links: Manesh’ recent article in Trends in Cognitive Sciences: “A complex systems perspective on psychedelic brain action” ​​Psilocybin vs Placebo Brain Connectivity Diagram from Dr. Robin Carhart-Harris The Psychedelic Scientist YouTube Channel The Psychedelic Scientist on Instagram The Psychedelic Scientist on Twitter Manesh on LinkedIn EntheoTech website Psychedelic Medicine Association Porangui

In this episode of the psychedelic medicine podcast, Dr. Johnathan Edwards joins to discuss the potential of ketamine treatments for mental health conditions in adolescent populations. Dr. Edwards is a board-certified anaesthesiologist and author with a key focus on treating mental health conditions with ketamine. He has provided ketamine in his practice for over 20 years and has worked with psychiatrist Dr. Sam Zand to help patients with mental health conditions.  In this conversation, Dr. Edwards shares the current state of research exploring ketamine for adolescents, mentioning that there are currently 120 studies of ketamine treatments for mental illness in this population. He shares how he works with these young patients to ensure they are well prepared to experience the effects of the dissociative anesthetic, saying that adolescents typically do very well when adequately prepared.  From Dr. Edwards’ experience, treatment resistant depression, suicidal ideation, and eating disorders seem to be the conditions where ketamine seems to have the biggest effect for adolescents. In closing, Dr. Edwards emphasizes how significant it is to be able to help kids struggling with these hard to treat conditions, especially as teen suicide remains a significant issue, so he’s hopeful that pediatricians, psychiatrists, and anaesthesiologists can continue to collaborate to safely bring ketamine therapy to more patients.    In this episode: The existing research on ketamine in adolescent populations The danger of airway obstruction during ketamine infusions among people prone to sleep apnea Preparing adolescents for ketamine journeys Historical and cross-cultural precedents for psychedelic journeys in adolescents and young adults Potential indications for ketamine treatments in adolescents Is there an established protocol for adolescent ketamine therapy?   Quotes: “I go through a lot to reassure the parents, to reassure the child, ‘Hey, this is gonna be a different voyage for you and you’re gonna be in a different place but tell yourself at all times you’re safe…’ and it goes very well.” [5:06] “As long as you have a medical clearance from your pediatrician and a medical clearance from the psychotherapist/psychiatrist/psychologist… and you put those two together, along with parental consent, you’re pretty well covered to go ahead and do a ketamine treatment on a child… It’s not standard of care but again, you’re trying to save a kid’s life.”  [24:39]   Links: Dr. Edwards’ website Dr. Edwards’ forthcoming book: The Revolutionary Ketamine: How a Little-Known Drug Can Cure Depression and Prevent Suicide Previous episode: Psychedelics for Eating Disorders with Dr. Reid Robison Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Paul Thambi, MD joins to discuss insights on the optimal delivery of psychedelic experiences stemming from his recent trial on psilocybin therapy for cancer patients suffering from major depressive disorder. Dr. Thambi is a medical oncologist with nearly 20 years of experience treating patients in a private practice. He now serves as CMO Sunstone Therapies, a company focused on how to best deliver psychedelic therapies.  In this conversation, Dr. Thambi shares the details of the design of his recent study, which involved two preparatory sessions, a treatment session, and two integration sessions. He also discusses the efficiency of delivering psychedelic therapy to a group rather than to individuals, allowing the therapist to help more patients at once while still providing focused one-on-one guidance during the psychedelic experience. Additionally, Dr. Thambi discusses the importance of music and space design to provide an optimal state of mind going into the therapy and while under the influence of the psychedelic.  Dr. Thambi is happy to report very positive data from this initial trial, with both patients with active cancers and those with no current signs of disease showing great improvement in depression scores. He looks forward to continuing to work to better optimize the delivery of psychedelic therapies, not only for the patients but also for the therapists. Currently, he is pursuing a new “diad trial” of psychedelic therapy for cancer patients and a loved one which may have the potential to ease the suffering caused to a family system by these diseases.    In this episode: The design of Dr. Thambi’s study of psychedelic therapy for cancer patients struggling with depression Group versus individual forms of psychedelic therapy Crafting an ideal setting for psychedelic therapy with music, artwork, etc. Changes in depression scores, anxiety, and pain amongst the participants in Dr. Thambi’s trial Optimizing the experience for psychedelic therapists as well as patients Dr. Thambi’s on-going “diad trial” for cancer patients and a loved one    Quotes: “What we were trying to do was create something that… could be used when it needed to be for a lot of people—something that was scalable. So something that was efficient, but still had compassion to it. And that’s how we came up with the [study design].” [22:16] “80% of [participants] had their MADRS score cut in half or greater within one week of the treatment. And half of those people had what we called a sustained remission, which means a MADRS score of less than or equal to ten on each of the measurements we took, including the last one, which was done at week eight.” [23:54]   Links: Sunstone Therapist website “Psychedelics may ease cancer patients’ depression, anxiety” article by Manish Agrawal California Institute for Integral Studies (CIIS) Certificate in Psychedelic-Assisted Therapies and Research Previous episode: Psychedelics and the Chemistry of Connection with Dr. Julie Holland Previous episode: How Setting Can Affect Psychedelic Journeys with Frederick Barrett, PhD Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Joel Castellanos and Jim Harris join to discuss the possibilities of addressing spinal cord injuries using psychedelic medicine. Dr. Castellanos is a board certified physical medicine and rehabilitation and pain management physician and an associate professor in the department of anesthesiology at University of California, San Diego School of Medicine. Jim Harris is a National Geographic photographer who suffered a spinal cord injury during one of his adventures who became notable in the psychedelic space with the article in Outside “Jim Harris Was Paralyzed. Then He Ate Magic Mushrooms.” Jim starts off by sharing his own backstory of how he broke nine vertebrae in his spine during a 2014 ski expedition in Patagonia, Chile, leading to significant loss of motion and sensation. After some promising success in traditional rehabilitation and physical therapy settings, Jim details his surprising experience of healing with psilocybin.  In this vein, Dr. Castellanos discusses the importance of neuroplasticity in healing for spinal cord injury patients. He talks about how forming new neural pathways can help a patient regain function and sensation in a part of the body that had previously been paralyzed, and leveraging this neuroplasticity using psychedelics and other tools may be a promising way to improve outcomes among these traditionally underserved patients.  Considering the unique needs of spinal cord injury patients, Jim wonders whether lower doses of psychedelics may be more beneficial for this population, as it would allow them to maintain a greater degree of sobriety and groundedness to pursue physical therapy and rehabilitation activities while under the influence of the substance.  Dr. Castellanos expresses excitement about the possibilities of psychedelic therapies for these patients, as not only does early anecdotal evidence such as Jim’s story suggest that these substances may be effective in helping to facilitate regain of function and sensation, but also because of the mental changes brought on by a psychedelic experience. Patients may feel more optimistic and eager to apply themselves following a psychedelic experience, which will facilitate healing beyond just what occurs as a result of the effects of the substance itself. He is also encouraged by current research into different forms of neuroplasticity which have different mechanisms. Dr. Castellanos suggests employing these in combination, such as using psychedelic therapy alongside vagus nerve stimulation, may offer more effective treatment options for spinal cord injury patients.  At the end of this conversation, Jim poses Dr. Castellanos a fascinating question: whether there may be any downsides to over-encouraging neuroplasticity. Dr. Castellanos responds that there could be certain risks of increasing pain in patients, as neuroplasticity encourages new connections to be formed in the brain, but it matters what specifically becomes more interconnected. As such, there is reason to proceed with caution even as neuroplasticity offers significant benefits.  In closing, Jim shares some hard reduction tips for other spinal cord injury patients interested in exploring psychedelic healing. Both he and Dr. Castellanos are optimistic at the possibilities of psychedelic therapies used in conjunction with other treatments for patients like Jim.    In this episode: Leveraging neuroplasticity using psychedelics and other tools to help physical medicine and rehabilitation patients regain function Anecdotes of other spine injury patients who’ve regained function or sensation following a psychedelic experience The connection between spasticity and psychedelics How the response to psychedelics has changed over time for Jim  Connecting physical therapy and psychedelic therapy to improve efficacy of rehabilitation How different mechanisms of neuroplasticity may be used in concert to promote recovery Harm reduction tips   Quotes: Jim: “[when I first took psilocybin] all of a sudden I had an ability to contract my hamstring and… lift my heel off the ground, like up toward my butt, and I hadn’t been able to do that up until that time.” [9:12] Joel: “My primary focus is on neuroplasticity and ways that we can creatively modulate the nervous system to optimize recovery and optimize quality of life, whether that’s from a pain perspective or a regaining motor strength perspective.” [13:34] Joel: “If we can demonstrate that through psychedelics we can optimize and improve and make recovery more efficient, it is something that will be a huge deal for a great number of patients, and make my job as a rehab physician easier.” [14:37] Jim: “The reason I’ve become interested in psychedelics as medicine has been trying to figure out… what are all the ways that I can have some sort of personal efficacy in my own recovery.” [19:22] Jim: “I do know of other anecdotes kinda similar to mine, of people—maybe especially it seems like with a first psychedelic experience—suddenly regaining sensory or motor functions.” [22:41] Jim: “It seems there’s maybe some reason to suspect that some of the nerve plasticity that psychedelics can allow may reopen the critical period of this pivotal mental state where, say having a psychedelic and doing physical therapy in that state and maybe even the days afterwards, might result in a bigger functional change than just doing the therapy alone.” [24:28] Jim: “My hypothesis would be that a useful physical therapy dose [of psychedelics] might be a lot less than what Johns Hopkins and other institutions are dosing as a therapeutic dose. It seems to me that maybe a really high dose psychedelic experience is going to make it harder to stay connected to your body, connected to doing a task.” [29:17] Joel: “If I can identify three or four different ways to open up neuroplasticity that each have different mechanisms, it allows me to leverage those to give robust functional recovery and that’s what I’m interested in.” [33:56] Joel: “If psychedelics can reframe someone’s cognition and reframe their situation where that gives them a little bit of hope, along with having a supportive therapy team, along with it working on descending inhibition and activating muscles that were previously paralyzed, that’s multiple different levels of approaching someone that just had the worst thing in their whole life happen to them… It builds resilience and then it’s also working on the neuromuscular pathway to improve functional recovery.” [37:30] Joel: “I don’t think just taking a psychedelic or other medication on its own is always going to be efficacious in solving that maladaptive pattern. But, when combined with specific and guided therapy, whether that’s physical therapy, or psychotherapy, or cognitive therapy, I think that’s where you can guide those neurons to a healthier connection through neuroplasticity.” [50:17]   Links: “Outside article: Jim Harris Was Paralyzed. Then He Ate Magic Mushrooms.” Psychedelics and Health Research Initiative at University of California San Diego Dr. Castellanos on Twitter Jim on Instagram Previous episode: Psychedelic Therapies for Pain with Joel Castellanos, MD Fireside Project website Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Agnieszka Sekula joins to discuss her research into the applications of virtual reality in psychedelic-assisted therapy. Agnieszka is a researcher at Swinburne University and co-founder of Enosis Therapeutics. Her research focuses on investigating therapeutic mechanisms in psychedelic treatment that can be strengthened through experience design and translating findings of this research into real-life applications by developing virtual reality scenarios. Additionally, she has recently conducted the first ever case study of VR and psychedelics. In her research, Agnieszka considers many possible uses of virtual reality in the context of psychedelic therapy, as well as potential dangers. The first application she discusses is using VR to promote relaxation prior to a psychedelic journey. Similar to the synergy between psychedelics and meditation, Agnieszka suggests that the immersive experience of VR could be useful in promoting states of calmness which are ideal for a person about to enter into a psychedelic experience. Additionally, she suggests that the otherworldly imagery and soundscapes possible with VR technology can help prime a client for the shifts and intensifications of perception caused by psychedelics. Having the opportunity to explore these states prior to the experience helps the patient to feel more prepared for the experiences, especially since with VR these explorations occur in a context where one maintains a connection with sober consciousness and can easily opt out if things become overstimulating.  Next Agnieszka discusses the potential of augmenting peak psychedelic experiences with VR. Considering both psychedelics and virtual reality have the potential to occasion dramatic shifts in consciousness and affect, pairing these together is likely to be synergistic in promoting mystical experiences in the therapeutic process—something which appears to be closely tied to the efficacy of psychedelic-assisted therapy. Though little research currently exists in this area, Agnieszka believes that VR may have the potential to more reliably facilitate experiences of ego dissolution and deep awe during the psychedelic journey. Perhaps one of the most novel proposals in Agnieszka’s research is using VR to facilitate greater recollection of the psychedelic journey in order to promote more effective integration. She proposes that by building models of the psychedelic experience in the VR space, a patient can more readily return to the experience in sober consciousness by encountering these same stimuli again in virtual reality. The immersive experience of virtual reality may help facilitate access to feelings, memories, and intuitions which arose during the psychedelic session, leading to an easier process of integration.  However, Agnieszka’s research also considers potential dangers in combining VR and psychedelics. These include the risk of overstimulation and the potential of a trauma being triggered by certain imagery or auditory input. More mundanely, there is also the possibility of “cyber-sickness” and physical discomfort caused by the VR headset. Despite these potential drawbacks, however, Agnieszka is confident there are powerful applications of VR in psychedelic therapy, particularly in allowing for a more holistic and integrated approach to the altered states of consciousness theorized to be at the center of the efficacy of these new treatments.    In this episode: Using VR to induce relaxation in preparation for psychedelic journeys Augmenting peak psychedelic experiences with VR VR as a technology which may promote therapeutic alliance Using VR to store memories of psychedelic experiences to facilitate integration Transitioning between normal consciousness and altered states with the help of VR VR as a “digital diazepam” for decreasing the intensity of a psychedelic experience without pharmacological intervention The potential dangers of overstimulation or triggering traumas with VR and psychedelics   Quotes: “VR in itself is just a tool—it’s a method of delivery—but in itself it's not the active ingredient. So whenever we speak of VR we think about the way of delivering the content, and the content is that active ingredient.” [2:22] “The best way to prepare someone for what an altered state experience feels like is by actually experiencing an altered state, and here again VR can be very helpful in approximating… what that psychedelic experience might feel like.” [18:51] “VR is used as a multi-sensory canvas where the patient is building the model of their psychedelic experience so that they can store it for themselves and return to it later.” [28:17] “Using VR just as beautiful content, or… contextual design for the entire experience might not be beneficial because it might work more as a distraction than as something that supports the journey.” [49:15] “For me the most important thing is to start looking at psychedelic treatment as an experience in its totality and to look a little bit more deeply into design principles that could be used to maximize that experience of the patient, of the client.”  [53:46]   Links: “Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy” Enosis Therapeutics website Agnieszka on LinkedIn Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Andrew Penn joins to discuss the recent BrainFutures white paper on the elements of psychedelic-assisted therapy which he co-authored. Andrew is a psychiatric nurse practitioner and a professor at UC San Francisco who is also a psychedelic psychotherapy researcher and nationally invited speaker. Additionally, Andrew is the co-founder of the Organization of Psychedelic and Entheogenic Nurses (OPENurses). In this conversation, Andrew discusses his white paper and breaks down the five key elements which need to be present in all psychedelic-assisted psychotherapy to ensure safety and efficacy. These five elements are safety and establishing set & setting; screening and assessment; preparation; the medication session; and integration.  In terms of screening and assessment, Andrew mentions the interesting place the field finds itself in currently, as up to this point screening practices have been rather intensive and erring on the exclusionary side since this is the standard when drugs are being tested in clinical trials. However, with psychedelic therapy continuing to become more accessible with patient options outside of these trials on the horizon, the field will need to decide what makes the most sense in terms of balancing accessibility with potential risks, and in doing so more data will be collected which will give a better picture of exclusion criteria. Andrew also stresses the need for psychiatric screening in addition to focusing on medical consideration, mentioning that it’s essential for a psychedelic therapist to know a patient’s trauma history, as this is something that may come up in a session and the more preparation the better.  When it comes to preparation, Andrew suggests that this should include establishing a relationship of trust, educating the patient, obtaining informed consent, and establishing safety measures. On the topic of consent, Andrew discusses the intricacies of dealing with this gracefully in a context where a patient will be undergoing a drug experience where consent cannot be adequately given in that moment. As such, he stresses the importance of explicit conversations between the patient and therapist around topics such as whether or not the patient would want their hand held during an intense moment. Rather than dry, procedural conversations, Andrew thinks discussions of consent are actually crucial moments where the therapist and patient can establish a relationship of trust and also more thoroughly explore the possibilities of what may come up for the patient in the session so that they feel better prepared. In terms of the psychedelic therapy sessions and integration, Andrew suggests that the therapists play different roles in these two contexts, with the medicine sessions being more about supporting the patient in their experience without providing too much direction or prompting so that the experience may unfold naturally and autonomously, whereas in integration the therapist can take a more active role in helping the patient explore what the experiences brought up. One interesting feature about psychedelic therapy, and a reason why integration is so important, is that the intensity of the medicine experiences and the insights triggered during sessions can actually be destabilizing initially. As such, Andrew maintains that integration is a crucial aspect of psychedelic therapy in order to better ensure that these experiences can lead to deep and lasting healing.  Andrew hopes that this white paper can introduce the crucial elements of psychedelic therapy to a wider audience and encourage a standard of practice.   In this episode: How might screening and assessment change once psychedelic therapies are more widely authorized and not only accessible as clinical trials?  Reckoning with the exclusion criteria around psychedelic therapies The importance of thorough preparation in achieving the best patient outcomes The dynamics of consent in preparation versus in the midst of the session and how therapists can more intentionally approach these questions What should therapists do when a patient is not in a calm state of mind at the time of the scheduled psychedelic therapy? Why integration is critical to facilitating healing in psychedelic therapy   Quotes: “Trauma is likely to come up during the session and we want to at least know if there’s something there then we can anticipate that and also start to create a safer environment for that patient.” [7:53] “We’re gonna have to figure out what is the right dose of medical screening, and then, certainly, introducing some level of psychological screening will be really important.” [10:27] “Informed consent is this ongoing conversation with the patient where the patient can withdraw their consent at any time—they can revoke that—but people really need to know what they’re getting into if they’re going to make meaningful informed consent.” [16:12] “What we’ve learned from psychedelic therapy is that there’s a lot of value in just letting things unfold… really the goal of the therapist should be to support that inward focus, and not try to influence the session itself in one direction or another other than to maintain safety.” [33:19] “Psychedelics are things that tend to shove your face in whatever you’ve been avoiding and that’s something that therapists need to be really aware of—that they might encounter patients who get worse after the session, at least for a transient period of time.” [44:41]   Links: Andrew's full white paper on BrainFutures: "An Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy"  Previous episode: When *Not* to Proceed with a Planned Psychedelic Journey with Rick Barnett, PsyD OPENurses website  Psychedelic Medicine Association Translational Psychedelic Research Program - TrPR Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Kurt Rasmussen joins to discuss the potential benefits of non-hallucinogenic psychedelic drugs currently in development. Dr. Rasmussen is the Chief Scientific Officer at Delix Therapeutics and was previously at the National Institutes of Health where he led the Division of Therapeutics & Medical Consequences since 2018. Here, he directed the medications development program and played an integral role in evaluating the safety and efficacy of pharmacotherapies, behavioral therapies, and devices to treat substance use disorders. He is also Fellow in the American College of Neuropsychopharmacology and has over 100 publications and patents to his name. Dr. Rasmussen begins by discussing the ways psychedelics can bring out physical changes to brain structure, mentioning that this is an important mechanism for the therapeutic effect of these medicines. He mentions that these structural changes are theorized to be relatively distinct from the experiential, hallucinogenic component of psychedelics, and as such it may be possible to develop new drugs which condition the same cascade of events in neuronal structure without leading to intense subjective experiences and major alterations in perception. But what would the benefits of such drugs be? Dr. Rasmussen explains that the availability of non-hallucinogenic psychedelics could have the potential to significantly increase the accessibility of these substances and their associated therapies—both in populations for whom contraindications exist for traditional psychedelic medicines (such as patients with schizophrenia) and for individuals who may be resistant or fearful of the hallucinogenic experiences that can come with psychedelics. Rather than attempting to replace traditional, hallucinogenic psychedelics, Dr. Rasmussen hopes that these non-hallucinogenic alternatives would be able to serve populations or conditions where current psychedelics are not the best option. In fact, Dr. Rasmussen suggests that perhaps hallucinogenic and non-hallucinogenic psychedelics could be used powerfully in conjunction with one another, hypothesizing that the personally meaningful journeys conditioned by traditional psychedelics may be more effective for kickstarting healing from a condition like depression, but perhaps the non-hallucinogenic substances could be more convenient maintenance, as they would not require regular intense experiences facilitated by specially trained therapists to continue promoting neuroplasticity. Dr. Rasmussen does emphasize, however, that a psychotherapeutic component would still be recommended even with non-hallucinogenic psychedelics, as the combination of medication and therapy leads to greater efficacy. But, this also depends on the particular condition being treated. A patient with a mental health condition will likely benefit from the addition of therapeutic work, but a patient who is exploring psychedelic treatment for something like migraines or cluster headaches may only need the structural changes caused by these substances in the brain in order to feel better—another reason why non-hallucinogenic psychedelics may be preference for certain patients with various conditions.  In closing, Dr. Rasmussen reiterates that the exploration of non-hallucinogenic psychedelics is all about increasing patient options and broadening the cools in the psychiatric toolbox to tailor treatments to particular patients and conditions. Whether hallucinogenic on non-hallucinogenic, Dr. Rasmussen sees psychedelic medicine as an important and promising paradigm shift in psychiatry.    In this episode: How both hallucinogenic and non-hallucinogenic psychedelics may be used together to reach a greater patient population Why the hallucinogenic component of psychedelics may not be necessary for their efficacy Contraindications involving the hallucinogenic component of psychedelics Potential cardiovascular concerns with regular psychedelic use due to action on serotonin receptor 5-HT2B  Why it may be desirable to have a range of psychedelic medications which produce different intensities of subjective effects to treat a wider range of patients   Quotes: “There are changes in your brain as a result of administration of these compounds that occur. It’s not just a sensory and emotional experience, but actually there are physical changes in your brain, in different circuits, very specific circuits.” [5:28] “SSRIs and other antidepressants can have effects by themselves, psychotherapy can have an effect by itself, but the real efficacy, the magic is when you combine the two and I have no doubt that these compounds [non-hallucinogenic psychedelics] will benefit from psychotherapy associated with it.” [11:07] “We need more options for patients for sure, and hopefully the psychedelic medications with the hallucinations will help a certain set of patients and hopefully we’ll have other non-psychedelic compounds that are neuroplastic that will help patients.”  [18:25] “I think different compounds will be affecting different circuitry or different microcircuits… in the brain so that different compounds will have varying levels of efficacy for different indications, and like I said the indications can be from neurology to psychiatry.”  [25:58]   Links: Dr. Rasmussen with his puppy Ruby Dr. Rasmussen on LinkedIn Delix Therapeutics website  Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Max Wolff joins to discuss his 2020 study exploring how psychedelics can facilitate the healing process of “letting go.” Dr. Wolff is a psychologist, psychotherapist and head of psychotherapy training and research at the MIND Foundation. He is also therapist and researcher in the EPIsoDE Study, a government funded clinical trial investigating psilocybin-augmented psychotherapy for treatment resistant depression at CIMH Mannheim and Charité Universitätsmedizin Berlin.  In this conversation, Dr. Wolff shares insights from his study, “Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance,” which appeared in Frontiers in Psychiatry in February 2020. In this paper Dr. Wolff and colleagues explore how psychedelic assisted therapies can help patients work through maladaptive avoidant behaviors at the root of many mental health conditions. Dr. Wolff explains that there are two fundamental motivations systems at work in human beings—the approach system and the avoidance system. In healthy individuals, both of these have important and adaptive roles to play as people work towards goals and seek balance in life. However, adverse experiences in unsafe environments can cause individuals to develop unhealthy avoidance, often leading to mood disorders such as anxiety and depression in more severe cases.  One of the goals of psychotherapy—psychedelic or otherwise—is to facilitate a safe container where an individual can work through avoidance, says Dr. Wolff. Psychedelic assisted therapy may be especially effective to this end, as the introspective nature of the experience precludes avoidant thought patterns or behaviors and there is nothing to use as a distraction in the therapeutic context. However, this isn’t the only way psychedelics facilitate the process of letting go.  Dr. Wolff also discusses the effect of psychedelics on relaxing the beliefs of the patient. This recent theory, called “relaxed beliefs under psychedelics” (REBUS), considers how psychedelics encourage an open mindedness and curiosity around perceptions and ideas that would often be dismissed or ignored in sober states due to rigid structures of beliefs and assumptions. This is important in the context of avoidance, Dr. Wolff explains, as it means that the patient is primed to explore issues where typically an avoidant response would be triggered due to a fixed belief about the stressfulness of the topic at hand.  As a result, psychedelic assisted psychotherapy can be particularly effective in empowering patients to revise avoidance-related beliefs at the root of many mental health conditions. By helping patients work through fear and let go of traumas and stress around tender topics, Dr. Wolff thinks psychedelic therapy can make an important contribution to the broader field of psychotherapy.    In this episode: The approach and avoidance systems of human motivation How avoidant behaviors can develop into mental illnesses  How working through avoidance is crucial for both conventional and psychedelic therapies The experience of avoidance in psychedelic therapy and how this can be conducive to acceptance  How the idea of relaxed beliefs under psychedelics intersects with avoidance Different mechanisms for MDMA and classic psychedelics for facilitating letting go   Quotes: “The less favorable the environment is, or the conditions in which we develop are, the more likely we are to have interactions with our environment that are threatening to our psychological needs, or even perhaps violating to our psychological needs—that is where a lot of avoidance behaviors or avoidance schemas can develop.” [5:43] “Only by withstanding the urge to run away, and only by breaking this vicious circle of avoidance, you get the chance of revising the assumptions that underlie the anxiety.” [27:42] “In psychedelic experiences, one factor that may work in concert with this operant conditioning process of learning to let go is the emotional depth and richness that comes with psychedelic experiences and also the increased likelihood of actually encountering deeply felt fears.” [30:00]   Links: Dr. Wolff’s study: “Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance” MIND Foundation website MIND Foundation training for aspiring psychedelic therapists Psychedelic Medicine Association Porangui