The healing power of psychedelic drugs

It might not be the first place you think of if you’re looking for a place to get high, but people regularly come to the University Centre for Psychiatry to do exactly that. Some of them only visit once, to pick up five psilocybin capsules. Psilocybin is the active substance in psychedelic mushrooms. Others have regular appointments several times a week. They’re being prescribed ketamine.

But aren’t these psychedelic drugs illegal substances used by people in clubs and the like, sometimes with disastrous results?

Yes, says Robert Schoevers, professor and head of the psychiatry department at the UMCG, who specialises in therapy-resistant depression – the kind of depression that persists in spite different medications and therapy. ‘About ten years ago several small, isolated studies came out describing the positive effect of ketamine on persistent depression.’

Exploratory study

Schoevers, who has been working to help clinically depressed people for years, was intrigued by the idea. He says the suffering that depression can cause is mind-blowing. ‘It’s the mental equivalent to cancer. People can’t appreciate the sunshine, they don’t want to do anything or see anyone, and they have an extremely negative self-image. They can no longer function as a father, as a partner, as an employee… a lot of people think they would be better off dead.’

After hearing about the positive results from the exploratory studies, Schoevers became one of the first people in the Netherlands to set up his own study treating therapy-resistant patients using psychedelic drugs.

People got their lives back

So what were the effects? Schoevers cautiously reports that he saw ‘something’ happen in approximately 40 percent of his patients. For some people, the solution was long-term: ‘People got their lives back.’ But others only improved slightly, and the majority didn’t experience any change. The researchers also had no way of predicting which patients would benefit from the treatment. ‘This mainly showed that we needed to do a more large-scale study’, says Schoevers.

This larger, placebo-controlled study, a collaboration between the RUG, UMCG, the UMC Utrecht and institutes in Nijmegen and The Hague, has been running for two years now. Eventually it will involve over a hundred subjects.

Compassionate use

His ketamine research isn’t restricted to this large-scale study. The group at the UCP is also working with a small group of patients who are administered the drug as a last resort. These people have been through every kind of treatment possible and can no longer be helped by conventional healthcare methods. They’re ready to give up and have sometimes even started proceedings at an end of life clinic. ‘We give them the drug for compassionate use’, says Schoevers. ‘We developed a specific protocol for that. It can lead to positive or even really positive results in several ill people.’

The UMCG also started an unusual trial in which Schoevers collaborates with the universities of Leiden and Utrecht, as well as centres in Europe and North America. Parallel to the ketamine study is the psilocybin study, in which over 200 patients will be administered psilocybin, the active substance in magic mushrooms, under controlled circumstances and in the presence of two trained counsellors. There are indications that this substance can also help with depression. But scientists know less about how it works than they do ketamine.

Blurred lines

Here’s what happens when you get high on shrooms: the areas of the brain that don’t usually communicate start doing so. So people who are high often have new, intense experiences: feeling one with the universe, seeing amazing colours, having life-changing insights.

‘The lines between you and the rest of the world become blurred’, says Schoevers. ‘But that’s not all; the lines between you and your past experiences start to blur as well: suppressed memories, traumatic experiences.’ Patients in psychotherapy might get a boost from this treatment and often start improving.

It’s a really intense experience. Like your brain gets a factory reset

Even after the trial ends, the ketamine will be administered regularly. But the the psilocybin treatment is a one-off. ‘The study is still in its exploratory stages. We’re still trying to work out the most effective dosage for example.’

The patients are willing to wait for the doctors to get it right. ‘It’s a really intense experience. Like your brain gets a factory reset’, says Schoevers. ‘Besides, the experience has to land and be processed calmly, through talks with the psychotherapist.’

The most exciting thing about either substance, says Schoevers, is that they work completely differently than the antidepressants we currently use. These are aimed at the amount of serotonin, norepinephrine, or dopamine in the brain – neurotransmitters that can make people feel good. Popular knowledge says that when you don’t produce enough of these specific neurotransmitters, you are depressed.

Activating effect

But ketamine affects a different neurotransmitter: glutamate. Glutamate is plentiful in the cerebral cortex, and it has a strong activating effect on other nerve cells. Psilocybin does effect serotonin and dopamine, but not in the same regular antidepressants do. For one, it can cause hallucinations.

‘Both drugs have an effect on the brain’s neuroplasticity’, says Schoevers. ‘That’s the brain’s ability to create new brain cells and make new connections. This plasticity is diminished in people who suffer from depression. The brain’s activity pattern is out of balance.’

That’s why depressed people have such a hard time motivating themselves to do things, and why they can’t control their worry response. ‘The parts of the brain that are focused on fear, stress, and aggression are all working overtime. At the same time, cognitive control, the ability to calm yourself down, doesn’t really work. But the balance can be restored through treatment.’

Schoevers worries about people thinking psychedelics are miracle drugs

In some cases, psychotherapy and regular antidepressants are enough to restore balance. But not always. ‘The brain is a really complex organ. In treatment we only pull on a single thread, but that can lead to all kinds of secondary effects down the line.’ Schoevers thinks it’s possible that ketamine, with its dissociative effect, might be able to restore that balance via a different route.

Party scene

It also helps that the effects are visible very quickly. While it can sometimes take several weeks of regular antidepressants for patience to notice results, the effects of ketamine can be observed within a few days or even hours.

The research gives him hope, but Schoevers and his research coordinator Maurice Vischjager are cautious, too. They worry that people will get the impression that psychedelics are a miracle drug. ‘It’s medication’, Vischjager emphasizes. ‘And that means that it also doesn’t work for a lot of people. And we know very little about the effects on people with serious psychological problems.’

He worries people might think they can just buy the drugs they need for treatment on the party scene. But they can never know for sure what they’re taking, since magic mushrooms contain much more than just psilocybin. People have no control over the quality or quantity of the ingredients.

‘We would really not recommend it. We work with synthetic, pure substances. Ketamine dosages you get on the party scene are often higher by a factor of a hundred to what we prescribe’, says Vischjager. ‘You’d be taking an enormous risk.’

Are you suffering from severe, chronic depression and have you cycled through various treatments options without success? You might be a candidate for the ketamine study or the psilocybin study at the University Centre for Psychiatry.

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