The American military is treated for PTSD and depression with the help of psychedelics. How is this different from simply taking drugs?
These are completely different processes. The treatment is psychedelic-assisted psychotherapy. That is, the basis is still therapy, and the substance is a tool for a better result.
The US and some other countries already have special protocols and safety instructions for such treatment. Psychedelic therapy has three stages. The first is preparatory sessions with a therapist. They are used to determine exactly what disorder the patient has, how severe it is, whether other methods are effective, which substance is better to use and in what dosage. The second is sessions with the use of psychedelic substances. They can last from 4 to 8 hours, depending on the duration of the effect of the psychedelic.
There are two types of sessions. The first is that a person takes a substance and simply experiences its effects while being monitored by doctors. The second is a conversation with a psychotherapist under the influence of the substance. In both cases, the last stage is the integration of the experience lived under substances. That is, during sessions with a psychotherapist, the patient discusses his feelings, thoughts, conclusions, decides how to use them outside of therapy. It works like regular psychotherapy, but the substances "facilitate access" to the psyche.
Does a person just use drugs, talk about it and feel good? How does it work on a psychic level?
Itʼs not that simple. The process depends on what substance the patient is taking. The two most common options are ecstasy or MDMA, and psilocybin.
Now there will be a scientific explanation. MDMA changes connections between several parts of the brain: the prefrontal cortex, which is responsible for consciousness, the hippocampus, where memory is formed, and the amygdala, which activates feelings of anxiety. Thanks to these changes, negative experiences are weakened, and positive ones are strengthened. In such a state, it is easier for a person to speak and realize his or her trauma. And this is the basis of PTSD treatment, because with this disorder, the traumatic memory does not pass into long-term memory, which would allow us to perceive it as the past, but is experienced every time as a present event, from which a person cannot recover.
Psilocybin is extracted from mushrooms. It makes the psyche more plastic — it literally allows areas of the brain that usually interact little with each other to connect. This way, it is easier for a person to come to previously unobvious conclusions, which were previously hindered by fixation on the past.
Another substance used in such therapy is ketamine. In large doses it is an anesthetic, in smaller doses it is a substance, after taking which a person can look at his/her own mental processes from the outside, evaluate them and understand how to help oneself. This is called dissociation.
That is, under these substances, the psyche becomes malleable and vulnerable, and any intervention can make it worse?
It does not depend on the substance, but on the psychotherapist working with the patient. The substance simply facilitates access to consciousness, it is purely a tool. The main work is therapy. There will be no effect without quality therapy. Therefore, patients who choose this method should be sure of the psychotherapistʼs expertise.
After the end of the substance influence, does the positive effect disappear?
No. The state is temporary, but everything remains in the memory. The conclusions reached by a person under the influence of substances are his or her own, experienced and logical, and not just advice from the outside. That is, the psychedelic experience is perceived as a real experience.
But these are drugs, that is, they can cause addiction.
There will be no dependence on them, because the dosages are small. For example, for the treatment of PTSD, two sessions are conducted using MDMA: 120 mg of the substance is taken in the first, and 80 mg in the second. This is 2-3 times less than what is used for regular intake. In 40% of people, symptoms disappear already after the first session. In addition, the patient perceives substance use not as a psychedelic experience, but as part of treatment, which is already a different context than just entertainment that one wants more of.
Due to the small doses and the pure, proven substance, the person doesnʼt get worse after the effect vanishes, as is often the case after taking drugs. In addition, the course of the sessions is monitored by doctors.
However, antidepressants and psychotherapy also help. Why use psychedelics?
We have already said: classical methods of treatment do not always work. Almost half of patients with PTSD have its resistant form — that is, the usual treatment scheme does not give results. But 67% of people with such PTSD were cured after a course of psychedelic therapy. That is, this method is a chance to help people with whom other types of treatment do not work.
In some cases, psychedelics are much stronger than antidepressants — for example, the effectiveness of psilocybin in one study is 4 times higher.
Also, such therapy takes less time — PTSD can be treated for years, and psychedelics accelerate this process, creating conditions for a change in consciousness.
There are stories in the media of those who have been helped by this method. If you are interested, read them here, here and watch the video on The Economist.
Where and how can I undergo such therapy?
This is a fairly new method of treatment. MDMA therapy has passed the third phase of clinical trials in the USA, which means that it may be approved for widespread use this year. Currently, it can be completed under the program of expanded access to certain types of treatment for those who are not affected by other methods. This is how it works not only in the USA, but also in Canada, Israel, and Australia. And in Portugal, Spain, and the Netherlands, this is a non-medical procedure that can be performed by psychedelic experience facilitators, not doctors. Such specialists are trained in state universities and private companies.
In Ukraine, it is forbidden to conduct MDMA therapy or use psilocybin. However, as a medicine for PTSD, ketamine can be taken — though few people know about this and not every doctor will dare to use such therapy.
This is possible because ketamine is registered as a medicine and is a strictly controlled substance. This list is contained in Cabinet Resolution No. 770, which determines the level of access to psychotropic substances. MDMA and psilocybin are prohibited, that is, they cannot be used either in science or in medicine. This can be changed by the Ministry of Health with the consent of the Security Service of Ukraine and the Ministry of Internal Affairs. Then MDMA and psilocybin could be used for therapy only by doctors under police supervision.
Currently, such therapy is carried out illegally in Ukraine — it is dangerous, because no one controls its quality, and it will not be possible to punish for the damage. A legal, albeit expensive, way is to travel with your own therapist to a country where such treatment is permitted. Or find a therapist already there, but this is also a risk.
Translated from Ukrainian by Anton Semyzhenko.
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