Psychedelics for depression making a comeback

Could ecstasy and LSD be used as potential treatments for depression? Speaking at the Hay Festival alongside the UK government’s former chief scientific adviser, Sir Patrick Vallance, Kate Bingham, who led the UK’s Covid vaccine task force, told the audience about evidence suggesting that psychedelic drugs can help people who suffer from some mental health problems. Patrick Vallance said it’s imperative that more research is done. Professor David Nutt is a neuropsychopharmacologist, former government drug “Tsar”…

David - Well, I was grateful that they've actually owned up to what we've known for quite a long time, that there is a major mental health crisis in this country, that current treatments are failing up to 40% of people, and that psychedelics and MDMA do have a very strong evidence base. I was heartened that, at last, people outside of the field are getting interested in and promoting it.

Chris - Both agents are not new. MDMA was made by Merck around the time of World War I - that's ecstasy - and LSD came along a few decades after that. So they're not new drugs. So is this a new use for old drugs or have they been tried in this space before, dismissed because we had better stuff and now we're revisiting them? What's the story behind this?

David - Well, the story is one of what I call the worst censorship of research in the history of the world. These drugs were banned because they were being used recreationally. But the bans were particularly hostile because they banned them as medicines. Even though there was considerable evidence, particularly for LSD (1000 papers published on the clinical value of LSD in the fifties and sixties.) But when it was banned because it was seen to be fueling the anti-Vietnam War movement, they banned it as a medicine as well, which was reprehensible and spiteful. And it has taken us 50 years now, we still haven't overturned the ban, but at least we've got people to accept it is a medicine again.

Chris - What's the evidence base that it can work in people who have particularly intractable depression and things like that?

David - Well, I'm proud to say, it's evidence that we've started to generate at Imperial College. We did the first modern trial of a psychedelic, psilocybin, and people with treatment resistant depression, they'd all failed on these two antidepressants, they'd all failed on CBT, and we had remarkable effects. We had the most powerful effect of a single administration of any treatment in resistant depression there's ever been. And that's led to a lot of companies going off to try to replicate it. And one has already done that. So we probably have a thousand patients now around the world who've shown remarkable benefits just to psilocybin alone. And that evidence base was sufficient for the Australian government a couple of months ago to agree that psilocybin will be rescheduled for treatment resistant depression as a medicine in Australia at the end of this month.

Chris - And those effects aren't just while the person's taking the agent, presumably there is a legacy benefit after the acute effects of the drug - I don't want to say wears off - but you take the drug, you get some more mood altering effects acutely, but then there's a mood altered effect that persists?

David - In our first study, which was 10 years ago, there are some people who well still. The vast majority of the depression creeps back as it does tend to in most people. But we still had very powerful effects, more powerful than any other treatment at six months. So yes, a single administration of these drugs can lead to very long lasting benefits.