The future of psychedelic research

David Nutt told Phil Sansom and Sally Le Page about his research using psychedelic drugs to treat mental disorders...

David - So, our primary target has been depression. We've done two trials of psilocybin in depression. The first showed it was the most powerful treatment ever for resistant depression that a single trip produced 50% reductions in depression scores within a day. Many found quite long lasting benefits. A few of those people from that first trial are well eight years later, and then we went on to compare it with a conventional antidepressant, an SSRI called escitalopram, and again we found it worked on a range of symptoms better than the SSRI. So, now we're moving to other disorders. Currently in Imperial we're doing a study in anorexia and we're setting up a study in obsessive compulsive disorder. You might say, 'well, what they got to do with depression?' The answer is that those three disorders are all what we call internalising disorders. They're all disorders where people get locked into thinking ways of thinking that they don't want to be locked into, but they can't escape. We think that psychedelics might have the power to break down that over-learned that sort of repetitive stereotype thinking.

Phil - 50% reduction in depression scores is a big claim. Can you be absolutely sure that that's not some sort of extra placebo that they get from the actual trip itself?

David - Well, that's clearly a placebo effect of being involved in intensive research treatments, but comparing it with the best antidepressant we've got, which is what we've just done, one of the best antidepressants, and shown and we get significant benefit over and above that, convinces me that this is actually a very powerful, it's more powerful probably than any other treatment we've had.

Phil - Does it last?

David - Well, for some people it does, but for others, it doesn't. This is the big challenge for now, the real research direction is to see how we can maintain the effect. It may be we have to give top-up treatments maybe two or three times a year or it might be we want to do something else. We want to get people well, and then keep them well, perhaps with a traditional antidepressant or some other kinds of psychotherapy. That's where the real research challenges over the next few years.

Sally - So, David, are you suggesting that people with depression go out and take LSD, pop some magic mushrooms?

David - Definitely not. No, because we know that when people with depression have a psychedelic experience, it's generally not pleasant. It's challenging. They often go back to the traumas, which led them to be depressed in the first place. We really don't recommend self medication because you could have a bad trip, which could be very distressing. Our trips obviously always looked out, you know, people who was looked after by therapists, but beyond that, we think there's a real benefit for having the therapist there the next day for what we call the integration session. That's when people talk about the experience, tell the therapist what they saw and the therapist then helps them make sense of their illness, but more importantly, helps them develop ways to recover from the depressive thinking.