PSYCHEDELICS: CAN THEY TREAT TRAUMA?

In recent years, interest has grown around utilizing psychedelics as novel treatments for a variety of mental health concerns, including Post-Traumatic Stress Disorder (PTSD). Though we have a number of evidence-based therapies for PTSD, some people do not achieve symptom relief with these therapies alone. For this reason, researchers have been exploring the potential benefits of supplementing traditional psychotherapies with psychedelics as a means to improve treatment outcomes.

What is a Psychedelic?

According to the Cleveland Clinic Journal of Medicine, psychedelics are drugs that “significantly alter perception, cognition, mood, affect, social relatedness, and sense of self or meaning.” Psychedelics have potential therapeutic benefit because they seem to promote neuroplasticity which can in turn lead to more flexible thought patterns and positive behavioral change.

Which Psychedelics Have Been Used to Treat PTSD?

Interest in psychedelic-assisted therapy for PTSD has focused largely on MDMA and psilocybin.

MDMA was first synthesized in 1912, though its psychoactive potential was not understood until the 1970s. It has the capacity to reduce fear, increase empathy, compassion, and other positive emotions, and increase feelings of closeness and connection to others. It is thought to aid in the healing of PTSD symptoms through facilitating disclosure of emotional material, lessening stress responses, increasing self-compassion, promoting the unlearning of negative, trauma-related beliefs, and reducing fear and fear-based avoidance.

According to the VA, “Psilocybin is the active ingredient in a variety of hallucinogenic mushrooms.” When ingested and converted into psilocin, it induces “journeys” that last 4-8 hours during which individuals experience visual distortions, synesthesia, feelings of connectedness, and a letting go of the ego. There is hope that psilocybin could support PTSD healing through encouraging positive personality change, heightening a person’s sense of wellbeing, reducing fear, promoting the development of new neurons and neural connections, and allowing for emotional breakthroughs.

What Does the Research Say?

Studies on incorporating MDMA in PTSD treatment have produced promising results. Multiple randomized-controlled trials (RCTs, generally considered the “gold standard” for scientific research) have found that participants who received MDMA-assisted therapy saw significantly greater reductions in PTSD symptoms compared to those in control groups. For instance, phase 3 clinical trials conducted by Lykos Therapeutics found that over 70% of individuals who received three sessions of MDMA-assisted therapy no longer met diagnostic criteria for PTSD compared to 48% of those in the control group.

Because of these positive results, Lykos Therapeutics applied to the FDA for approval of MDMA-assisted PTSD therapy in 2023. The FDA responded in August 2024 denying this application and requesting further study of treatment safety and efficacy. Many view this decision as a major disappointment and an obstacle to bringing psychedelics into clinical mental health practice. Others, however, have emphasized that hope should be drawn from the FDA’s indications of receptiveness to psychedelic research.

Psilocybin has yet to be studied specifically for the treatment of PTSD. It has, however, been shown to reduce symptoms of depression and anxiety in multiple RCTs. Because depression and anxiety commonly co-occur with PTSD, it is thought that psilocybin has significant promise for PTSD treatment as well. Psilocybin-assisted therapy for PTSD has been identified as an area for further research.

is it legal?

MDMA and psilocybin are still classified as Schedule I substances, making them illegal at the federal level. Right now, the only way to access MDMA-assisted therapy legally is through enrollment in a clinical trial. With respect to psilocybin and some other psychedelics, Colorado is a unique case. Colorado voters passed proposition 122 in 2022 which decriminalized the use and possession of psilocybin for people 21 and over as well as authorized the creation of licensed facilities where individuals can receive psychedelic-assisted therapy.

That said, Coloradans have the ability to access psychedelic-assisted therapy and be guided through this process by a licensed facilitator. Therefore, at this point, the biggest obstacle to accessing psychedelic-assisted therapy for those who are interested in this novel treatment is cost. Insurance generally does not yet cover psychedelic-assisted therapy, and the cost of one round of psilocybin-assisted therapy can be many thousands of dollars.

Important Notes

There are a lot of reasons to be excited about the therapeutic potential for psychedelics in healing trauma and PTSD. At the same time, it is important to see the full picture of where we are at presently and to have realistic expectations of what these medicines can and can’t offer.

First, it’s important to name that both MDMA and psilocybin are commonly used as recreational drugs. Using these drugs recreationally is a very different experience than using them therapeutically, where great emphasis is placed on “set and setting” to help ensure a positive and meaningful experience. If you use these substances recreationally, do not expect that they will treat any mental health symptoms you might have.

Next, psychedelics are not a stand-alone treatment for trauma or PTSD. They are meant to be one component of a broader treatment plan that also incorporates more traditional talk therapies or trauma treatments in the preparation and integration phases. In short, these medicines by themselves are not quick fixes or cure-alls.

Further, there is still a lot we don’t know. Though researchers have theories about why psychedelics can help treat mental health symptoms, how exactly they affect the brain is not yet well understood. Further, many have pointed out that, though studies of psychedelics have attempted to “blind” participants to whether they are receiving the medicine or a placebo, in actuality it is often obvious to participants which they have received which makes drawing conclusions about the effects of the medicines challenging.

In addition, psychedelics are not risk-free. They may not be safe for everyone, such as individuals who have predispositions to psychotic illnesses. They also have the potential to produce high levels of distress, trigger flashbacks, interact negatively with other medications a person might be taking, worsen pre-existing medical conditions, or to be misused (though addiction risk is generally considered low).

Lastly, we must acknowledge the deep roots of plant medicine within Indigenous cultures. Indigenous peoples all over the world have used plant medicines for centuries as a part of sacred healing work. As Western medicine adopts portions of these ancient practices, we need to be mindful of the potential for harm to be done. Indigenous voices should be central to conversations about research and clinical practice to ensure that Indigenous communities also have the opportunity to benefit from the expanding use and popularity of psychedelics.

Psychedelic-assisted therapy will likely become increasingly mainstream in the years to come. While it is exciting to have different treatment options, it can also be confusing if you are a person who is struggling and don’t know what kind of help you should seek. Conduct your own research and also know that you don’t have to figure this out on your own. A licensed mental health professional can collaborate with you to determine what treatments will be most effective for you.

Please note: This content is for informational and educational purposes only. It is not a substitute for professional diagnosis or treatment. Always seek the advice of a licensed mental health provider or other healthcare professional for guidance related to your specific mental health or medical concerns.