Can Psychedelic Therapy Go Mainstream?

Aisha Roscoe, and this is a Sunday story from Up First, where we go beyond the news of the day to bring you one big story.

Today, we're going to take a trip through the world of psychedelics.

Now, for me, that word makes me think of party drugs like LSD and ecstasy and magic mushrooms, you know, people going on a trip far out.

But in the last few decades, there's been a surge of research showing that psychedelics can help with mental health conditions that can be very hard to treat, like PTSD, depression, addiction.

Still, there are major obstacles to the widespread use of psychedelics, including the fact that they're illegal under federal law and that doctors can't prescribe them.

Last summer, it seemed like there might finally be an opening for psychedelics to become a part of the medical mainstream.

The FDA reviewed its first official application for a psychedelic treatment, a version of ecstasy known as MDMA to treat PTSD.

But the FDA ultimately rejected the application, citing flawed data and questionable research.

This was a sign for many people in the industry that it could be years before psychedelic treatments would be federally approved.

But a couple of months ago, the federal government changed its tune.

U.S.

Health Secretary Robert F.

Kennedy Jr.

recently told members of Congress that he wants to expedite the approval of psychedelic treatments.

This line of therapeutics has a tremendous advantage if given in a clinical setting,

and we are working very hard to make sure that that happens within 12 months.

Joining us now is NPR's Rachel Carlson.

She's a producer on our science podcast, Shortwave.

Today on the Sunday story, Rachel takes us through the current state of psychedelics research from neuroscientists who are working to overcome obstacles to the use of these drugs and therapy to a company that's found another way to increase access by turning to the drug ketamine.

Rachel, welcome to the podcast.

Hi, Aisha.

Thank you.

So Rachel, before we get into the science of how psychedelics work to possibly treat depression, PTSD, anxiety, and more,

I want want to ask probably like a very basic, maybe simple question.

What's wrong with our current treatments for depression and PTSD?

Why do we have to look into psychedelics?

Honestly, Aisha, I don't think that's a basic question at all.

And I think the answer really comes down to the fact that there's not necessarily anything wrong with the treatments that we have now.

It's that there's this big need for alternatives.

One estimate from the CDC shows around 13% of Americans over the age of 12 have symptoms of depression.

So that's one in eight people.

And at least a third of those people have depression that's considered treatment resistant, which means the treatments we have now, like antidepressants or SSRIs, just don't work for them.

So that's a lot of people who really need a different option.

So how do psychedelics work in the brain?

Like, how are they different from SSRIs like Lexapro or, you you know, Prozac or something like that.

So, right now, researchers think psychedelics work by increasing something called neuroplasticity.

And I talked to one neuroscientist about this.

My name's David Olson, and I'm a chemical neuroscientist.

He researches psychedelics at the University of California, Davis.

And Olson used this metaphor I've come across a few times, which is that the neurons in the human brain are kind of like trees.

It really does look like the arbors of trees.

And just like in a healthy forest where the the trees are thick with branches and leaves, a healthy brain is buzzing.

It's full of growth, connections.

Think of a forest in spring.

It's lush, active, everything's working together.

Here's Olsen.

Another way I like to think about it is: if you have a very rich canopy, squirrels can hop from one tree to the other very easily.

Just like neuronal impulses can transfer from one cell to the next very easily.

But when people have conditions like depression, it looks like winter time.

You know, all of the leaves have fallen off the trees, and now there's not that physical connectivity between adjacent neurons.

And that lack of connectivity within the brain, some research suggests that it can have an effect on mood.

So existing treatments like SSRIs, you mentioned Lexapro, Prozac, those can also help these connections regrow, but they can often take weeks or even months to make a difference if people respond to them at all.

So when it comes to psychedelics, the idea is that they could make this happen in a matter of hours or days.

And produce therapeutic effects that can last for weeks to months after just a single dose.

I mean, that seems like a really big deal,

especially if you're struggling with depression.

It is.

It's a really big deal.

And I will say, a lot of this research is happening on animals, and researchers think something similar is happening in humans.

So there's a lot more that needs to be understood.

But as much of this research was picking up in the early 2000s, Olson told me these discoveries led to a kind of paradigm shift for modern psychiatry and neuroscience.

Because it was moving us, you know, more towards a healing-based approach, where if you take a drug once or a few times, that could lead to long-lasting therapeutic benefit.

So now you're not thinking about taking a drug every single day for the rest of your life.

In the last several years, there's been even more excitement around psychedelics as a therapy.

So much so that a lot of people are calling this a psychedelic renaissance.

But Aisha, you mentioned before, one of the biggest obstacles to more research and use of psychedelics is they're illegal.

Things like psilocybin, LSD, MDMA, these are all categorized as Schedule I substances by the DEA, which means they're among the most highly restricted drugs in the country and illegal under federal law.

And as of today, none of them have been FDA approved for any kind of medical use.

There are ongoing clinical trials, but right now, psychedelics aren't available in most doctors' offices.

When we come back, what will it take for psychedelics to show up in doctors' offices?

Rachu tells us about two neuroscientists who have tried to figure that out by taking the trip out of psychedelics.

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We're back with a Sunday story.

So, Rachel, let's talk about the trip.

You know, so far we've talked about the neurological side of psychedelics, but the trip,

the hallucinations, that out-of-body experience,

that's the thing that I think most people probably think about when you bring up psychedelics, right?

Totally.

And this question is also kind of at the heart of what's going on in the science of psychedelics therapy now, because that trip can kind of be a problem when it comes to getting psychedelics to go mainstream.

I mean, I would imagine, you know, people can't just be tripping all over the place, but, but, but how specifically?

Like, what are the specific risks?

I mean, tripping can be dangerous, especially for some people, like people who have bipolar disorder or schizophrenia.

The trip can make those conditions worse.

And you probably don't really want to or shouldn't do things like go to work while you're tripping.

So it gets in the way of day-to-day activities.

Basically, it adds another layer of risk for drugs like psychedelics.

So while scientists are seeing a lot of potential here, some have started to wonder how important this whole trip is.

And if people could get those same benefits in their brains without tripping at all.

But what are psychedelics without the trip?

Such a good question.

And if you remember David Olson, he's the chemical neuroscientist at UC Davis.

This is what he told me.

We need to have something that is so safe that you can simply pick it up at your local pharmacy, bring it home, and put it in your medicine cabinet.

So he wants this to be like a regular antidepressant that you just run out to CVS or to Walgreens and then you just take it home.

Yeah, he's thinking about this from a pharmaceutical perspective, where you just take a pill and you go about your day-to-day life.

He co-founded a company called Delix Pharmaceuticals, where he's trying to engineer drugs like psychedelics to remove the trip.

So how do you take a psychedelic and engineer the trip out of it?

Olson told me it's kind of like playing with molecular bricks of Lego.

When we optimize our structures, we don't change them too radically.

We just move things around a little bit here and there, make them better versions of themselves.

So, Olson thinks this method could be one way to give more people access to the potential benefits of drugs like psychedelics.

Although, I should say that while Delix Pharmaceuticals' early research is promising, there's definitely more research that they'll need to do.

In the meantime, Aisha, I want to tell you about another scientist I spoke to who's also interested in removing the trip from psychedelics, but with a bit of a different perspective.

He wants to improve the research behind why these drugs work the way they do.

Okay, how is he doing that?

Let me start with a little bit of context, because there's this problem that's plagued psychedelic research basically since its inception.

And that's that when scientists want to prove that a drug or treatment actually works the way they want it to, they usually set up what's called a controlled study so that they can say that the treatment or the drug is what's really working on people and not something else.

So it's not the placebo effect.

Exactly.

So in a controlled study, one group gets the drug or treatment and another group gets a placebo.

And it's really important that neither group knows which one they're in.

But in a psychedelic study, this is actually very hard to do.

Because if you take the drug and you start to feel like you're floating, you know you got the real stuff, right?

Yeah, if you're tripping, if you're seeing things, you're going to know that you didn't get a placebo.

And that's a really big problem for the whole industry.

Let me introduce you to Boris Heifitz.

He's a neuroscientist and anesthesiologist at Stanford.

He's been working on a solution to this big problem.

So a lot of people actually have been talking about this for years.

Like, well, what if you just knock someone out?

So his idea is that you could put everyone in the study to sleep and then administer the drug or placebo.

And he was like, I'm an anesthesiologist.

I can do that.

So I found myself with a particular niche that I was very excited to fill.

So

tell me more about this study.

Like, how did he pull this off?

So in this study, Heifitz worked with 40 people who were all diagnosed with major depression.

And all of those people were also scheduled to have some kind of routine surgery where they were going to go under general anesthesia.

So the participants go in for their surgeries, they get their general anesthesia, they go to sleep, and then they're either given an infusion of the drug or placebo.

And the drug Heifitz was testing was ketamine.

Now, why ketamine?

Like, is that a psychedelic?

So technically, ketamine's not a psychedelic, but if you remember how researchers think psychedelics could help regrow the neurons in the brain, kind of like those trees in a healthy forest, and how that may help treat conditions like depression, scientists think that ketamine might have a similar effect on the brain.

So Heifitz is interested in understanding psychedelics more broadly, but ketamine's long been used medically as an anesthetic and it's a Schedule III drug, so it's a little bit easier to study.

So what did he find out?

Something he really did not expect.

But before I tell you about that, I want to introduce you to one of the patients in his study.

Hi, my name is Cindy Dahlman.

When she agreed to do this study, Dahlman was in her late 50s and scheduled for an appendix surgery.

But she'd also been dealing with depression for pretty much her entire life and said she was at a particularly low point.

I'm from Santa Cruz.

Life should be wonderful at the beach, right?

But it wasn't in my head.

And

I just fell into a depressed spiral.

So as part of the study, she went in for her surgery like normal.

I was nervous.

I was still depressed.

But I was feeling hopeful.

So what happened when she woke up?

Here's what she told me.

It was like the next day that I really felt the overall,

oh, this is something's different, you know.

I did have a little bit of a bluebird on the windowsill kind of feeling, the joyfulness of more awareness of the presence of the day around me.

and not just the funk in my head.

Did she actually get the ketamine?

Yeah, she did.

But remember, when she got it, she was under anesthesia, so she had no idea.

And Heifitz told me that in Dahlman's group.

The patients who got ketamine came in with depression and got a lot better.

50 to 60% of our patients saw a halving of a symptom load.

30% met criteria for remission from treatment-resistant depression.

I mean, who wouldn't be happy with that result?

And then Heifitz told me about a different patient who also had depression.

This was like her, you know, and like fifth like cancer surgery.

Like this had been a recurrent cancer.

She'd been through the ringer.

He saw this other patient a couple of days after her surgery.

She was almost like dancing.

This is, you know, someone who had like a lot of stuff in their belly, like still had drains, bandages.

I thought to myself at the time, like, if she didn't get ketamine, like, I'm quitting.

So this woman was definitely not in the placebo group, right?

Or did he have to quit?

He didn't quit, but she was in the placebo group.

That's mind-blowing.

How is this happening?

No, it's super confusing.

Like, I was confused when I first read the study.

Heifitz told me he was confused because statistically, when they looked at the results, everyone in the study got better, the ones who got ketamine and the ones who were in the placebo group.

They were indistinguishable from the patients who got ketamine.

So

that was a surprise and actually very difficult for us to wrap our heads around.

Okay, well, that's a trip right there.

Where does that leave Heifitz then?

So, I mean, I guess just to preface this, it's one study.

It was 40 patients.

But Heifitz told me that the findings of the study made him think a lot about the importance of all the parts of psychedelic or ketamine therapy that aren't the drug.

It's what he calls the non-drug factors.

Like hope, expectations, and integrating change.

Like, that's all, that's what drove this big therapeutic effect.

So the experience around taking the drug clearly matters.

At least that's what Heifitz told me he took away from this study, that the experience around the drug is hugely important for healing.

And that includes things like therapy, support systems, and even the expectations a patient has.

It's not just chemical.

Heifitz told me his discovery points to a need to see psychedelics holistically.

So there are lots of questions that researchers are still grappling with to make psychedelics safer and more understood.

But while they're doing this research, ketamine is already going mainstream and companies are facilitating sending it straight to people's homes.

More on that after the break.

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We're back with a Sunday story.

So, so Rachel, before we get into at-home ketamine therapy, let's talk more about ketamine and what it is for a second and

help me to understand like just how similar is it to a psychedelic.

So people can still get kind of like a trippy feeling, but it really depends on how much a person takes.

So it could feel like anything from being a little bit drunk to a complete dissociative experience.

So someone might feel like they're separated from their own body.

And it lasts anywhere from 45 minutes to two hours versus something like LSD, which might last at least most of a person's day.

And technically speaking, it's not considered a psychedelic at all because scientists think that ketamine works by binding to a different receptor in the brain.

But the key thing with ketamine when it comes to people actually using it for mental health conditions is it's currently way more accessible to patients.

Doctors can legally prescribe ketamine right now.

In fact, there's one FDA approved version of ketamine to treat depression.

It's a nose spray called Spravado.

It's like a chemical cousin of ketamine.

And patients have to take it in a doctor's office under medical supervision.

But because ketamine is already legal as an anesthetic, doctors can also prescribe it through something called off-label use.

So that's when they'll prescribe a drug for something that it hasn't been specifically approved to treat.

And this is a pretty common practice.

In this case, it means they can prescribe things like ketamine injections and lozenges for a variety of conditions, including things like anxiety, depression, or PTSD.

And that's kind of how, in the last few years, ketamine has really burst onto the scene.

Right.

I mean, I've heard a lot about ketamine in the news with people like Elon Musk, who has said he's used prescription ketamine in the past.

Yes, it's been all over the news.

And this was interesting to me because a lot of people sort of lump it into the same bucket as psychedelics.

And there are these companies that will even facilitate sending ketamine directly to your home.

So tell me about one of these companies.

One of those companies is called Mind Bloom.

I wanted to talk to them because it's the largest at-home ketamine therapy provider in the United States.

So I talked to the founder and CEO, Dylan Binan.

We provide at-home ketamine therapy for people with anxiety, depression, and PTSD.

And we've brought the cost down to make it affordable for everyday Americans.

So Aisha, if a person goes to a clinic and gets a dose of ketamine there, the cost of sessions can range a lot, but they can get up to about $1,000 each.

People also need to get someone to drive them to and from their treatment, maybe take time off of work to do that.

But if they go through Mind MindBloom, their website says that a session for new clients can range from $150 to $200.

And their clients do their treatment at home.

Okay, so walk me through like how this process works.

Yeah, so for MindBloom, they start with a psychiatric evaluation.

This happens virtually.

A licensed clinician meets with a client on a video call and goes through their medical and psychiatric history, and they'll determine their diagnosis and make sure that the patient is eligible for ketamine therapy.

And if they're cleared to receive treatment, the clinician who works with MindBloom will write a prescription for ketamine, and that prescription is then fulfilled by a pharmacy that delivers the ketamine straight to the client's home.

What they also get in the mail is a whole kit that includes things like an eye mask, a blood pressure cuff, and a journal.

And Binan also told us that MindBloom has an app that clients download with things like soundscapes and journaling prompts.

And then after their sessions, they're going to integrate.

And so after everybody's session, they voice journal into the app and they get integration tips and practices for how they can really make changes in their life while they're in this neuroplastic state.

I mean, this sounds almost like a self-care routine,

but it's a powerful drug.

Are there still some things that could go wrong?

Absolutely.

Ketamine can make people feel dizzy, nauseous, panicked.

It can also increase their blood pressure, and it could induce more serious side effects like a stroke or a heart attack or heart arrhythmia.

I do want to make clear that MindBloom is far from the only company involved in sending ketamine to people's homes.

In the last few years, there have been at least a dozen companies popping up that provide this service.

and some medical professionals have started to express concern about this growing industry as a whole.

The FDA, for example, issued a statement in 2023 specifically warning that using ketamine at home without monitoring from a healthcare professional comes with serious risks.

And when I heard this, I also wanted to reach out to the American Psychiatric Association, the APA, for another perspective.

I got an email back from Dr.

Gerald Bush, who works on the Council on Addiction Psychiatry.

And he wrote that they have significant safety concerns about at-home ketamine therapy.

His main concern is that there's not immediate medical help if something does happen at a patient's home.

He's also worried that the at-home industry doesn't have regulatory oversight when it comes to things like consistent safety and dosing standards.

So

how does MindBloom, for example, manage all these risks when their clients take ketamine at home without a doctor present?

I asked them this question, and this is what they told me.

They said, quote, not all ketamine therapy programs are created equal, and its protocols are developed by leading experts in psychiatry.

They also pointed me to two peer-reviewed studies, including one they published last year, that had over 11,000 of their clients.

One of the key findings they highlighted there is that fewer than 5% of those clients reported any adverse effects.

They also walked us through their safety protocols.

So before clients start treatment, MindBloom says they screen for medical conditions.

And for the first session, they take the ketamine with a company-trained guide on Zoom.

This guide serves as kind of a facilitator or coach for the client's experience, but they're not a medical provider.

Before and after each session, clients monitor their own heart rate and blood pressure with a cuff the company provides.

And MindBloom also requires clients to have an adult nearby each time they take the ketamine.

That's what they call a peer treatment monitor.

So, if something does go wrong and it's minor, that person's instructed to reach out to MindBloom's on-call clinician, but if it's a medical emergency, they're told to call 911.

So, Rachel, it's clear through all of this that there are people who are really enthusiastic about what psychedelic therapy and ketamine could do.

And then there are others who are, they're sort of pumping the brakes a little.

When you take a step back, how do you see it?

It's honestly still a really hard question to answer because in my reporting, I talk to all of these people who are weighing the serious risks and serious benefits of these drugs in really different ways.

So, on the one hand, clearly people need access to new treatment options, and they need those options soon.

Ketamine and psychedelics are promising.

On the other hand, these are all really powerful drugs, and there are risks to using them.

But some patients have decided that that risk might be worth it.

Cindy Dahlman, for example, the patient in Boris Heifit's study who received ketamine, still isn't totally sure if the drug is what made her feel better.

I went in overall just hopeful, you know.

So,

did I play a part in that?

Was it mindset?

Was it ketamine?

I don't know.

But what she does know is that something made a difference.

I still felt joyful inside.

Well, Rachel, thank you for bringing us this very

significant reporting on psychedelics and ketamine.

This just seems so important because it could really change people's lives.

Yeah, thanks, Aisha.

This episode was produced by Kim Nader Fame Petersa and edited by Justine Yan.

Reporting for this episode was brought to you by NPR Shortwave Podcast.

Rebecca Ramirez and Jeff Brumfield edited the original series.

Fact-checking help from Tyler Jones.

Mastering by Quacy Lee.

Thanks also to Micah Ratner.

The Sunday Story team includes Andrew Lombeau, Ginny Schmidt, and our senior supervising producer Liana Simstrom.

Andrew Serunik is our fellow.

Irene Naguchi is our executive producer.

I'm Aisha Roscoe.

Up First is back tomorrow with all the news you need to start your week.

Until then, have have a great rest of your weekend.

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