With rates of depression and other forms of mental illness through the roof, doctors are crying out for new and better treatments. In the world of research, many eyes have settled on psychedelics like magic mushrooms, which seem to offer patients (and healthy people, too, for that matter) much more than just an unforgettable ride. Are these drugs a breakthrough weapon against the scourge of depression, or more hype than substance?
Van Humphries used to be a world-class rugby player. In 2010, he toured with the Wallabies on their annual trip to the UK, pulling on the gold jersey for two midweek games. Standing over two metres tall and weighing upwards of 120 kilograms, he looked like a man who could handle just about anything. Nonetheless, shortly after hanging up his boots in 2012, Humphries developed depression and anxiety, brought on by persistent neck pain, a painkiller dependency, life-threatening illness in his family, and unresolved trauma arising from a childhood of scarcity in the northern NSW town of Moree.
By 2015, while knowing he needed to act, Humphries was disinclined to sit opposite a GP or psychiatrist to be formally diagnosed. Instead, with his mother, he got into meditation, which helped. But as Humphries tells it, the turning point for his mental health was his first experience with magic mushrooms, the naturally occurring and abundant fungi containing the psychedelic compound psilocybin. After performing due diligence, he ingested a dose in a “loving and spiritual space”.
“The first thing that happened is that I felt, I knew, that everything is connected,” says Humphries, now 45 and living on the Gold Coast with his partner and two children. “I saw the outline of everything. I saw how it all moved and connected. Everything is one. We share this experience [of life].”
Sometime later, he recounts, came an “overwhelming download of understanding of my life journey to that point”, which included a sense of lying on his left side and holding the son whom Humphries and his partner had lost to a miscarriage – father and child wallowing in infinite mutual love. “The journey lasted for between 4-7 hours but it seemed like years,” says Humphries.
“Psilocybin was the bridge,” he adds emphatically. To what?
“To understanding my own power. It allowed me to sit with some traumatic, deep-level conditioning that I experienced as a child and to start unpacking that in a loving way. I didn’t need to relive those experiences. I could just observe them and heal.”
By self-treating with psilocybin, Humphries went rogue. Then as now in Australia, the only lawful way to use psilocybin – or another psychedelic drug, MDMA (ecstasy) – is to take part in one of a handful of clinical trials. But viewed from another angle, Humphries was ahead of the curve, an early adopter of what most experts agree is a highly promising medicinal substance. In research and clinical circles, there is a growing interest-cum-excitement in psychedelics, and for their most ardent proponents, also a frustration that things aren’t progressing more quickly towards a situation in which a subset of health professionals can legally treat patients with psychedelics alongside psychotherapy. The consensus, however, among experts in the field is that psychedelics haven’t yet been shown to meet safety-and-efficacy benchmarks applied to all medicines.
As Men’s Health went to press, the Therapeutic Goods Administration was weighing up whether to take a first step towards making psilocybin and MDMA accessible to doctors as a treatment option. You can be sure the full sweep of this regulatory process will drag on for years – and rightly so, many wise heads will chorus. But regulation doesn’t make the top three of the most engrossing features of the psychedelic landscape. Those would be the ways in which psychedelics cause changes to normal brain functioning; how those changes can help people with mental illness; and what to make of the typically mind-bending experience people have while under the influence. Is the psychedelic trip a doorway to some profound truth? Or is it closer to a dreamlike state in which everything is an illusion and any meaning we attach to it subjective?
“Can you think of it as a revelation from the soul of the universe?” poses Vince Polito, a senior research fellow in the department of cognitive science at Macquarie University, who is only trying to condense a long-winded, faintly daft question of mine down to its core. “There are certainly people within the psychedelic cultures who view it like that.” Polito doesn’t fit that description, however. He’s a scientist, currently recruiting for a trial in which investigators will use MEG scans to see what happens in the brains of subjects while they’re micro-dosing with magic mushrooms.
Some of what you’ve heard about psychedelics may sound like crazy talk. But take a deep dive into the subject and you might change your mind about that. Take, for instance, the results of a famous study led by a team at Johns Hopkins University in which participants received 30 milligrams of psilocybin. Researchers reported that the dose induced in most subjects a mystical experience defined by feelings of transcendence and the dissolution of self. A third of participants called it the most meaningful experience of their life; two thirds ranked it in their top five. Moreover, 4 in 5 said it improved their sense of wellbeing, an effect still there at follow-up a year later.
There might not be this kerfuffle around psychedelics if conventional antidepressants – specifically, the selective serotonin reuptake inhibitors (SSRIs) – had a better strike rate. And what is that strike rate? It’s hard to say. Because no matter how many studies address that question, experts will interpret the results differently. The most you can say with confidence is that SSRIs are not useless – they help a proportion of patients – but they also do nothing worthwhile for many others, probably more than half of all users.
As the new and funky kid on the block, psychedelics are quite grey around the temples. The fact is that cultures all over the planet have dabbled in them for millennia. Historians have identified what appear to be magic mushrooms in Christian iconography.
The first wave of modern scientific interest in psychedelics began in 1943, when a Swiss chemist, Albert Hofmann, inadvertently absorbed a tiny amount of a recently synthesised substance known as LSD-25 and shortly afterwards experienced a florid array of hallucinations. In the decades that followed, psychiatrists and psychoanalysts in the US reported
that LSD, used medicinally and accompanied by psychotherapy, was having a profound effect on thousands of patients across a range of disorders, from depression to alcoholism. The substance seemed to open their minds to new ways of viewing their problems, and in many cases, a single high dose was sufficient to cause remission.
Alas, in 1971, US President Richard Nixon declared his War on Drugs, which brought research into LSD and other psychedelics to a halt. This research resumed only around the turn of the century and has gathered pace in the last five years.
The top person in the field in Australia is Paul Liknaitzky, who is the head of the Clinical Psychedelic Research Lab at Monash University. Our Zoom meeting lasts just long enough for me to clock him as a youthful-looking, bearded man with a sonorous voice. Within a minute, however, the connection drops out and our conversation shifts to the phone, where I ask him to explain what happens in the brain when you take a high dose of, say, psilocybin.
“My view is that the most powerful level of explanation for psychedelic medicine is not neurobiology,” Liknaitzky says. “We’re still a long way from understanding the neurobiological correlates of what matters under psychedelics. We can get far more granular when we ask people about their experience.”
That said, he goes on, we do know some things about how psychedelics affect the brain.
Demonstrably, they inhibit activity in a hub known as the Default Mode Network (DMN), which links the cerebral cortex with older structures involved in memory and emotion, and activates whenever you observe something and reflect on how it is relevant to you: is it dangerous, for example, or could it help me? The DMN is also involved in mental time travel – those periods when you don’t live in the moment and instead dwell on past blunders (turning down that job last month; snapping at your wife over breakfast) or project into the future (I’m going to get sick and die!). “And right there,” says Liknaitzky, “you see some of the building blocks of psychopathology.”
The DMN’s prominence in the normal waking state suggests that humans have evolved to treat our survival – which includes not just our bodily survival but the preservation of our societal status – as our top priority. By making everything about you, your DMN is expert at keeping you alive, but less tuned to having you feel content or intimately connected with your environment. And while self-reflection and self-concern have their place and are crucial in learning and planning, if the DMN too often has the whip hand over other areas of your brain (areas that activate only when your attention is absorbed in the outside world), your outlook on things will tend to be negative. In certain important ways, your brain is now different to that of a child’s, in which the interconnections are flexible and lubricated. Your brain, by contrast, has become something of a rust bucket, your thinking rigid, reflexive and predictable.
“We’re constantly seeing the world in a highly constrained way,” says Liknaitzky. “It’s a tiny little window through which we see the world, and the frame of that window is the frame of your survival.”
Think about that. We assume the world is exactly as we perceive it, and only as we perceive it. But you need only observe another species to realise that isn’t so. Recently, I watched my cat enter the backdoor of my home, where a strange cat had just visited. For me, there was no trace of the other feline’s presence, but instantly my cat went onto high alert; she’d picked up a scent undetectable to me.
A psychedelic might not sharpen your senses, but by inhibiting the DMN, it will create a situation, explains Liknaitzky, “where parts of the brain that don’t normally speak to each other are now connected”. No longer constrained by the DMN’s prerogatives, “you are getting a wider set of perspectives on familiar information about yourself and the world. For many, this can feel like waking up from the dream of your life. It’s the sense that while, yes, the walls are bending around you and you’re aware you’re under the influence of a drug, there are elements of the psychedelic experience that seem like better representations of reality than your sober ones”.
If it weren’t for that sense of having been shown an alternative reality – or even the one true reality – then the experience would be nothing more than a drug trip, and all the knowledge and insight obtained from it would be set aside. “But that’s not what happens,” Liknaitzky says. “My sense is that this feeling of reliability – we call it verisimilitude, the sense that what you’re experiencing on psychedelics is true, or at least part of it is – comes because you have the metacognitive sense that you’re getting way more information than usual.”
The sudden, overwhelming sensation of being at one with everything in nature appears in most accounts of the psychedelic experience. And it gets me thinking about what’s behind the explosion in depression rates since the 1980s.
Seventy years ago, when the Swiss pharmaceutical company Ciba-Geigy AG developed the first antidepressant, imipramine, it baulked at taking the drug to market for fear there weren’t enough depressed people in the world to make it profitable. The wisdom of the time was that endogenous depression affected about 1 in 1000 people at some time in their lives. Things have changed: according to the Australian Institute of Health and Welfare, 1 in 7 will become depressed during their lifetime.
Until recently, I suspected soaring prevalence had less to do with a spike in clinical-grade human misery than with definitional blurring: it suited certain stakeholders in the mental-health industry to medicalise moods that were once accepted as falling within the normal range of emotions. Now, however, I’m more inclined to the view that there really is an epidemic of depression – that a state of depression is, for many people, the inevitable outcome of a host of seemingly unstoppable societal trends.
In his 2018 book, Lost Connections, Johann Hari argues against the idea that depression is usually or even sometimes the result of spontaneous chemical changes in the brain. Far more likely, he argues, is that it descends like a fog when your life
is failing to meet at least one (but probably more) of your emotional needs, when you have become disconnected from certain crucial elements, such as the natural world.
What has this got to do with psychedelics? Everything. Psychedelics seem to be spectacularly good at repairing broken connections. Consider this account of a trip on psilocybin from Joel [not his real name], a 33-year-old from Sydney who’s currently working as a researcher in the psychedelics field.
“I nibbled on some magic mushroom and went for a stroll in a bush area of the Southern Highlands [south of Sydney]. After a while, I noticed an inner light coming from each tree, from everything, and I had this sense that we are all one – the tree, me, everything . . . we are all one. And a sense of knowing it to be true, that this is absolutely, undeniably true.”
While the psychedelic experience winds down in a matter of hours, its effects linger, not just for days or weeks but sometimes for decades. Joel says he couldn’t stop thinking about what he felt and “learned” in the scrub that day, and his curiosity was piqued to the point where he felt compelled to find work in the psychedelics field.
“I now have a mostly naturalistic perspective on the psychedelic experience, while incorporating spiritual insights,” he says. “For people, it’s so natural to define ourselves as individuals, with the boundaries being around our bodies: ‘I’m an individual [Joel]’. And there’s obviously a degree of truth to that. But it’s also a fact that we are all interconnected. If you zoom out far enough, we’re part of a universe that is 13.8 billion years into unfolding, and we’re a product of our family and other environments, and when you try to put boundaries around us and other objects in the universe, it’s hard to say where one thing ends and another begins. Psychedelics can move your sense of identity along that spectrum, to where you’re less an individual and more a part of the whole.”
For Hari, a separation from nature is just one of the problematic disconnections that can make you depressed. Among the others he cites are disconnection from other people, from meaningful values and from meaningful work. A psychedelic trip won’t wind back social media. It won’t restore integrity to politics or the sense of belonging which fading rituals such as Sunday church attendance used to engender. It won’t, by itself, land you a more rewarding job. But by triggering estranged parts of your brain to communicate with one another for the first time in a while, it seems to be able to change your perspective on the stuff that might have been dragging you down into the depths.
TRIP TO THE DOCTOR
Stuart Saker is a Newcastle-based psychiatrist who’s spent almost two decades as an army reserve medical officer. Most of his patients are veterans, police officers or ambulance workers who suffer from some combination of treatment-resistant depression, PTSD and alcohol use disorder.
Were he suddenly allowed to treat his patients with psilocybin or MDMA, “I’d be planning a session for this weekend,” he says. His research into the effects of psychedelic therapy, which included a trip in 2011 to Israel’s Beer Yakkor Mental Health Center, where PTSD patients were being treated with MDMA in clinical trials, has convinced him it would be a game-changer. His reading of the trial data is that 60-80 per cent of depressed patients treated with psilocybin are significantly improved by two or three treatments. If and when authorities in Australia give the greenlight, Saker is ready to go: earlier this year, he completed the Certificate in Psychedelic-Assisted Therapy provided by Mind Medicine Australia, a not-for-profit focused on making psychedelics available to qualified practitioners. “The need is huge,” says Mind Medicine co-founder Tania de Jong. “More than 15,000 health professionals have reached out to us because they don’t currently have the tools in their toolbox. That’s what they’re saying – that they can’t get their patients well with current treatments.”
As to the mechanism by which psychedelics may help mentally ill people, Saker puts a colourful, anthropomorphic spin on the role of the DMN. “I describe the default mode network as the brain’s version of resting bitch face,” he says. “It’s scowling at everything else the whole time, and it doesn’t let any other brain structures connect. It’s a control freak. It’s a source of constant unhappiness, of a sense of mediocrity and failure, and all that stuff feeds into depression. But when you turn it off, that bullying harassment from the DMN that makes some people sick, stops.”
Of course, the DMN will look to resume control once the effects of the psychedelic wear off, but it’s as though you’re now partially inoculated from misery. Now that those other, previously siloed, parts of your brain have got talking, “people can come away with feelings that are the antithesis [of what they’d been mired in],” says Saker. “We’re all in this together. We’re part of the planet too. We’re in an ecosystem. Why do I hate that person? I don’t want to be racist anymore. Whatever it is, it’s something different to bashing yourself up.”
I ask Saker what’s known about the risks of psychedelic therapy – about the likelihood of bad trips, if you like, resulting in panic attacks or worse, full-blown hallucinogenic disorders. After all, it’s one thing to go mad. But to bring it on yourself, to invite into your mind some demon that refuses to leave, to shift into an alternative state of consciousness from which you can’t escape… that’s the stuff of nightmares.
“The evidence of anyone having lasting psychosis from this in research settings is infinitesimally small,” says Saker. It’s not going to make a sane person psychotic, he adds, but you would never use this form of therapy on someone who has say, schizophrenia – or a familial history of it.
“We’re talking two doses in a controlled environment,” says Saker. Let’s say that while under the influence of psilocybin you visualise a snake. Saker might guide you to crawl into the snake’s mouth and peer through its eyes. The point is, you’re encouraged to trust, let go and be open.
RESISTANCE FROM “THE MAN”
In May last year, the Royal Australian and New Zealand College of Psychiatrists issued a clinical memorandum on the therapeutic use of psychedelic substances. Acknowledging the “emerging evidence” that these drugs may be of benefit in the treatment of a range of mental illnesses, it called for further research to assess their safety and efficacy.
Professor Ian Hickie, co-director of health and policy at the University of Sydney’s Brain and Mind Centre, concurs, arguing the force of advocacy for psychedelic medicine has outstripped the evidence for its usefulness provided by trials that have been mostly underpowered and lacking controls. “The exceptionalism that’s been attached to [these substances] is entirely unjustified,” says Hickie. “It’s become a crusade, a battle against authority. Plenty of other drugs – not so sexy but with equal claims to novel pathways – are sitting there too awaiting approval but attracting little or no interest.”
Before filing the above as typically conservative obstinancy, know that Liknaitzky, the country’s leading investigator into psychedelic therapy, is also adamant it’s too soon to make these drugs available to anyone. “There is an enormous amount of hope associated with psychedelic treatments, and for good reason. But attached to that hope is hype,” he says. If psychedelics are eventually to be used effectively in clinical practice, Liknaitzky adds, there needs to be a workforce and infrastructure that are “fit for purpose – and fit for purpose in this case is no trivial matter”. For most doctors and mental healthcare professionals, psychedelics are “not just another tool in the toolkit – you really have to get a new toolkit”.
Emyria, a Perth-based clinical-services and drug development company with seven sites around Australia, is ready to step up, says its managing director, Dr Michael Winlo,
who was approached by Mind Medicine Australia last year to assist with the opportunity emerging around psychedelics.
“The psychedelic community is a very broad church,” observes Winlo. “You’ve got people on one side saying this is a natural plant-based medicine that should be taken out in the bush, and then you’ve got others taking a more medical view, and [these groups] are sceptical of each other’s intentions. Somehow, we’ve got to find a way to be comfortable with private industry’s interest here because it can bring money and resources and traditional drug-development skills.”
SEARCH FOR MEANING
As things stand, resourceful people can easily get their hands on magic mushrooms. They’re being used by folk who are neither ill nor hippies – guys like fortysomething teacher Aden [not his real name], a father of three who lives in northern Sydney.
In recent months, Aden and his wife have tripped together in nearby bushland. Their experiences, he says, have been “beautiful . . . nature looks incredible, and the connection I felt to it was powerful”. Something else that is great: no hangover – and no urge to do it again tomorrow or even next month.
Here’s something Aden and his wife would really like to know: why? Why do naturally occurring psilocybin mushrooms exist? Could they be here to help us, not just to ease our psychic ills but to point the way to a sweeter, simpler, calmer life in which feelings
of love, empathy and belonging swamp all the agitation and striving and division? Is that just faintly possible? It’s such an intoxicating question, you could almost be tempted to take a trip in search of the answer.