What is presented in the media is often a little less nuanced than reality, for practical reasons. In a culture where information has to be easily digestible, the media can’t present enough information to give us an accurate picture. So some show the highlights from one side and others show highlights from the other. You end up with black-and-white stories that often polarize and contradict each other. Some read articles from newspapers about MDMA deaths and LSD psychoses that confirm the existing beliefs of one side. And others read selected articles about how safe MDMA is compared to alcohol and what amazing results psilocybin has treating variety of mental illnesses. Both live in kind of a bubble and many of my clients have one leg in each bubble. Psychedelic therapy is no high risk sport, but neither a magic pill that fixes everything at once. Here I will try to present some nuances.
Psilocybin - one treatment is all it takes?
Research on psilocybin-assisted therapy has focused mainly on depression. There’s one relevant study by Johns Hopkins in the United States and one at Imperial College in England. Both studies show very promising results, well above alternative medicines available on the market today. In addition there are some benefits of psilocybin over today's antidepressants - they're fast acting, there are fewer side effects and you do not have to take it every day. Antidepressants and psilocybin also have opposite functions in many ways, with the former alleviating the symptoms and the latter taking you to the core of the problem instead. There are, however, facets of psilocybin treatment that rarely are presented.
One is the experiences people have through such treatments. They may be beautiful, but for many it is perhaps one of the most challenging experiences they have had in their lives. When researchers at Johns Hopkins asked participants to rate how meaningful the experience was, of which 75 % placed it in the top five in their life, they used just that word with care. They did not use the words beautiful, positive, or healing, simply because the experiences and the period after can be quite challenging.
The second point is that the studies are small, so it is common to see less promising results in larger studies. The researchers hand pick candidates among a large group of applicants, giving them the possibility to choose the candidates they believe will respond best to this kind of treatment. In addition, the depression seems to creep back over time. The study from Imperial shows that almost two thirds of the participants were depression-free after two treatments (one low and one high dose). After three months, less than half were depression-free, and long-term follow-up (6-12 months) shows that the percentage decreases slowly and that the depression returns for most people. These are still good results compared with other medications/treatments and when one takes into account that the participants in the study have on average been diagnosed with clinical depression for 17.8 years. But it also confirms that this is not a quick fix. And based on research, we do not actually know how patients would respond to more treatments over time.
So the only thing I can offer here is the experience from my clients and from other psychedelic therapists/retreat organizers in other countries. We also see that depression returns over time in almost everyone, but often in a slightly different form than before. One of my clients described the phenomenon in a good way: “I still have dark periods where I lie on the couch in fetal position, but the difference now is that I know that it is not everything and that it will pass. I couldn’t feel that before." It seems that several treatments (2-6) a year are required over several years to achieve a marked, long-lasting effect for the majority. It is perhaps not strange that it takes time to learn to see the world in a different way than we’re used to.
MDMA - are you cured in three dosing sessions?
MDMA for post-traumatic stress disorder (PTSD) has documented a better long-term effect than psilocybin has for depression, but these studies also differ a great deal. The MDMA studies involve three high-dose treatments over three months with associated 36 hours of psychotherapy. This means that the participants receive several hours of therapy a week over a long period in addition to the session days with MDMA. This is both a more intensive and expensive course of treatment than is usually administered, and it is a huge part of the treatment. In some cases, PTSD can also be an easier "nut to crack", simply because there might a more specific goal available. Like being able to process a specific trauma.
On the one hand, I would say that the impression one gets in the media is a bit sensationalist, simplified and exaggerated. On the other hand, I also see a huge potential in the use of less rigid treatment protocols than those used in research today. The research is limited by economics, stigma and the authorities' drug regulation, so the researchers stick to the most conservative framework they can until these become approved drugs. It is also important to emphasize that neither MDMA nor psilocybin are new substances and that these are substances that have been used as medicine in underground therapy for 50 years. Several of which have published books (eg Leo Zeff, R. Coleman and Anne Other). In underground therapy, the treatment is adapted to the client. You often work through different medications in phases, sometimes even in combination, to achieve the best possible results over time. And the research might show the benifit of that 10-20 years later.