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Scientists discover that psychedelics can have positive clinical impacts, helping patients with afflictions ranging from addiction to depression to PTSD.
Scientists discover that psychedelics can have positive clinical impacts, helping patients with afflictions ranging from addiction to depression to PTSD.
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00:18To me peyote is a very intimate medicinal herb.
00:23Psychedelic assisted treatments allow us to reinvent ourselves.
00:26They're allowing the brain to see itself.
00:30In the 1960s, psychedelic drugs were famous for their mind-bending recreational effects.
00:37But today, they might offer hope for treating devastating conditions from addiction to PTSD to depression.
00:45I did take psilocybin to go find Martians.
00:49I needed to work with scientists to be able to stop smoking cigarettes.
00:56I was on antidepressants for about four years prior, and I haven't been on any since.
01:03I haven't felt sadness.
01:05How is this possible?
01:08Scientists are searching for answers within the brain, where psychedelics alter consciousness
01:13and can open the mind to positive change.
01:15It's like reprogramming the operating system of a computer.
01:20You're getting down to very basic code-level changes.
01:24We observe a radical change in the way that brain regions talk to each other.
01:29It's not only that these states of consciousness are beautiful and inspiring, they seem to have therapeutic power.
01:40The psilocybin shifted my perception from negativity to positivity.
01:47The research is cutting edge, but early results from clinical trials offer hope.
01:53You don't forget the breakthrough moments that you had, and you don't forget what you learned.
01:57They stay a part of you.
01:59I haven't drank since my very first session.
02:02It worked almost like an antibiotic, where I did this treatment, and then I was done.
02:07Can psychedelics cure?
02:10Right now, on NOVA.
02:30Psychedelics.
02:32LSD.
02:34Magic mushrooms.
02:36Peyote.
02:36These powerful, mind-expanding substances fueled the 60s counterculture.
02:44For some, they're powerfully transformative, even spiritual.
02:49It was a spiritual experience that I'd never had in my life.
02:54It was probably changing me forever.
02:58But for others, terrifying and dangerous.
03:02They felt that I was having a psychotic episode.
03:05I was hospitalized.
03:08And ultimately, they were criminalized.
03:11We must wage total war against public enemy number one, the problem of dangerous drugs.
03:18But today, a growing number of clinicians argue that there's another side to psychedelics.
03:23The psilocybin therapy has been the most powerful tool I've seen.
03:27I said, wow.
03:28I feel like I've been treating trauma with stone tools, and there's the state-of-the-art treatment.
03:35That they have the potential to heal the mind as a treatment for addiction, depression, and PTSD.
03:41They have this big effect, opening the mind and brain up for change.
03:48The good that can come out of the responsible use of these substances is quite amazing, really.
03:56It's an about-face that few saw coming.
03:59How do you shift from a position of, these drugs are illegal, these drugs are bad for you, to, these
04:08drugs are therapeutic.
04:10This is the way that you heal from mental illness.
04:13What are these drugs doing to patients' minds to give some doctors such hope for their potential?
04:30I grew up in New York City.
04:33It was fairly easy to get access to alcohol through friends.
04:40We'd go to a corner deli.
04:43And that all started probably around 12, 13 years old.
04:48It would take a couple of drinks to feel anything or feel good.
04:52But then, a couple of years later, those two drinks wouldn't cut it, or three drinks wouldn't cut it.
04:57And I'd need more to get to where I was before, when I first started drinking.
05:04I wouldn't drink every night.
05:06I was more of a binge drinker, so I'd pick my battles.
05:10But during one of those nights, it would be about 23 drinks in a night.
05:17Over the years, John Costas struggled to quit.
05:21I went to my first AA meeting at 16.
05:26I tried AA for years.
05:28I tried rehab.
05:31I tried different pharmaceutical drugs.
05:34I've been practicing psychiatry for 21 years, focusing on addiction.
05:39And John came to me in his early 20s, and he probably was the worst case of alcohol use disorder
05:45I'd ever seen for someone his age.
05:47You'd go on these terrible benders that he was starting to experience alcohol withdrawal, which is very rare for somebody
05:53in their early 20s.
05:54And I was very scared that he was going to have a premature death because of how much he was
05:59drinking.
06:01Worried that John was at risk of death, psychiatrist Steven Ross helped him enroll in a clinical trial at NYU
06:08with his colleague, psychiatrist Michael Bogenschutz, who was testing a controversial experimental treatment for alcohol use disorder using psychedelics.
06:20During a series of carefully designed therapy sessions over 12 weeks, John received two doses of a hallucinogenic drug.
06:29His addiction to a recreational drug would be treated with what most people think of as another recreational drug, psilocybin,
06:38which is classified as a Schedule I narcotic right alongside heroin.
06:46Psilocybin is the mind-altering molecule found in magic mushrooms.
06:51They were introduced to American popular culture in 1957 by a Wall Street banker named R. Gordon Wasson, who wrote
07:00about them in an article for Life magazine.
07:04These fungi have been used by indigenous peoples in the Americas for thousands of years.
07:11Psilocybin is just one of a family of substances often called psychedelics.
07:17They include mescaline, found in the North American cactus peyote, as well as synthetic chemicals like LSD and MDMA.
07:28Users report that these drugs bring about an altered state of consciousness, sometimes accompanied by hallucinations or heightened sensitivity to
07:36colors, sounds and patterns.
07:38The entire range of possible visual experiences can be encountered.
07:44Walls breathing, illusory movement, seeing movement in a carpet when the carpet's not really moving.
07:50Many also report a loss of ego accompanied by profound feelings of empathy and connection to others, even the entire
08:00universe.
08:01And what's perhaps most unusual about these drugs is that after the experience of the so-called trip, users often
08:09feel changed in positive ways.
08:13Though there are clear differences between psychedelics, they all, with the exception of MDMA, act in a similar way in
08:21the brain.
08:23Each of the active molecules fits like a key into a lock by binding to a specific protein in the
08:29nerve cells of the human brain, called the serotonin 2A receptor.
08:34And this can alter perceptions and even consciousness itself.
08:39And that's central for producing their subjective states, including mystical states of consciousness and these unusual states of mind.
08:48The drugs are very powerful.
08:50And for some people, the experience of going on a consciousness-altering trip that they can't control or stop can
08:57be very challenging or frightening.
09:00I was afraid of psychedelics. I never experimented with them growing up because I was too afraid.
09:06I heard all the bad stories of having a bad trip, or I thought I could go permanently crazy, or
09:13if you stare at the sun, you'll go blind.
09:15And so when I raised those concerns with the doctors at NYU, they said, listen, that's totally normal going into
09:23it, but this is incredibly safe to do.
09:26We've already properly screened you, and you're mentally and physically fit to go through this.
09:33Patients with a personal or family history of psychiatric disorders like schizophrenia, bipolar, or psychotic disorders are deemed to be
09:43too at risk for the treatment.
09:45There's a possibility that classic psychedelics could precipitate a psychotic episode or a psychotic disorder in someone who was predisposed.
09:54And that hasn't happened in any of the trials to date, but it remains a concern.
10:00Would you like to state your intention?
10:03In trials like this one, the drug is part of a larger plan to help participants address specific issues.
10:10And each psychedelic trip is facilitated by a therapist.
10:16When John took his first psilocybin trip in an effort to curb his cravings for alcohol, the experience was powerful.
10:25There were a few monumental experiences that I saw during this.
10:33There was a glass bottle, a liquor bottle, in the middle of the desert.
10:39And all of a sudden, the glass disintegrated into the sand, back into the desert, and just vanished.
10:48And I thought that was pretty powerful symbolism that my addiction was leaving me.
10:54And pretty much after that, I had felt, this is going to work.
11:03John stopped drinking after his first dosing session.
11:06It worked almost like an antibiotic, where I was sick, I had a disease, I went in, saw the doctors,
11:14did this treatment, and then I was done.
11:17I don't have to see doctors, I'm not on any prescriptions, I don't go to any support groups.
11:23I live without the addiction, which I never thought would be possible.
11:29The NYU study recruited 93 patients who were randomly assigned psilocybin or a placebo.
11:37All the participants received psychotherapy over the 12-week treatment period.
11:42John's case is particularly dramatic.
11:45But the results overall have been encouraging.
11:49The psilocybin plus psychotherapy group had a 50% reduction in drinking compared to just the group that got psychotherapy
11:56alone.
11:56It's a large difference, it's a clinically meaningful difference, and if these effect sizes hold up,
12:03it's a much larger effect than we've seen in any of the medications that are currently approved or alcohol use
12:11disorder.
12:13Doctors are trying to understand why psychedelic-assisted therapy might be more effective than currently available treatments.
12:20They think that the key difference may be in the way that psychedelics can allow the brain to change rather
12:26than simply suppressing symptoms such as craving.
12:32Our brains are composed of billions of nerve cells that branch out like trees.
12:38They carry messages between each other and connect different regions which are like departments with different functions.
12:45Such as the amygdala, the department where the emotions associated with memories are stored.
12:51The striatum, the office of reward and habitual behavior.
12:55And at the highest level, the prefrontal cortex, like a front office overseeing them all and making decisions.
13:04So in the normal brain, you can say especially in adults, the prefrontal cortex has this top-down control.
13:13We control our emotions, we control our habits through very strong prefrontal cortical activity.
13:24Yasmin Hurd is a neuroscientist who studies the effects of drugs on the brain.
13:30She's found that alcohol can erode the nerve cells that connect departments.
13:35With alcohol, these branches retract, they shrink, and that then diminishes communication between the brain regions.
13:44So the amygdala is much more hypersensitive to context associated with the drugs, which is alcohol.
13:52It's like acting on its own.
13:56If the amygdala goes rogue, the result can be irresistible cravings leading to decisions that put alcohol ahead of everything
14:04else.
14:05Even ignoring pleas from the front office to stop.
14:10Habitual behavior takes over.
14:12They stop thinking about what may be the bad outcome.
14:16So their executive control is diminished.
14:21But when John took psilocybin, he seemed to get control over his cravings.
14:27Somehow, the front office re-established its authority.
14:32The research is still early, but scientists do know that psychedelics activate specific serotonin receptors in the brain involved in
14:41mood and unusual states of consciousness.
14:45One idea is that activating these receptors may also lead to new nerve cell connections, even growth.
14:53Perhaps that is the key.
14:55It's hypothesized that psychedelics will restore the branches in these trees that we know are impacted by alcohol use disorder.
15:08So by restoring and allowing the branches to grow again, that improves communication once again in the brain.
15:16But stimulating serotonin receptors or expanding nerve cell connections can't be the full explanation.
15:25After all, the drug cocaine also increases nerve cell connections.
15:29But there may be a critical difference.
15:33Cocaine will also increase the projections, these branches, but it's too many.
15:39One thing about how psychedelics are used as compared to cocaine is that cocaine, its habitual behavior, they're using it
15:46chronically.
15:47It can produce perhaps too much growth.
15:49So with psychedelics, it seems that the growth may be, you know, it's not too much, it's not too little,
15:55it's just right.
15:56Like the Goldilocks effect in a way.
16:00One factor that John attributes his sobriety to is the mystical experience he went through, which is often a hallmark
16:08of a psychedelic journey.
16:10Something definitely happened because my relationship with alcohol changed and I don't think about it and have the same emotions
16:19I used to have towards alcohol.
16:21People ended up having experiences that they rated as among the most personally meaningful and spiritually significant experiences of their
16:33entire lifetimes.
16:34And I think that's a really important element that kind of stamps in the enduring attributions made to these experiences
16:45because they're profound experiences felt to be precious, felt to be absolutely true.
16:52And that accounts for why months, years later, people are often reflecting back on that experience and can tap in
17:00and draw from it.
17:02The idea that one or two doses of a mind altering drug could create such a profound impact with potentially
17:10beneficial results is not new.
17:13Western medical research into psychedelics began in the 1940s, not long after the accidental discovery of lysergic acid diethylamide or
17:23LSD.
17:24In 1943, Swiss chemist Albert Hoffman was working with ergot, a potentially poisonous fungus sometimes found on wheat, oats and
17:33rye, which had been used for medicinal purposes for centuries.
17:38Ergot poisoning was known to constrict blood vessels.
17:41Hoffman was hoping to isolate a chemical compound that would reduce the risk of fatal bleeding in childbirth.
17:47In the process, he accidentally absorbed a minuscule amount of LSD, possibly through his fingertips, ultimately launching him on what
17:58some would call the world's first acid trip.
18:03Kaleidoscopic, fantastic images surged in on me, alternating, variegated, opening and then closing themselves in circles and spirals, exploding in
18:15colored fountains, rearranging and hybridizing themselves in a constant flux.
18:22Word got out about this mind-expanding substance and the lab began synthesizing and shipping samples to research centers around
18:30the world.
18:32Initially, scientists thought psychedelics like LSD could be used to explore schizophrenia, since a person's tripping experience mimicked some aspects
18:41of psychosis.
18:43But then they observed that some patients, including those with alcohol use disorder, reported feelings of transcendence or spiritual epiphanies
18:51that helped them to quit drinking.
18:53I was so curious that the most studied indication was the use of LSD to treat alcoholism.
19:00It turns out there was this huge body of research from the 1940s to the 1970s, and it was a
19:06big part of psychiatry. There were over 40,000 participants treated. It was hailed as a wonder drug.
19:13But as scientific research continued, some efforts took a dark turn.
19:19The CIA attempted to weaponize LSD with top secret projects like MKUltra, in which they experimented on volunteers and unsuspecting
19:29government employees to see if minds could be controlled, memories erased, people programmed.
19:37And then LSD escaped the lab.
19:44Ken Kesey, the author of One Flew Over the Cuckoo's Nest, was one of the CIA research volunteers.
19:51Ken Kesey first got exposed to LSD in a CIA experiment.
19:55And then later, he became one of the leaders of the hippies.
19:59You know, he helped the Grateful Dead, began at the acid tests, the Merry Pranksters.
20:03So the history of the CIA and the mind control and the nefarious uses of psychedelics are interwoven into the
20:11cultural story of psychedelics.
20:14The first experience I had was with seven little mushrooms in Mexico.
20:18In 1966, the former Harvard psychology professor, Timothy Leary, promoted psychedelic drugs as a means of personal and cultural transformation.
20:28Urging youth to turn on, tune in, drop out.
20:34Timothy Leary became the Pied Piper of psychedelics and it so alarmed the Nixon government at the time.
20:41Nixon declared Timothy Leary the most dangerous man in America, declared war on drugs.
20:46America's public enemy number one is drug abuse.
20:50And enacted the controlled substance act in 1970, which kind of erased them from the history books.
20:57The act classified drugs like heroin, cannabis and psychedelics as having the highest potential for addiction and abuse.
21:05The whole war on drugs wasn't really a war against like stopping people from using drugs.
21:11If you declare war on drugs, you should declare war on alcohol and tobacco, the most damaging ones.
21:15They were absented from the controlled substance act.
21:18You went after psychedelics, which are really not addictive at all.
21:23The latest revelations about the benefits aren't surprising to many indigenous populations who have venerated plant based psychedelics for thousands
21:31of years.
21:34In many cultures, psychedelics have been used in rites of passage and to gain wisdom, usually administered in specific religious
21:42and healing ceremonies.
21:47In North America, some indigenous peoples use peyote, a cactus that grows in northern Mexico and a small region of
21:55South Texas.
21:57I am Adrian Primo. I come from five generations of peyote people, myself being the sixth and then my son
22:06being the seventh generation.
22:08To me, peyote is a very intimate medicinal herb.
22:18We use it as a guide. We use it as a means to synchronize with the universe.
22:23My grandparents explained to me at a very young age that we could acquire any means of success through medicine
22:32and peyote if we approached it with the right intent.
22:37Peyote use can touch on many aspects of life.
22:41How this medicine is able to heal, there's a lot of complex facets.
22:47Within indigenous forms of thought, we believe that the spirit exists somewhere back there in the subconscious that's connected to
22:55the universe.
22:56So, this plant medicine helps you reach those depths of your ability to manifest whatever it is you can picture
23:04in your mind.
23:05Maybe you're picturing pain going away. Maybe you're picturing your cancer going away. Maybe you're picturing your body being healthy.
23:12Maybe you're picturing education.
23:13Whatever it is that you're picturing, your subconscious brain has that power to create that for you.
23:19And this medicine is just a tool to help you to reach that point.
23:26When we think about how native people have used these substances, it was a ritual.
23:33So, there's something still really important about the setting, the ritualistic aspect.
23:39You can see this positive outcome. You can hear the positivity around you.
23:45All of that then gets encoded into the brain in a manner that when you're not in that hallucinogenic state,
23:53it still stays with you.
23:56A peyote cactus can take over 10 years to reach maturity.
24:01Since the arrival of Europeans, Native American tribes have often been persecuted for peyote use and had limited access to
24:09the plant.
24:10Now, commercial interests and poachers are putting pressure on peyote's fragile ecosystem.
24:19Recently, a philanthropist purchased 605 acres of peyote land here in South Texas to provide access for members of the
24:27Native American Church,
24:28which teaches Native American traditions, sometimes elements of Christianity, and regards peyote as a sacrament.
24:37In order to assure that this medicine is going to be available, we have to have some kind of direct
24:46connection with this land.
24:49And this land, I think, is an answer to a prayer from years ago that there will be medicine for
24:59our children.
25:03This land means the world to all of us, Mother Earth and what she has provided us.
25:10This represents the future. It's about what you are going to teach your children, your grandchildren,
25:16and what you're going to leave behind, the essence of generational responsibilities.
25:23Words cannot suffice what the spirit feels in connecting with this land.
25:32Psychedelic assisted therapy is still in its early stages.
25:36But scientists are inspired by Indigenous practitioners' careful and non-recreational use of these powerful substances.
25:44One concept that the emerging use in therapy shares with Indigenous practices is the importance of taking these psychoactive substances
25:52only in the right environment and frame of mind.
25:56We know that like any drug, including aspirin, that is in our medicine cabinet,
26:02the use of any drug not in the way it was designed to be used can be harmful and even
26:10catastrophic.
26:11So when we talk about psychedelics, the setting is very important, not just the preparation, not just the integration,
26:18but your safety, who you're with, what your intention is, what is the physical environment.
26:24The setting plays a crucial role in a psychedelic assisted therapy experience.
26:31No detail is overlooked in this physical space, and the mindset or intention a person brings to the session is
26:38of paramount importance,
26:40just as it is when Indigenous people prepare for the use of peyote.
26:45My intentions were just to go in with an open mind, whether it be a good trip or a bad
26:51trip, just experience it.
26:53My intention was self-exploration, self-understanding, and openness.
27:02My intention was to see the face of God.
27:08My intention was to take my experience of having cancer at age 11 and transform it into something neutral or
27:18even something positive.
27:19My intention was to have no intentions. I wanted to be open to accepting whatever the experience would give to
27:27me.
27:37What draws these patients together is a common enemy, cancer.
27:43I've had the privilege of being with you guys all this last year.
27:46Here in Rockville, Maryland, oncologist Manish Agrawal is the first doctor in the country to run a psychedelic assisted clinical
27:54trial
27:54treating depression and other mental health impacts of cancer with group therapy.
28:00I was having really bad monthly depressive episodes where I would just cry all day.
28:05As many as a third of patients with a cancer diagnosis will experience major depressive disorder.
28:13But perhaps because it exists in the shadow of a cancer diagnosis, the condition is rarely acknowledged.
28:20I've been an oncologist for almost 20 years and I've been taking care of patients and there's an aspect of
28:26their care that was really missing.
28:28You know, we take care of the physical aspects, but then I close the door and I know so many
28:32important issues are really unaddressed.
28:36I wanted to start with something to help us center. I'd just like to invite you to close your eyes.
28:42I think healing is bringing the body, the mind, the emotion, the spirit back home where you feel comfortable with
28:49it again.
28:50And so you can't just fix the physical pain and then people are healed. It doesn't work that way.
28:59Building on pioneering clinical trials at NYU, UCLA and Johns Hopkins, Manish saw that it was important to treat the
29:07depression as part of treating the cancer.
29:10Okay.
29:11That sort of whole person care and that in order to take care of someone, in order for them to
29:16feel good, it's not just killing the cancer.
29:20Manish was surprised by the results.
29:23To be honest with you, the numbers were so good that I wouldn't believe it if I wasn't with every
29:28session. I saw every person go through here.
29:32We treated 30 people and 82% had more than a 50% reduction in their depression symptoms.
29:39When we measured quality of life, we measured anxiety. All of those were improved.
29:45The experience just kind of made me more aware of myself and the space that I take up in the
29:51world and the energy that I put out into the world and how that affects people too.
29:57Prior to the dosing, I had this tendency to get caught up in distressing thoughts related to the cancer.
30:04I noticed a subtle shift in that while distressing thoughts would still come up, I was able to let them
30:11go for the first time ever.
30:14I don't feel the need to follow them.
30:17While Eric's endless distressing thoughts and John Costas' alcohol use disorder may seem to have nothing in common, some see
30:25a possible similarity at work in the brain.
30:29These different disorders, I've really thought of them all as forms of addiction.
30:34So whether we're talking about depression or what we normally think of as addiction, these are all just forms of
30:40being stuck in a suboptimal pattern.
30:43It's being stuck in a narrowed mental repertoire, a narrowed pattern of behaviors.
30:50In patients with depression, scientists have noticed an abnormal increase in activity in a network of different regions in the
30:58brain called the default mode network.
31:01The default mode network refers to this pattern of activity across a number of brain areas that is strongly associated
31:11with thinking about oneself, thinking about one's past, projecting oneself mentally into the future.
31:20The default mode network activates when a person is introspective and under normal circumstances becomes less active when a person
31:30shifts their attention to the outside world.
31:33But brain studies show that under the influence of a psychedelic, the default mode network is quieted, while other regions
31:42of the brain increase communication with each other.
31:45A mathematical model captures a normal brain's activity.
31:50In contrast, a brain under the influence of psilocybin reveals a dramatic increase in global communication.
31:57Thousands of new connections form, linking brain regions that don't normally talk to each other.
32:04One analogy I've used for how psychedelics work in the brain is a snow globe.
32:10When you pick up a snow globe, you know, the snow's settled at the bottom, it's sort of fixed, and
32:16then you pick it up, shake it, and things jiggle around and there's randomness and a kind of chaos, if
32:22you want, in the system.
32:25The user experiences this as an altered and heightened sense of awareness.
32:31But what causes this?
32:34Early in our functional brain imaging studies of psychedelics, scientists were finding that the default mode network was turning down
32:41or turning off during these experiences.
32:43And that was a really good place to start.
32:46But we began to then look one layer deeper.
32:49Why was the default mode network turning off?
32:52New research led neuroscientist Fred Barrett to investigate a region of the brain called the claustrum.
32:58The claustrum is a really thin sheet of gray matter in the brain, tucked deep within each of the hemispheres
33:07of the brain.
33:08Recent animal models have shown that it is incredibly highly connected to just about every other region of the brain.
33:15Understanding that the receptors targeted by psychedelic drugs are also really densely expressed in the claustrum.
33:23We began to wonder whether the claustrum may be at the center of psychedelic effects.
33:30Fred believes the claustrum's central location and shape suggest it regulates communication between the departments.
33:39When it's functioning normally, the claustrum is essentially acting like a switchboard.
33:44It's trying to help other brain regions figure out when to turn on and when to turn off.
33:48But when we experience a psychedelic drug, we believe that it's binding to specific receptors in the claustrum and somehow
33:58disrupting or disorganizing the claustrum.
34:01It's almost as if the switchboard walks away.
34:04What happens next is that we seem to observe a radical change in the way that brain regions talk to
34:13each other.
34:13And it may be within this context that we're experiencing learning and a possible even rewiring of the circuits that
34:23govern our behavior.
34:25And it may be that it's that radical reorganization that allows people to encounter new psychological insights that they hadn't
34:31encountered before.
34:32Fred thinks the claustrum's sudden abdication of control may help explain why rigid behavior and thought patterns have a shot
34:41at resetting.
34:43It's almost like they've seen this kind of grand menu within their mind that they weren't aware of, that this
34:49greater number of possibilities that they can explore.
34:53It took a while to recover.
34:54I was having headaches and muscle pains, but it was the best headache I'd ever had in my life because
35:02it told me that the psilocybin was working.
35:06It was actually physically restructuring my brain, something that I never imagined could happen before.
35:13It's like reprogramming the operating system of a computer.
35:19You're getting down to very basic code level changes that can enduringly change someone going forward.
35:28As of 2022, there were more than a dozen clinical trials underway involving psilocybin and MDMA.
35:37Early efforts to revive this research began with individuals like Rick Doblin, who founded the Multidisciplinary Association for Psychedelic Studies,
35:46or MAPS, in 1986,
35:49to facilitate research into the therapeutic benefits of psychedelics with a focus on MDMA, or ecstasy, for post-traumatic stress
35:57disorder.
35:57One of the reasons that MDMA is so successful in therapy is the way in which it builds a certain
36:06self-confidence, a self-acceptance.
36:09MDMA can increase the hormone oxytocin, and that oxytocin is really important for bonding.
36:17That may be why that therapeutic bond, the setting that they have, all induce these positive emotional mood states.
36:26People under the influence of MDMA are able to feel more connected, both to themselves, to their inner world, and
36:34also to the people that they're with.
36:37But these feelings of connectedness and love, paired with an altered mental state, can make participants uniquely vulnerable.
36:46There is concern among researchers about how to ensure patient safety, and there are not yet universal guidelines or a
36:55code of ethics for administering this kind of therapy.
36:59In addition, unlike LSD and psilocybin, MDMA has stimulant properties that can lead to toxic side effects.
37:08MDMA, because it impacts on dopamine or adrenaline, it has stimulant properties to it.
37:14It can induce chills, it can induce nausea, it can increase heart rate, people even thinking that they're having heart
37:22attacks.
37:24Since 2000, more than 200 PTSD patients, including survivors of interpersonal violence, disasters, and combat, have received MDMA-assisted therapy
37:37in MAPS clinical trials.
37:39One of those patients is Scott Ostrom.
37:43In 2006, he was deployed to Fallujah, Iraq, where he engaged in multiple combat missions.
37:52Real war is scary.
37:54You play for keeps, and everything's unexpected.
37:57You know, you go there highly trained and as physically fit as you can be, but a lot of it's,
38:04you know, luck.
38:06On the front lines, Scott was under constant threat and would go on to develop PTSD.
38:13We know that at its core, PTSD involves the amygdala, an over-activation of the amygdala.
38:20The amygdala is the fear center of the brain.
38:22It keeps us alive, it keeps us away from being killed.
38:25But it's the main pathological construct in PTSD.
38:29You have an over-active amygdala.
38:30People respond to neutral stimuli, like a door slamming can remind them of being a combat.
38:37So, innocuous stimuli trigger this exaggerated fear response.
38:43MDMA seems to calm the amygdala.
38:47By having people not be so hypersensitive to negative emotional state,
38:54the prefrontal cortex now can dampen the amygdala, reduces its hypersensitivity to the stress,
39:03to old memories that would cause the amygdala to be overactive.
39:10Your prefrontal cortex is really important.
39:12It's the most evolved part of our brain.
39:14And it helps you say, you know what, the trauma's in the past, it's not happening now.
39:19And it allows you to rationally think through something and make executive decisions.
39:24People with PTSD, they're just stuck in this, like, fight-or-flight reactive thing.
39:31Scott qualified for a clinical trial with MDMA-assisted therapy,
39:36which helped him to confront traumatic memories.
39:38If you think of your mind as kind of a hallway where there are a lot of doors,
39:44and you try very hard to walk down the hallway and not be triggered by bad stuff that you know
39:51is behind those doors,
39:53one of the things that happens with MDMA is you say,
39:56I wonder what would happen if I opened that door?
39:58Maybe it's not so terrible.
40:02I started seeing this, like, spinning, black, oily ball.
40:08And it started off in the distance, and then it would grow and get closer to me and closer to
40:13me.
40:13And then when it would get close enough for me to kind of realize that it was this spinning black
40:18ball,
40:18I would say, like, what are you? What are you doing here?
40:20And it would retreat away.
40:22Instead of asking it what it was, as soon as I surrendered to it,
40:25and I surrendered to the feeling that it gave me on the inside,
40:28and I let that anxiety grow, it started to open up in different layers like an onion.
40:35And when I got to the center,
40:37I relived a memory of a phone call that I had with my dad when I was overseas in Iraq.
40:44What I had said to him was, Dad, I'm really scared.
40:47They said some of us aren't coming home.
40:49And my dad had said to me,
40:51Don't worry, Scott, you're highly trained.
40:54You're with the best guys the Marine Corps has to offer.
40:57And don't worry, your training is going to take over.
41:01All of a sudden, I realized that's where this shift happened.
41:06I had become this other person that I needed to become, that I had to become,
41:10to survive those combat deployments.
41:14The only thing that I could think to name that person was the bully.
41:18Taking his father's words to heart, Scott let his training take over to become the bully.
41:25But the bully could not shield him from the pain of loss.
41:30One thing that was really tough was not being able to save someone that I felt close to.
41:35The vehicle that he was riding in, um, ran over an anti-tank mine.
41:43I had ran up to the vehicle shortly after that explosion, and the vehicle had caught fire.
41:51My friend was trying to get out of the passenger seat, and he couldn't, and I couldn't get to the
41:57passenger door.
41:58My body wouldn't let me get any closer, because the fire was too hot.
42:02And, um, he burned alive.
42:06There was nothing I could do.
42:09Nightmares of the war followed Scott home, along with painful regret.
42:15I felt a lot of guilt for not being able to save him.
42:24And for a long time, I punished myself for that.
42:28My interpersonal relationships were completely down the tubes.
42:33I had high-risk behaviors, like getting into fights, self-medicating with drugs, alcohol,
42:39being just aggressive and martial in general.
42:42And after, like, three and a half years of having nightmares every night,
42:46I really started to kind of fall apart.
42:51Scott wasn't alone in his desperation.
42:54Every day, almost 20 military veterans die by suicide.
42:59Current treatments for PTSD are of limited benefit.
43:04After identifying the bully within him, after the first MDMA dosing session,
43:10Scott had another breakthrough in a subsequent session with his therapist,
43:14Marcela Otalora and Scott's dog, Tim.
43:19Marcela was sitting in her chair, and I was spooning Tim on the rug,
43:24and Marcela had just told me,
43:27well, would it be okay if you asked the bully if Scott can take over for a little while?
43:35And being in the state that I was in, I was like, hmm, I don't know, I guess I'll give
43:39it a shot.
43:40So I had an unconscious conversation with the bully where I was able to ask if it was okay if
43:48I took over for a little while.
43:49Scott took over.
43:50Right. And it was more like, can he step up to the side for a moment to see who else
43:56is there,
43:57to see what other parts of Scott are there.
44:00And it was just this beautiful time of being able to connect.
44:06And I think after that, you didn't call him a bully anymore.
44:12The MDMA helped Scott to reframe the guilt he felt over not being able to save his friend's life.
44:19You don't forget the breakthrough moments that you had, and you don't forget what you learned.
44:23They stay a part of you.
44:26So no, MDMA is not something you microdose.
44:28It's not something you have to take all the time.
44:33It's just the key that fits into the psychotherapy lock.
44:38The psychedelic-induced experience can help a person get unstuck in a way that's not just being told it,
44:45but really experiencing it firsthand. And I think that's where there's a lot of power in these experiences.
44:52Remarkably, nearly 70% of participants in Phase 3 of the MAPS MDMA-assisted therapy trials
44:59no longer qualify for a PTSD diagnosis.
45:03We learned that MDMA-assisted therapy works in combat-related PTSD.
45:07It works in the hardest cases, and it works regardless of the cause of PTSD.
45:11So our Phase 3 studies are PTSD from any cause, and if we manage to get FDA approval, it will
45:19be for PTSD from any cause.
45:23Rick Doblin thinks that the treatment could be beneficial to many more people,
45:28including some who struggle with stressful experiences that aren't easily associated with PTSD,
45:34like bullying and systemic racism.
45:38But introducing psychedelic therapies to communities of color brings a special set of challenges.
45:45Because this is a new treatment, because it's connected to research,
45:49and because it's connected to a substance that's been stigmatized due to being illegal,
45:54a lot of people of color are very wary.
45:56The African-American community has suffered a great deal from the War on Drugs
46:01and having their communities targeted due to drugs.
46:04Just growing up, I was always taught, stay away from drugs.
46:08This is a trap. This is a way that people are going to get you and put you behind bars.
46:14Aware of abuses in the past, MAPS teamed up with therapists from communities of color
46:19to offer them training in the use of MDMA-assisted therapy.
46:24One of the participants, Sarah Reed, chose to experience an MDMA dosing session
46:30as part of her training to become a psychedelic-assisted therapist.
46:34One of my therapists made a comment about,
46:37there's a part of you that doesn't want to be understood.
46:41As a black woman, there is nothing more that I want than to be understood.
46:46I felt that so deeply in that moment.
46:52Particularly with problems like racism,
46:55I mean, one of the ways that it hurts people so much
46:57is that you're experiencing it all the time, but other people don't see it.
47:01And even when you point it out, they're like,
47:03oh, are you sure that's what happened?
47:04Or that didn't really happen.
47:05Or maybe you're being too sensitive,
47:07so your whole experience is one of being invalidated,
47:10and of being not seen and not heard.
47:13Learning from this experience,
47:15Sarah went on to provide one of the first MDMA-assisted therapy sessions
47:19for a participant of color experiencing racism
47:22and post-traumatic stress disorder, or PTSD.
47:26Look out, look out.
47:31I'm dropping my weights, but it's going to feel so sunny.
47:35From a young age,
47:36Kanu Kaplash had been the target of racist remarks and bullying.
47:41With racism, often it's not necessarily one big problem.
47:46It's not necessarily like, oh, the Ku Klux Klan came and burned across on your lawn,
47:51and now you have trauma.
47:52It's usually a lifetime of smaller things.
47:55They may have some big things here and there,
47:58but at some point, the stress becomes overwhelming,
48:00and it tips into PTSD.
48:04We call that racial trauma.
48:08Kanu was already experiencing racism when, as a swimmer,
48:12he was sexually assaulted in the locker room, tipping him into PTSD.
48:18So, the nightmares and the symptoms really started to take effect after the sexual assaults,
48:23which happened when I was 13.
48:25I was sexually assaulted four times.
48:27If it wasn't for the study, I don't know if I'd be, you know, alive today,
48:30because, like, there was times kind of right before the study,
48:32where I was really, really struggling, where I really wanted to kill myself.
48:36Our site was focused on providing participants with a culturally informed experience with MDMA therapy,
48:43and as one of his therapists who was attuned to his racial background, his religious background,
48:51his childhood upbringing, I wanted to incorporate chants.
48:58During one of his dosing sessions where one of those chants played,
49:02I just remember it seemed like something really resonated with him in that moment.
49:10He was actually able to go back to a childhood memory.
49:18I'd be transported to, like, a different galaxy.
49:22I look down, and I see this long set of piano keys going on to infinity.
49:27And it's crazy, because as I'm going down the keys, I can see different parts of my life.
49:32I find a sexual assault, because I'm like, that's the big one.
49:35That's the one that I had trouble remembering and kind of trouble processing.
49:39I remember I jumped in, and I woke up on another world.
49:44I sat there, and I meditated on that planet for, like, a thousand years.
49:48And I was able to go through my memory and walk through it like a museum,
49:53and, like, walk through each of the incidents and remember vividly everything that happened.
49:57I was, like, flexing my arms really, really hard and just getting out all of the effectively, like, pain.
50:02You know, I was just kind of stuck in my arms, stuck in my body.
50:05The one thing I learned through the study is, like, there's no other way but through.
50:11The only way to handle the beast is to confront it, to recognize it is what it is, it's a
50:17part of you, but it doesn't necessarily have to define you.
50:20And when you do that, eventually, you know, you will accept more of yourself, but also you will accept, like,
50:26the larger world in a more kind of positive light.
50:31As of 2022, MDMA-assisted therapy for PTSD is in the final stages of the FDA approval process.
50:42Psilocybin-assisted therapies for major depression and other conditions are also in the FDA pipeline.
50:49While hope runs high for psychedelic medicine, scientists are quick to point out the inherent risks.
50:55People think about psychedelic drugs and they think, oh, you know, you're going to kind of zone off into a
51:02world with clouds and unicorns.
51:03But I see them more as medicines, as tools for healing, and they are powerful tools.
51:09And so I think as such they require a lot of respect because I think something that has that kind
51:16of power to heal could also cause harm.
51:19You got to use it safely.
51:22Scientists are cautiously moving forward.
51:25The psilocybin therapy has been the most powerful tool I've seen.
51:29It's not for everybody, it's not to be, it's not a magic bullet, but it does change things meaningfully for
51:35many patients.
51:37It's so different than any other intervention we have within psychiatry because it's changing the very narrative structure about how
51:48people tell their own story, what they believe going forward.
51:54We're not going to have this whole jigsaw puzzle completed for a while.
51:58And I think that we want to stay a little humble about that.
52:02The less we kind of interpret and the more we just state what our observations are, I think the better
52:11off we're going to be.
52:12To be successful.
52:39In the last century.
52:41Before you see we are going to work together.
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