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Professor David Nutt joins WIRED to answer the internet’s burning questions about psychedelic therapy. Do magic mushrooms combat depression? How does ketamine therapy work? What happened during Bryan Johnson’s 5-MeO-DMT livestream? Answers to these questions and many more await on Psychedelic Therapy Support.
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00:00I'm Professor David Nutt, psychiatrist, neuropsychopharmacologist, and brain scientist.
00:04I'm here today to answer your questions from the internet.
00:07This is Psychedelic Therapy Support.
00:14This is from Sir Chutney.
00:16Apparently magic mushrooms help combat depression.
00:18Well, it's hard to feel sad when you're in a knife fight with Kermit the Frog.
00:22That's not anything any of our patients have described.
00:24But I think what you're getting to is the fact that there is a conception of prejudice.
00:30That psychedelics distort thinking so you are no longer depressed.
00:35Psychedelics for depression do not work simply by giving people a good time.
00:40That's what critics say.
00:41They say, oh, well, of course, you know, you give people a really happy trip.
00:45And they come out of it.
00:45They're not depressed anymore because they've had fun.
00:47And then their depression will come back.
00:49The truth is most of our patients, whether it's depression or anorexia or PTSD, the trips
00:55are very challenging because they are having to deal with the consequences and the reality
01:01of their mental illness.
01:02So it's actually quite insensitive to imply that they're just getting off their heads and
01:07having fun and getting better because they're not.
01:09They're working through often very deep trauma.
01:11But the second thing to say is that the process of changing your experience of yourself during
01:17the trip and the plasticity, which comes as a result of the psychedelic, they put people
01:22into a much better place so they can then use cognitive processes, psychotherapeutic processes
01:27to then lay down new ways of thinking about their past and new plans for the future.
01:33And that's where the long-term therapeutic benefits comes from.
01:36This is from Foxy Troxy.
01:38How well understood are the effects of psychedelics on the brain and consciousness?
01:42The key feature of the state is that the brain becomes much more integrated.
01:47Parts of the brain which haven't connected before become connected.
01:50That is why people have profound insights often.
01:53But also afterwards, there's an enduring impact on learning and memory we call neuroplasticity.
01:59And that is probably responsible for the very long-term benefits and insights that psychedelics
02:04produce.
02:04The most remarkable surprise from our research with psychedelics was the fact that they switch
02:11off parts of the brain rather than switch them on, which regulate what we see and how we see
02:16and how we think and how we feel.
02:18And that then lets the brain reorganize itself in a way which is normally not allowed.
02:23This one is from Chance Impact 2425.
02:28Psychedelics do cause psychosis, right?
02:30And the answer is wrong.
02:31There is no evidence in the modern era where we have nearly 20 years of experimental studies
02:37with psychedelics.
02:38However, if you have a vulnerability to psychosis, if you are psychotic, psychedelics can destabilize
02:45you.
02:46So they can make psychosis different and sometimes worse.
02:50This is from Crazy Horse Rider.
02:52What to do when you're overwhelmed by the experience?
02:54If the trip is becoming very disturbing and causing anxiety and fear, then you need to have
03:01prepared an exit strategy.
03:04So the first thing to say is that you should never trip unless there's someone with you
03:08who is not tripping, who can talk you down, who can reassure you, ground you in the reality
03:13that you're actually still you and you're still where you are and you're still alive
03:17and you're not having morphed into some atom in another universe.
03:21This question is from Bouncy Beach.
03:34I'm afraid, Bouncy Beach, you are wrong for a number of reasons.
03:38The main one is that people with psychosis hallucinations end up being very disturbed
03:43by them and actually often acting out on them and harming themselves or other people.
03:48That doesn't happen with psychedelic hallucinations.
03:51But the more important difference is that people with psychosis have beliefs which are fixed
03:57and usually wrong.
03:59They may think that a neighbor is poisoning them or that a friend is harming them in some
04:04way.
04:04Psychedelics do exactly the opposite.
04:06They actually make people more understanding of themselves and of the external world.
04:13But I want to say one other thing, and this is also very important.
04:16We now know from at least seven studies that have looked at this that the hallucinations
04:22of psychedelics do not correlate with the positive changes in mood and attitude and behavior.
04:29So they're incidental.
04:30What's critical to the benefit of psychedelics is people getting insights, getting a sense
04:35of being more than they were.
04:36Those powerful subjective experiences, not the hallucinations, predict good outcome.
04:41So this question is from Highly Affected.
04:44My therapist keeps telling me about the advances of psychedelics to treat complex PTSD.
04:50And I'm starting to think she may be implying something.
04:53There is definitely some evidence that psychedelics can help with PTSD.
04:58There is also some evidence that another drug called MDMA, that can also be useful in complex
05:04PTSD.
05:05And also really critical to say that the best outcomes come from having therapy between
05:11the sessions, i.e. after the trips.
05:14I've recently seen data from the new group of patients who are being treated in Australia.
05:18Australia two years ago made MDMA and psilocybin available for therapy.
05:23And MDMA was specifically indicated for treatment-resistant PTSD.
05:27And there's a colleague of mine, a professor Gunnar Wadney in Sydney, who's now done over
05:3240 people with chronic complex PTSD with MDMA, and the results are rather spectacular.
05:38So from MDMA therapy, what exactly happens during an MDMA-assisted therapy session?
05:43The way we engage with these sessions is to prepare the patients as to what they're going
05:48to experience.
05:49And they will often experience the coming up phase.
05:52They might feel a bit of a heart pounding.
05:54They might feel a bit of anxiety.
05:55We reassure them that we're measuring their blood pressure, no harm is going to come to
05:59them.
05:59But the key is when the drug starts to change the brain.
06:02And what we say is, go where you need to go.
06:06Use the effect of the MDMA to allow you to deal with the things that traumatise you.
06:11Go back to the bomb in Iraq.
06:13Go back to the road traffic accident.
06:15Go back to you perhaps being traumatised through rape or assault.
06:20Go back to those situations.
06:21And then we will be with you.
06:24We will support you through reliving those experiences, which will be unpleasant.
06:29Now, the way MDMA works is to allow people to re-engage with the memory without the emotion
06:37that comes back with the memory overwhelming them.
06:41This is Dogwater79.
06:43MDMA worsened my depression.
06:45Am I an alien?
06:47Never done any studies on MDMA and aliens.
06:49I can't comment on that.
06:50It's not impossible that MDMA could worsen your depression.
06:53We know that if you use a lot of MDMA and you do a lot of other things when you're
06:58taking
06:58it, you know, if you dance for hours and hours and hours and exhaust yourself, you get very
07:02disruptive sleep for a few days.
07:04Yes, MDMA can produce low mood.
07:06That was actually one of the arguments that was used to try to justify the banning of MDMA.
07:11Because people say, well, this is a form of brain damage.
07:14In fact, ridiculous studies were done where animals were poisoned with enormous doses
07:18of MDMA.
07:19And yes, it will cause brain damage.
07:21And in our MDMA study, we looked very carefully at this.
07:24We took people who had quite severe alcohol dependence.
07:28We gave them two MDMA trips.
07:29And after each one, we looked very carefully at whether there was a negative impact on their
07:33mood.
07:34And there wasn't.
07:34In fact, there was a positive impact on their mood.
07:36Because MDMA in a therapeutic session, though challenging, can also lead to improvements
07:41in mood and insight.
07:42So we can say, if it's done right, MDMA doesn't cause depression.
07:47This is from Klotzak.
07:48How does ketamine therapy work?
07:50Do you actually have to live through your trauma again?
07:52And the answer is that you don't.
07:54So ketamine therapy disrupts your thinking.
07:56And for some people, that's just good enough.
07:58That gets rid of the thinking about the trauma.
08:00It just cuts it.
08:01But for other people, the trauma may come to the fore.
08:03And you may have to work through it.
08:05So we cannot predict.
08:06What happens for most people is that there's a period of two or three days after the ketamine
08:11where they're much more able to think rationally about the past, the present, and the future.
08:16And that also helps them if they need to deal with the trauma.
08:18But you don't have to relive the trauma.
08:20It's not the same, really, as using MDMA for PTSD, where re-engaging with the trauma is quite
08:25critical to the benefit.
08:27This is from GirlBrain69.
08:29Cancelling this week's therapy appointment because I sorted out my inner child healing
08:33in a K-hole.
08:34The K-hole is a term that's used by people who take ketamine where they get into a state
08:39where they're completely dissociated.
08:40It definitely happened upon something we're using a lot.
08:43Because ketamine is easier to work with because it's a medicine, even though it's an illegal
08:48medicine recreationally, we and others are using ketamine as an alternative to psilocybin
08:53or other psychedelics for therapy.
08:55But we're using it as a way of changing the way people think about their problems to facilitate
09:00therapy.
09:01So we, in our current studies, are doing three, four, or five ketamine sessions, usually
09:06one or two weeks apart, with therapy in between.
09:09And we're getting outcomes there which are pretty similar to what we get from a single
09:13psilocybin treatment.
09:15So ketamine produces changes in the brain similar to psilocybin, but not as long-lasting.
09:20And that's why you need repeated doses to build up to get the same size effect.
09:25So this is from the Therapeutic Ketamine subreddit.
09:27Having my first ketamine infusion, what to expect?
09:31You will feel possibly a bit of flushing to start with.
09:33Maybe your heart pounds a little.
09:35And then you'll go into a state where the world doesn't seem quite so real.
09:38Your vision will start to distort a bit.
09:40Your sense of control of your eyes and your body will start to become a bit disrupted.
09:45No one can predict what their brain is going to go into under ketamine.
09:49But that state is transient.
09:51Ideally, you use it if it takes you somewhere interesting where you can grapple with a problem
09:55you've had in the past or you're having in present.
09:58But afterwards, with ketamine, your brain is much more tranquil.
10:02And you can then, with your therapist, work on the insights that you have gained during
10:08the therapy and build them up and start using them to develop new strategies for dealing
10:13with how you feel, how you relate, how you deal with the future.
10:17So this one's from Kimberly Monty Bailey.
10:19Okay, Trump signs executive order to loosen restrictions on psychedelic drugs.
10:24And, and, what the fuck does that really mean?
10:27I think it's actually a very positive move.
10:29And it's positive for two reasons.
10:30I mean, these drugs are still illegal.
10:32So that makes research with them very, very difficult.
10:34Each study takes two years to get permissions.
10:37Despite the fact we've done loads of them.
10:39We're still treated as if we're using a really dangerous drug in patients.
10:42And that means that the research has been very, very slow.
10:45So I'm hoping this executive order will accelerate access and reduce the cost so more studies
10:51can be done and we will get to clinical trials being finished and reported much more cost-effectively.
10:56This is from AtMRCOLEC.
10:59Crazy how nobody talks about ibogaine therapy.
11:02The magic that it works on the brain is nothing less than a miracle.
11:06Well, I don't disagree.
11:07Ibogaine is atypical in the sense that it doesn't work through the serotonin system as obviously
11:12as, say, psilocybin or LSD.
11:15It's atypical in the effects are very, very odd and very long-lasting.
11:19Often people are in a kind of tripped-out state for several days.
11:23Many people describe it as the most powerful, disturbing experience of their life.
11:28One thing I can say is that people don't get addicted to ibogaine.
11:30It's not very pleasant.
11:31But it is very powerful.
11:33And that is one of the reasons why it's been used in perhaps the most difficult of all
11:37disorders to treat, which is addiction.
11:39And there is reasonable evidence that ibogaine can help break the thinking patterns, the craving
11:45patterns, the behavioural patterns of addiction.
11:48The problem with ibogaine is that it can cause heart irregularities.
11:53And worldwide, there have been over 30 deaths from people using ibogaine.
11:57We're now recommending that anyone who's having ibogaine therapy at least does it in a clinic
12:02where there's a cardiologist who can deal with any cardiac arrhythmias, irregularities if they occur.
12:08So this is Brian Johnson, who says he's live streaming 5-MeO-DMT this weekend.
12:14What should I expect?
12:16So 5-MeO-DMT is more usually known as toad.
12:20This is very similar to DMT.
12:22It was first found in the exudates of the skin on the Sonara Desert toad.
12:26It has an effect which is somewhat different from DMT.
12:30It's more powerful.
12:32A lot of people say it's 10 times more powerful than DMT.
12:35It puts you into a state where you really don't know where you are.
12:39People often describe it as either complete blackness or complete whiteness.
12:42They're often unaware of what they're doing.
12:45And we've just completed a study of 5-MeO-DMT trying to image it.
12:48Very difficult to image it because people were screaming, shouting, running around in a very dissociated state.
12:53We think that's because the pharmacology is half a psychedelic.
12:57But it also has some other actions which we think may change the brain experience.
13:02So the next question is from Bohem.
13:04What are your opinions on the future of psychedelics in the medical field?
13:07We already know that psychedelics can have powerful effects in some disorders,
13:14like cluster headaches.
13:15Cluster headaches are the most extreme form of headache.
13:18They're associated with high rates of suicide.
13:21And psychedelics can put cluster headaches to bed.
13:24Another area of considerable research interest at present is can psychedelics help heal the brain,
13:30which has been traumatized?
13:32One of the things we know is that they increase the growth of neurons and synapses.
13:38And there are preclinical studies showing they can accelerate recovery from stroke.
13:42So currently a study is going on where people are given intravenous infusion at a sub-psychedelic level of DMT,
13:49dimethyltryptamine, to see if we can accelerate recovery from stroke by inducing this growth of neurons,
13:56this phenomenon we call neuroplasticity.
13:58And then there are also other disorders, there are neurodevelopmental disorders,
14:01where people often discover that psychedelics have helped them.
14:04I think the best example of someone with a sort of little neurological condition benefiting from a psychedelic actually is
14:11Paul Stamets.
14:11When he was young, he had a stammer and he took magic mushrooms and the stammer went away.
14:16And that makes perfect sense because we know that stammering is due to a failure of communication between two sides
14:23of the brain.
14:24And magic mushrooms increase connectivity across the brain, so almost certainly cured his stammer by increasing that connectivity.
14:31So this is from Alia2121.
14:35Ayahuasca is not 10 years of therapy in one night.
14:37And I hope this idea stops being marketed.
14:39So ayahuasca is a drinkable form of DMT, dimethyltryptamine, a cocktail of two herbs,
14:45one which contains a psychedelic DMT and the other which contains a substance called harmaline.
14:51Harmaline prevents the breakdown of DMT by the gut and the liver.
14:54Ayahuasca has been used for thousands of years by indigenous peoples in the Amazon basin
14:58as part of religious and developmental and cultural experiences.
15:04Usually in group therapy, usually overnight, usually with music,
15:08the processes are curated by kirindarrows or shamans.
15:12It's very powerful.
15:13For many people, ayahuasca can be a life-changing experience.
15:16The experience itself is very powerful.
15:18But when it's used as a therapy, yes, one or two ayahuasca overnights can cause profound benefits
15:23in people with traumas, veterans, even with addiction.
15:26That's all for today.
15:27Thanks for watching Psychedelic Therapy Support.
15:31And if you want to learn more, feel free to read the book called Psychedelics by me, Professor David Nutt.
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