Introduction

In recent years, the scientific community and wider society have been looking at substance use in a new light. A complex web of factors pushed millions of Americans into addiction and/or the criminal justice system, and public opinion on the issue is shifting fast. As the stigma around psychedelic medicine and other substances diminishes, experts are increasingly able to conduct experiments and explore novel therapies for mental health care and well-being.⁽¹⁾

Recent discoveries involving two psychedelic compounds, psilocybin (the main chemical in magic mushrooms), and 3,4-Methyl​enedioxy​methamphetamine (MDMA, commonly known as molly or ecstasy), have fascinated researchers and medical practitioners.

Both psilocybin and MDMA are part of the psychedelic family of drugs (though MDMA is considered a non-classical psychedelic). Psilocybin (aka magic mushrooms) has long been associated with the counterculture movement of the 1970s. Known for giving users vivid, often euphoric, and mystical psychedelic experiences, new discoveries are beginning to shed light on this psychedelic fungi’s huge medicinal potential to treat mental health disorders.⁽²⁾

MDMA, on the other hand, is not typically associated with visual changes or distortions (although subtle shifts in the ability to detect lines and colors may occur). Instead, MDMA generally causes euphoria, improved mood, lowered anxiety, increased music appreciation, heightened empathy, raised libido, and a general sense of excitement and well-being. MDMA users also report feelings of deep connection and closeness with those around them, friends, and loved ones.⁽³⁾

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What Conditions Can Psychedelic Medicine Treat?

This review explores a range of studies examining the use of the psychedelic medicines psilocybin and MDMA, in a psychiatric setting. The first was published in 2016 in the journal The Lancet Psychiatry, and examines psilocybin and MDMA. Both substances show promise as therapeutic treatments for patients with:⁽⁴⁾

Ultimately, if the FDA approves therapeutic psychedelics, millions of individuals struggling with one or more psychiatric disorders could see significant improvements in their quality of life. 

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How New Psychedelic Medicines May Help with Mental Health Conditions

During a psychotherapy session, healthcare professionals administer and supervise the patient as they safely go through a psychedelic experience. The influx of neurotransmitters released by MDMA and psilocybin makes the brain more receptive to change. Scientists believe this “plastic” state of mind has the potential to allow people with mental disorders to open up emotionally more easily and rapidly build new, healthy connections through talk therapy.⁽⁶⁾

One of the key differences between the use of MDMA vs. psilocybin to assist in talk therapy sessions is the timing and structure of psychiatric treatment. Psychotherapy sessions where patients take MDMA typically alternate between dialogue and inner focus. With psilocybin, the dialogue between the patient and the psychotherapist occurs before and after the patient feels the effects of the psychedelic drug.

Psilocybin is a natural active alkaloid present in over 100 mushroom species, most notably, the psilocybe family of mushrooms. This family includes common strains like psilocybe cubensis (commonly known as Golden Teachers). First documented in the 1950s, indigenous populations in South and Central America have used the substance for divination and healing for centuries.⁽⁷⁾

MDMA (commonly known as ecstasy or molly) was used in the 1970s-80s by approximately 4,000 psychiatrists as part of their psychotherapy sessions before it was an illegal Schedule I substance.⁽⁸⁾

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Studies On Psilocybin and Psychotherapy

Psilocybin combined with therapy shows promise for improving patients’ quality of life with advanced-stage cancer. They could also help minimize the anxiety many experience following a diagnosis.

Lysergic acid diethylamide (LSD) and di-propyltryptamine (DPT), which is similar to psilocybin, were used in a series of studies in the late 1950s, which proposed the following possible benefits for patients:

More recently, a study at the Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute explored the use of psychedelic medicine to help cancer patients manage their end-of-life anxiety.⁽¹⁰⁾

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Psilocybin Therapy Study Results

The study looked at 12 individuals who participated in two sessions spaced one month apart. During one session, they were given psilocybin and, during the other session, a placebo. Data collected for six months indicated positive outcomes:

• Significant reductions in anxiety one month and three months after treatment
• Safe physiological and psychological behaviors during the sessions and afterward

Similar studies from Johns Hopkins University indicated that healthy volunteers who received a high dose of psilocybin under optimal conditions had mystical experiences. Participants in this study reported continuing to experience positive feelings for up to a year after treatment. Another pilot study found that psilocybin treatment results in a higher rate of participants quitting smoking.^(11, 12)

Psilocybin could be life-changing for people who are reluctant to take psychiatric medication long-term or haven’t experienced relief from traditional treatment methods. What’s more, adherence to therapy and medication protocols can be challenging for individuals with mental health disorders. By almost entirely removing the potential of missed doses and appointments, successfully completing treatment can become significantly easier.⁽¹³⁾

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MDMA and Psychotherapy

Scientists have also been researching the benefits and risks of MDMA-assisted therapy. Phase I and Phase II clinical trials saw more than 1,100 people receive MDMA without serious adverse reactions. The only reported reaction was in a patient requiring overnight observation for a transient increase in preexisting ventricular ectopy.

Because psychedelic drugs have been given a bad reputation in the media in the past, these psychiatric treatment studies are essential for showing the public their safety profiles under controlled conditions.

MDMA Therapy Study Methodology

Patients were given two or three doses of MDMA several weeks apart during therapy sessions. These sessions lasted approximately eight hours at a time, and there were periods of dialogue with the therapist and periods of introspection within that time frame.

The first completed Phase II trial for MDMA and psychotherapy looked at 20 patients who didn’t see the desired success with pharmacological treatment or psychotherapy. Many participants, who had PTSD for over 20 years, saw a significant decrease in their symptoms following the trial. In total, 83% no longer met the requirement for PTSD after receiving MDMA-assisted psychotherapy, compared to just 25% who took a placebo.⁽¹⁴⁾

In addition to experiencing improvements in PTSD symptoms, trial participants in this study reported meaningful therapy experiences that increased functionality in multiple areas of their lives. Psychedelic medicine alone isn’t the key to success in this treatment model, but the unique approach to therapeutic experiences may be.

Relation to Current Psychotherapy Treatments

There are differences between existing psychotherapy methods and the new model of MDMA- or psilocybin-assisted psychotherapy. In MDMA-assisted psychotherapy sessions, the outcomes included:

• Imaginal exposure, which is like exposure therapy, but via the patient’s imagination.
• Correction of cognitive distortions (specific negative thought patterns reinforcing anxiety and depression).
• Insights into the underlying unconscious processes that reinforce mental illnesses.

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The Future of Psychedelic Medicine in Psychiatry

Over the next five years, further research needs to be done on the psychiatric use of psychedelic drugs like MDMA and psilocybin. Completion of ongoing Phase II and Phase III trials will look at the safety and therapeutic efficacy levels of these substances for treating PTSD and anxiety linked to mental illness.

Researchers must gather and analyze data regarding the lived experience of people who undergo MDMA-assisted or psilocybin-assisted psychotherapy. For now, the scientific community and the media are excited about the promise of psychedelic medicine in this capacity. Importantly, public perception of psychedelics for psychiatric treatment is also beginning to change. This is partly thanks to the publication of studies, as discussed here, that showcase the remarkable potential of psychedelic drugs. If future studies confirm the positive impacts of MDMA and psilocybin for psychiatric and mental health disorders, the FDA will have a stronger path to approve them as medications.