This Week in Psychedelics: Mixing psilocybin and antidepressants, ketamine concerns, psychedelics’ financial outlook, and more

Happy Friday, and welcome back to The Microdose. Here's what happened this week in the world of psychedelics:

Mixing antidepressants and psilocybin. As researchers have been investigating how psilocybin can be used to treat depression, their strategies vary. One key difference is whether researchers include participants who are already being treated with antidepressants, and if so, whether they’re asked to stop using medication while participating in a study. Researchers believe antidepressants could attenuate people’s response to psilocybin. According to a new study, that doesn’t seem to be the case. 

The clinical trial, published in Clinical Pharmacology & Therapeutics, was conducted by researchers at University of Basel in Switzerland and sponsored by the U.S. psychedelic biotech company MindMed. The study followed 23 participants for 4 weeks — about half of participants took the antidepressant escitalopram, also known as Lexapro, for two weeks before going in for a psilocybin session, then took a placebo antidepressant for two weeks before their second session. The other half of participants experienced the two weeks of placebo first, followed by two weeks of escitalopram. The researchers found that escitalopram didn’t seem to alter the way participants’ bodies actually processed the psilocybin, but it did reduce patients’ self-reported experiences of anxiety and adverse effects of psilocybin use, like high blood pressure. The authors note that longer-term studies of interaction effects between psilocybin and antidepressants are still needed, but conclude that “escitalopram and psilocybin can be safely administered together.”

Via Getty Images

Psilocybin’s spiritual experiences. In addition to treatment for depression, psilocybin is also being used to treat other mental health problems, like alcohol dependence. In one such clinical trial, researchers at the New York University School of Medicine decided to study not only the drug’s potential therapeutic effects, but also the spiritual experiences participants reported. In a paper recently published in Spirituality in Clinical Practice, the researchers detail experiences reported by three participants, which included visions of deceased family members, an encounter with a “universal power,” and a visit from a Hindu holy man who left the participant a glowing blue pearl.  “Each of these participants attributed the success of their treatment to the lessons learned through the experiences in the medication session. This demonstrates the role that spiritual experiences have in the healing process,” the authors write, and they hope that sharing examples can help therapists and guides better anticipate and respond to their own patients’ spiritual experiences.

There has never been a more exciting – or bewildering – time in the world of psychedelics. Don’t miss a beat.

Shining a light on misconduct. New York Magazine released the first episode of Power Trip, its first investigative podcast series which explores “the dark underbelly of psychedelic therapy.” The series will include eight episodes, and centers around the experience and work of Lily Kay Ross, a researcher who came forward in 2017 about her sexual assault during an ayahuasca experience in Ecuador. Ross, now an editor at Psymposia, a non-profit psychedelics publication, is the co-creator of the podcast. “I used to have such faith in the work,” Ross says in the first episode. “Now I want to have an honest conversation because I think people’s safety depends on it.”

Ketamine concerns. A couple of weeks ago, we featured this Guardian piece on the “wild west” of ketamine clinics in the UK — and two new pieces this week detailed a similarly lax regulatory structure in the US. First, the Seattle Times reported on the ketamine boom in Washington’s Puget Sound area, where a dozen clinics have opened in the last three years. Some are run primarily by nurses, not physicians, which concerns some psychiatrists, and the quality of care can differ greatly from one clinic to another, leading to inconsistent treatment.

Vice’s Shayla Love reported on another ketamine business model: telemedicine. During the pandemic, federal regulations have allowed for the temporary expansion of telehealth services, including therapy services like the mail-order ketamine treatments offered by companies like Mindbloom. Love talked with nine Mindbloom clients who shared “organizational difficulties, long wait times, an overall lack of therapeutic support and consistency, as well as cases where Mindbloom was misleading about two medical experts being affiliated with the day-to-day operations of the company.” Moving forward, it’s unclear whether telehealth psychedelic therapy will continue to be permitted — and how companies will ensure patients’ safety if they are taking ketamine unsupervised. 

Psychedelics’ financial outlook. PSYCH, a psychedelic content company, just released the third edition of their Psychedelics as Medicine Report. (Contributors include giants in the psychedelic clinic and pharmaceutical industry, like Atai Life Sciences, NovaMind, COMPASS, and Filament.) The document, available for free download here, includes analysis of the psychedelic market, which PSYCH reports is currently valued at $190 million, and expected to exceed $2.4 billion by 2026. They also report the results of a June 2021 consumer survey in the US, UK, Canada, France, and Germany, which found that about two-thirds of people contacted supported legalization of psychedelics for medical use.  

• The New York Times covers the rise in psychedelic retreats internationally.

• DoubleBlind highlights how mining and poaching threatens the Wixárika people’s millennia-old peyote pilgrimage.

You’re all caught up! Have a great weekend, and stay tuned on Monday for 5 Questions, our weekly Q&A with a leader in the psychedelics space.

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