Treating patients with challenging psychedelics experiences: 5 Questions for psychiatrist Azin Bekhrad
Azin Bekhrad trained as a medical doctor at Wayne State University in Detroit, then completed a year of residency in obstetrics and gynecology at Northwestern, then a psychiatry fellowship at Johns Hopkins. She stayed at Hopkins for a few years after, doing clinical work and teaching, before going into private psychiatry practice, seeing adults, adolescents, and children. During that time, she grew increasingly interested in functional medicine, integrative health, and the mind-body connection. When she learned about the potential use of psychedelics in treating mental health issues, she was intrigued.
Now, Bekhrad has returned to Johns Hopkins, providing outpatient care through a new personalized psychiatry program at the university’s Green Spring Station Clinic, a few miles north of Baltimore. She also spends a day a week at the university’s Center for Psychedelic and Consciousness Research, where she collaborates with researchers to better understand the nature of challenging psychedelic experiences. Some of the patients she works with at the clinic were referred to her because they had some kind of difficulty in the aftermath of taking psychedelics. The Microdose spoke with Bekhrad about her work and what we know – and don’t yet know — about treating patients who have had challenging psychedelic experiences.
How many patients have you been in touch with so far, and are there any trends you’ve gleaned from their experiences and backgrounds?
We just started this in late January, and we’ve gotten quite a few calls and inquiries, but there have only been a handful of people who have been able to make it to the clinic for a consultation.
So far, one pattern seems to be that most people have been self medicating to target some sort of psychiatric illness, or have been doing spiritual exploration or introspection. Some also come to us after use at a festival, or as a recreational user. And then there are some, but fewer, that were in a clinical trial. Those patients are typically looking for follow-up integration care, or want to address something lingering from their experience; they generally haven’t had super challenging cases. In general, though, we’ve seen a little bit of everything: people with anorexia or autism self-medicating, and most often they present with symptoms like mania or psychosis.
What spurred the creation of a program that helps people who have had challenging psychedelic experiences?
Over the last several years, there’s been such an increased attention to psychedelics, which has also led to an increase in naturalistic use — and a result of that is that some people have had challenging experiences. And while there are a growing number of people trying to help them — there’s Tomislav Majić’s clinic in Berlin, and Jules Evans’s Challenging Psychedelic Experiences project — but there aren’t yet enough people who are on the ground. The need is there, but the help is siloed in many areas; there are integrative therapists and psychiatrists that are psychedelically informed, but there should be more cross-collaboration. One of my hopes for this program is to bridge that gap. I’m a psychiatrist who can also provide therapy, and also understands psychedelically-informed care.
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How might seeing a psychedelically-informed provider affect the patient experience?
Some people have profound subjective experiences — strong noetic symptoms, like “I saw God.” These are things some patients are fearful of sharing with people in the medical community; they’re worried about being judged or misdiagnosed, so they’ll simply share that they’ve had an experience without going into detail, or they’ll medicalize the language they use to describe it. But we want them to be able to go into that detail, because that detail is important!
They need someone who isn’t quick to judge, and who will give them space and time. We need to work together to figure this out. We need to carefully understand their medical history, without being quick to medicalize and quick to medicate; we need to really understand them as a person on all levels, because that’s going to be important for getting to the bottom of what’s going on with them.
What are the logistical barriers to you doing this work, and for patients getting help?
One barrier is telehealth laws — here in the U.S., I can only see people in the states where I’m licensed, or if they come in person. Also, the personalized psychiatry clinic is out of network; we don’t participate with insurance, so patients will need to pay for service. Those aren’t necessarily deal-breakers for everyone, but they do introduce some hurdles.
Is there a standard of care for working with patients struggling with challenging post-psychedelic experiences?
I don’t think there is yet, but I think there will be. Like I mentioned earlier, things are currently pretty siloed, and we’re hoping that people across the psychedelics ecosystem — not just in academic medicine — will get the message here, so we can come together and report on what we’re seeing. For instance, we might use the word manic to describe a patient, but there are other questions we can ask to get a deeper understanding of what’s happening with them: Is the symptom profile they’re showing unique compared to someone else who might not have psychedelic-induced mania?
I think the clinic’s partnership with the Center for Psychedelic and Consciousness Research is a real added bonus as well. I tell my patients that with their consent, I can take their story to the group – I can ask, ‘What would you do in this situation?’ and we can put all our heads together. Eventually I would love to do this not just within our institution but across institutions so we could have a network — a type of safety net — of clinical supervision where we can share cases, share thoughts, and identify patterns to describe what we’re seeing.
This interview has been edited and condensed for clarity and length.
