Evidence-based psychedelic therapy: driven by science, away from bogus spiritual fixes

Dr Henrik Jungaberle covers the INSIGHT 2023 themes, and the importance of scientific rigour in the expanding field of psychedelic therapy.

Translated from the original German version.

About Dr Henrik Jungaberle

Dr. Henrik Jungaberle is director of the MIND Foundation, and one of the two managing directors of OVID Health Systems. In addition, Jungaberle is a health scientist, psychotherapist and medical psychologist as well as the director of the INSIGHT conference in Berlin.

Dr Jungaberle, what is the aim of the INSIGHT conference?

Dr Jungaberle: It's about science communication. Our goal is to bring the public up to date with the research on the medical use of psychedelics. We have seen an increase in interest in psychedelic therapy for years and there are several dozen research projects at more than 30 universities worldwide. Of course, citizens can come and inform themselves. There is a lot of misinformation and profiteering in this field. That is why scientific, reliable information is important. At INSIGHT, the most important leaders of the main research groups are represented, but also many from the younger generation. We have over 40 poster presentations by PhD students. And we are reporting, for the first time, on the German EPIsoDE psilocybin depression study - the second largest in the world.

What clinical areas is research targeting with psychedelics? And how successful are the therapies?

Dr Jungaberle: Clinical research with psilocybin, MDMA etc. is mainly dedicated to depression, addiction, eating disorders, and post-traumatic stress disorder. Psilocybin has shown very good results in depression and addiction. What is still needed for approval as a drug, is a large phase 3 trial. This is expected in 2024. In trauma treatment, MDMA is the drug of choice from the psychedelic method group. Here, too, a large phase 3 trial will begin at the end of the year in the USA.

And what does this year's INSIGHT conference offer?

Dr Jungaberle: We are presenting two interesting phase 2 studies at INSIGHT. The second largest is our own, the EPIsoDE study, which includes 144 patients. It clearly shows that many people with treatment-resistant depression can be helped adequately. So this is a serious new treatment option. We included 25- to 65-year-old patients. Exclusion criteria are psychotic disorders in their history or family, previous organic medical conditions - especially in the cardio area -, as well as severe personality disorders.

We also present numerous real cases - for general practitioners, psychiatrists and psychotherapists this is be super exciting. In addition, half a dozen patients will be on hand to talk about their experiences on stage. The topics here are depression, obsessive-compulsive disorders, and trauma. And another highlight is the ongoing training: our network of MIND Foundation and international experts, including from the Central Institute of Mental Health (in German: Zentralinstitut für Seelische Gesundheit, or ZI Mannheim) in Mannheim and many international universities, has already trained 100 psychotherapists and doctors in psychedelic therapy. Around 60 of them will be present at the conference, and about a dozen will appear on stage and talk about their experiences.

Who are the appropriate patients for the treatments?

Dr Jungaberle: These are people who have an interest in not only addressing brain-related treatments, but who themselves want to participate psychotherapeutically in their therapy. We strongly advocate a combination treatment. For us, psychedelic therapy is psychotherapy with occasional administration of a pharmaceutical. Unlike antidepressants, these substances are not given daily, but only once or twice during the course of the study - and in the course of later treatment no more frequently than about four times a year. And this is always done with therapeutic support, because the patients sometimes go through intense emotional processes for four to six hours. These are then processed and classified in further therapy sessions.

What happens in the brain when the substances are taken?

Dr Jungaberle: Classic psychedelics such as psilocybin and LSD are 5HT2a agonists. They resemble the neurotransmitter serotonin and dock at a clearly defined receptor. We know from animal experiments that they promote neurogenesis, that they can have an anti-inflammatory effect - which is why, incidentally, Alzheimer's research has recently also become interested in the effect of psychedelics.

It is interesting that during the time span of effects, the default mode network (DMN) is reset, which ensures predictable interpretation and behaviour sequences in everyday life. And this causes a temporary "shaking" of the brain. It makes it possible to feel anew, to think in novel ways. In addition, a learning window of at least one week opens up after the intake with the increased chance of learning things anew. Psychotherapy can support here to develop a new view of oneself and life.

What is the goal of treatment?

Dr Jungaberle: The goal is to go beyond symptom relief. We can demonstrate very impressive symptom improvements with the Hamilton score. But beyond that, it is about finding a new way of dealing with stressors and a new approach to one's own values and the meaning of one's own life, and thus gaining more security in life. For example, many depressive patients experience a lack of meaning.

How high is the interest of the general public in your research?

Dr Jungaberle: Interest in scientifically-based psychedelic therapy is growing strongly. The EPIsoDE study led by Prof. Gerhard Gründer from the ZI Mannheim, for example, is funded with 5.4 million euros by the German Federal Ministry of Education and Research, and I am very proud that we are able to do this research in association with state institutions, and with therapists and scientists from the MIND Foundation. Big pharmaceutical companies still have very little presence in this field. In the American market, however, there are medium-sized and smaller players who are starting to get involved. 

At the same time, we see how esoteric and "New Age" approaches are being pushed into the market - and that is also why our conference is so important, where we critically examine the field of psychedelics applications. Psychedelic therapy is a valuable part of evidence-based medicine. We distinguish ourselves from an esoteric scene that opposes evidence-based medicine. The conference also hosts dialogues to assess these and wider perspectives. For example we invited philosophers like Thomas Metzinger, who refers to a "culture of consciousness", which means: not being satisfied with spiritual illusory solutions, and not taking refuge in an illusory world. For example, it is more important to go to the playground with your own children and improve your relationship with them, than to meditate for hours or have the next psychedelic experience.