What physicians should know about psychedelic therapy

Drugs for mental health? That may still seem strange to some. We explain what physicians need to know about novel forms of therapy with psychedelic substances.

Psychedelic therapy: LSD, psilocybin and ketamine in clinical tests

Mental illnesses have been on the rise for years. Depression, post-traumatic stress disorder, anxiety or obsessive-compulsive disorders and also addictive disorders are the focus of new therapeutic approaches that work with psychoactive substances.

Psilocybin, LSD, MDMA, DMT are some of the substances that are currently being tested in phase II and phase III studies. They achieve remarkable therapeutic successes that cannot be achieved with conventional pharmacological therapies; however, they have not yet been approved. Only ketamine is already used as an off-label treatment.

Andrea Jungaberle, MD, specialist in anaesthesia and emergency medicine, co-founder of the MIND Foundation and medical director of the OVID clinic in Berlin, knows what physicians need to know about psychedelic therapy, how they can further educate themselves and what they can do to show their patients therapy options.

Augmented psychotherapy with ketamine

In the OVID Practice for Augmented Psychotherapy, Andrea Jungaberle and her team work with altered states of consciousness and psychotherapy. In addition to breathing techniques (Breathwork), ketamine is also used here. Five to six doses of ketamine plus psychotherapy, which integrates the experience with the psychotropic substance, form the framework of the treatment. Patients mainly come to therapy with depression, but generalised anxiety disorders, obsessive thoughts or PTSD can also be successfully treated with ketamine: "So in every situation where people are very constricted, think in very narrow ways, or are very rigid, loosening up in these states, especially the emotional loosening up, helps very well if you intercept it well therapeutically," Dr. Jungaberle reports.

When asked about the sustainability of the therapy's success, she answers: "After half a year, many say, 'yes, I'm not as good as I was right after the therapy, but nowhere near as bad as before'. Some say, 'yes, it came up again, but with what I learned with you, I was able to face it differently' and some, who then need antidepressants again, say 'with you, I got a feeling of who I actually am when I am not depressed'. This feeling of experiencing oneself without being under the framework of depression helps many people to get out of depression. I would already say that the therapies are sustainable, but sustainability is hard to define with mental illnesses, especially with something as long-lasting as chronic depression."

Private health insurers often cover the therapy portion of ketamine-assisted therapy. In some cases, the costs are covered in full, but only if other, larger costs, such as a longer stay in hospital, can be avoided. The statutory health insurance funds have also been able to cover at least the psychotherapeutic part of the costs. However, patients usually have to pay half of the costs for augmented psychotherapy themselves.

Patient referrals

Those patients who have been in treatment for a long time but have not responded or responded inadequately to other methods of therapy are often good candidates for onward referral. "The thing is that you can contact us and introduce a patient briefly in an email. We are always easy to reach and also respond quickly," says Dr. Jungaberle. "Then we exchange information and, if necessary, take over the patient from the colleague for a certain period of time, usually two or three months. After the treatment, he is then handed back to the colleague with a good transition. It is not at all the case that we want to take over patients completely, but our reference psychotherapist is then in contact with the treating colleague. If the latter is trained and familiar with augmented psychotherapy, psychotherapeutic sessions can sometimes be conducted by that professional."

Psychedelic research gives cause for optimism

Psychedelic research is booming. Psilocybin in particular is currently being researched for the treatment of severe depression (major depression) or untreatable depression (treatment-resistant depression), the physician says. In Berlin and Mannheim, the EPIsoDE study (in German), a clinical study with psilocybin, is currently taking place under the direction of Prof. Dr. Gerhard GrĂ¼nder, in which Andrea Jungaberle is also involved. 

Half of the planned patients have just been included; about 70 participants can still be enrolled. The inclusion criteria can be viewed on the website. "The screening looks at six to eight patients and usually one of them is suitable for participation. That means the chances are there," says Dr Jungaberle. "We are always happy to be contacted by our colleagues," she says.

Expectation management

MDMA-assisted therapy has proven effective for post-traumatic stress disorder, but other psychedelics such as 5-MeO-DMT and ayuhuasca also have great potential for patients in the context of substance-assisted psychotherapies.

A new class of substances is on the rise - pseudodelics. These are substances that come from the same substance class, but no longer have a psychoactive effect. They work only on the brain-organic level, but do not produce a psychedelic experience. The application is being tested for cluster headaches, for example.

Ayuhuasca is used in the context of trauma therapy, and ibogaine is very popular in the United States for weaning opiate patients. The potential of psilocybin and MDMA for the treatment of addiction is also being researched.

With all these possibilities and the media boom that psychedelic therapies have triggered, Dr. Jungaberle nevertheless warns against expecting too much: "It's not like you take a pill that resets your brain and then everything is fine again. Some people come with a very mechanistic idea of their person and their functionality that you first have to work on developing an understanding of the disease. Then one can work and treat with one's own initiative and altered states of consciousness. That is a big task for us, to correct the ideas that are partly caused by the striking media reporting."

INSIGHT 2023 and APT continuing education

For interested physicians, there is the INSIGHT Conference every two years, which in 2023 will deal with the topic "Psychedelicas: Bridging Therapy, Research, and Society" and will take place in Berlin on the last weekend in August. In addition, the OVID Clinics Berlin offer further training for licensed medical professionals. The two-year training to become a psychedelic therapist (Augmented Psychotherapy Training - APT) is hybrid in online and face-to-face sessions.