Hope that psychedelic drugs can erase trauma

When Lori Tipton saw an advert on social media seeking subjects for a study on post-traumatic stress disorder (PTSD), her curiosity was piqued. She had already tried antidepressants and anti-anxiety medications. She had been to therapists, social workers, psychiatrists and psychologists. When all that failed to quell her anxiety, panic attacks, insomnia and suicidal thoughts, she sought help from other sources: a dietitian, an endocrinologist, a shamanistic healer and an ayurvedic doctor. She even pursued a yoga teaching certification to become more present and mindful. Nothing had helped.

The trial would test whether the psychedelic drug MDMA (better known as ecstasy) could treat PTSD. She didn’t expect it to be successful, but with other options exhausted, she decided to give it a try.

Post-traumatic stress can develop in anyone who has faced danger or experienced chronic stress, the most common causes being disasters, sexual assault, domestic abuse and combat experience. Tipton’s PTSD stems from a series of traumatic events. When she was 20 years old, her brother died of a drug overdose in her apartment in New Orleans, Louisiana. When she was 25, her mother killed two family friends before turning the gun on herself. Tipton discovered the murder scene. The same year, Hurricane Katrina displaced her and her entire community. The following year she was raped, became pregnant and aborted the pregnancy. She recalls that the nurse in charge of her care had anti-abortion views, and shamed her, withheld pain medication, and was physically rough in examining her.

PTSD can manifest as recurrent, intrusive memories or, more rarely, as memory loss. The best-studied treatments are cognitive behavioural therapy, in which people are helped to identify patterns of negative thought and behaviours with a view to changing them, and exposure therapy, in which they confront things that trigger fear and anxiety in a safe setting. These are often combined with antidepressants and anti-anxiety medications. But relatively few people reach true remission and, for some, such as Tipton, the treatments provide, at best, little or transient relief.

In the past decade, an increasing number of combat veterans with chronic post-traumatic stress have sought relief in the psychedelic underground, trying everything from magic mushrooms to ayahuasca, a powerful psychedelic made from South American plants. But only in the past few years have researchers finally been able to properly test whether psychedelics can help. The decision of the US Food and Drug Administration (FDA) to approve esketamine for treatment-resistant depression in 2019 signalled a shift towards the potential acceptance of psychedelics as treatments for a variety of mental-health conditions. Clinical research on psychedelics has been pressing forwards at a mind-bending pace.

However, the enthusiasm for clinical trials, driven partly by anecdotal reports of success and partly by the desperation of people who have spent decades searching for relief, has led to a sense of optimism not fully grounded in evidence. How and why psychedelics work remains poorly understood. Many researchers think that holding clinical trials without understanding the biological mechanisms is putting the cart before the horse. “Psychedelics can represent a new paradigm of care, but we haven’t done the work yet,” says Rachel Yehuda, a psychiatry and neuroscience researcher at the Icahn School of Medicine at Mount Sinai in New York City.

Published: September 29, 2022

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