Over the last year, Awakn – the UK’s first private clinic offering psychedelic treatment in combination with psychotherapy for addiction, anxiety, depression, PTSD, eating disorders and other issues – has opened centres in Bristol and London. But the costs of private treatment are high – an 11-week session at Awakn costs around £7,500 – and other scientists point out that while prescribing antidepressants is very straightforward, psychedelic therapy is a lot more complex.
“It’s got huge potential, but I think it’s going to be non-trivial to roll this out to large numbers of people,” says Jennifer Barnett, a psychologist and cognitive neuroscientist at the University of Cambridge, who is CEO of Monument Therapeutics, a Cambridge-based biotech developing new therapies in psychiatry and neurology.
“It’s not prescribing someone a drug and walking away; it’s a lot more involved than that. It requires giving patients the drugs, and then giving them skilled psychotherapy during and after the trip experience. And there’s already a lack of good psychologists out there.”
If the evidence base continues to grow, some wonder whether psychedelics could one day be made available on the NHS. Last autumn, Boris Johnson agreed to review the legal landscape surrounding psilocybin to make it possible for more clinical trials to be conducted in the UK, but even the biggest advocates of psychedelics agree that they retain something of an image problem.
While the therapeutic doses and uses of drugs such as MDMA and ketamine for mental illnesses are very different from nightclub culture, they remain tainted by their association with teenagers overdosing. Some are concerned that patients may attempt to self-medicate with psilocybin or other psychedelics. Nutt says that they should only be used in clinical settings under the strict guidance of a trained psychotherapist, with carefully controlled doses.
Nutt also admits that many psychiatrists are still uncomfortable with the idea of prescribing a therapy that gives their patients a hallucinogenic experience, especially as long-term safety data remains lacking.
One idea is to renounce the name psychedelics entirely. “We can say they are serotonin 5-HT2A receptor drugs and maybe that would sound better than saying psychedelics,” says Barnett.
In the coming years, the whole field of psychedelic research is only likely to grow, with big pharma beginning to show an interest. Earlier this year Japanese pharma giant Otsuka announced a partnership with Canadian psychedelics company Mindset Pharma, while researchers are trying to identify different biomarkers which could pinpoint which patients are likely to benefit most from these drugs.
For Nutt, given the immense need for better treatments, he believes it is critical to find ways to make this therapy more widely available because the need is so great.
“Whether we’re talking about depression or addiction, it shortens life,” he says. “By about 10 years, particularly with severe depression. And it’s not just suicide, people also die prematurely from things like heart disease. And it’s getting worse.”
‘For me, there were no trippy hallucinations, it was more like a waking dream’
In 2011, Jemma Rapley was diagnosed with clinical depression following the collapse of her marriage.
“It manifested in crippling self-doubt and criticism,” she remembers. “I’d failed, I wasn’t good enough, I wouldn’t ever get better. Eventually, I stopped leaving my flat, ate the same meal every night, lost friends, struggled at work, and got into debt. I felt very alone.”
While her GP prescribed different antidepressants, and she tried mindfulness and cognitive behavioural therapy to cope with the negative thoughts, the benefits were minimal. “Talking therapy was extremely limited on the NHS, so I looked for alternative coping strategies but nothing was actually able to lift me out of the despair,” she says.
After reading about psilocybin and its potential to help depression, she was accepted onto a clinical trial at Imperial College London in 2019. The effects were immediate. “For me, there were no trippy hallucinations, it was more like a waking dream,” she says. “I was just rising, feeling unburdened for the first time in years. I was finally able to recognise with clarity the people and things that were important to me, and the positives in my life that the depression had hidden for so long.”
She credits the treatment with helping her endure the repeated lockdowns of the last two years and emerge from the pandemic mentally unscathed. In particular, the connections with a song which was playing during her first psilocybin session – ‘Ma’ by the Kundalini yoga therapist Benjahmin Steele – has provided her with stability.
“Since the trial I’m happy to report I haven’t needed further treatment for depression, and I believe I’ve truly conquered it,” she says. “Whenever I listen to that song, I feel newly unburdened – it’s given me a tether to my happier self and a way to get back there if I ever find myself slipping. After this life-changing experience, I’m excited about the future again.”