Implementing value-based care can help providers improve patient health and reduce care costs, but it also presents the opportunity to explore new and emerging areas of research in breakthrough treatments that can revolutionize healthcare as we know it today. Embracing such a paradigm shift is for the mindful, who acknowledge that certain aspects of medicine are not working as intended. If we are to truly attain better patient outcomes at a lower cost, we must consider emerging areas of research that can create new knowledge in the practice of medicine. On this week’s podcast, you will learn about some of the research being done to further scientific rigor and expertise in the study of psychedelic therapy. In clinical research settings around the world, renewed investigations are taking place on the use of psychedelic substances for treating illnesses such as addiction, depression, anxiety and posttraumatic stress disorder. Psychedelics fell from medical grace nearly half a century ago, their reputation mired by associations with counterculture drug excesses and Cold War era enhanced interrogation, but now a new wave of research has returned to psychedelics as potential candidates to treat mental health disorders.
We are joined this week by Charles B. Nemeroff, M.D., Ph.D the Co-Director of The Center for Psychedelic Research and Therapy at Dell Medical School at The University of Texas at Austin. Dr. Nemeroff is one of the nation’s most influential psychiatrists and has published more than 1100 research studies, and his research is currently supported by grants by groups such as the Multidisciplinary Association of Psychedelic Studies (MAPS). His research is focused on the pathophysiology of mood and anxiety disorders with a focus on the role of child abuse and neglect as a major risk factor. He has also conducted research on the role of mood disorders as a risk factor for major medical disorders including heart disease, diabetes and cancer. At the Center for Psychedelic Research and Therapy, he aims to advance the application of psychedelics for the treatment of mental health disorders through impactful clinical research. Additionally, the center looks to improve the health of those suffering from severe depression, anxiety and PTSD through psychedelic-assisted psychotherapy and research focused heavily on military veterans and adults affected by early childhood trauma.
01:30 “If we are to truly attain better patient outcomes at a lower cost, we must consider emerging areas of research that can create new knowledge in the practice of medicine.”
02:45 Introduction to Charles B. Nemeroff, M.D., Ph.D the Co-Director of the Center for Psychedelic Research and Therapy at Dell Medical School at The University of Texas at Austin.
05:00 The field of human-based research into psychedelic drugs has in the last ten years become a legitimate field of study, after decades of repression by governments around the world.
05:30 The renaissance of psychedelic research with renewed media and medical interest in LSD, psilocybin, MDMA, ayahuasca, DMT, and ketamine.
05:45 From the Woodstock generation to present day – Dr. Nemeroff provides an overview on this history of psychedelic research.
06:30 Early psychedelic research conducted by Timothy Leary and Ram Dass (formerly Richard Alpert) that created a spiritual awakening and captured a generation.
08:00 Distinguishing recreational use for spiritual awakening vs. psychedelic-assisted treatment for serious psychiatric disorders.
08:30 How psychedelics can rip away defense mechanisms in the mind that prevent people from facing the certainty of death and other unpleasant realities.
09:30 Dr. Nemeroff discusses his medical practice specialty in the psychiatric treatment of severe PTSD and treatment-resistant depression.
10:00 Military veterans, victims of sexual trauma, victims of childhood abuse, and others with severe depression often do not respond to conventional FDA-approved treatments.
11:30 The Public Health Problem of Suicide: There are approximately 50,000 suicides each year in the United States (the only leading cause of death that is increasing in number!)
12:00 The Next Big Addiction Treatment: Substance Use Disorder (SUD) can also be effectively treated with psychedelic-assisted therapy.
13:30 The economic burden of major depressive disorder among U.S. adults is an estimated $236 billion, an increase of more than 35% since 2010!
15:00 Lack of access to care for patients with depression leads to under-treatment, whereby increasing ED utilization and driving up overall healthcare costs.
15:30 Depression is a risk factor for the development of heart disease and stroke (and is a major risk factor for poor treatment outcomes).
16:00 Carving out psychiatric treatment from most commercial health plans exacerbates access challenges.
16:30 Further access challenges posed by cash-only mental health practitioners (i.e. psychologists, psychiatrists).
18:00 Most mental health practitioners do not offer Cognitive Behavioral Therapy (CBT)(“rent a friend” mental health support is not evidence-based treatment!)
18:30 Two-thirds of patients with depression are treated in the primary care setting – lack of specialization in treatment leads to over-reliance of pharmacological interventions.
19:30 The lack of medical concordance in behavioral health therapy due to lack of familiarity with the current evidence base.
23:30 How psychedelics have fundamentally changed the lives of military veterans.
24:45 The promising research from Multidisciplinary Association of Psychedelic Studies (MAPS) on MDMA treatment of PTSD.
25:00 Recent study on MDMA-assisted therapy for severe PTSD (“the largest magnitude effect benefit of the psychedelic in any psychiatric condition studied so far”).
27:15 Dr. Nemeroff discusses his interest in studying the use of psilocybin to treat alcohol use disorder.
28:30 Private foundation funding of study to evaluate treatment of severe depression using both psilocybin and transcranial magnetic stimulation (TMS).
30:00 The vast majority of those receiving moderate high doses of psilocybin have mystical experiences that are forever life-altering. 80-90% of people often report their psychedelic journey as one of the top 5 most meaningful and spiritual experiences in their entire life, comparing it to the birth of their first child or the death of a parent!
30:30 The classic psychedelics like mescaline, LSD, psilocybin, and DMT have effects that emerge from a particular type of serotonin receptor in the brain.
31:00 “Although psychedelics share a common pharmacological property, it is still unclear what the real mechanism of action of psychedelics actually are. We need to better understand this through research.”
31:45 “The psychedelic experience is not for the faint-hearted. It is pretty intense.”
32:30 Can non-hallucinogenic psychedelic analogs be created that block the psychedelic experience but still provide the same therapeutic benefits?
33:00 Dr. Nemeroff discusses the effects of psychedelic neuroplasticity where the brain can actually become rewired to overcome incessant fear-based thinking associated with mental health conditions.
35:30 “Psychedelics can help those suffering from PTSD and depression overcome the ‘circle of hell’ associated obsessive thought storms and irrational fear generalization.”
37:00 Given the overlapping experiences of ego dissolution and expanded consciousness between meditation and psychedelics, should we consider meditation as a core component of psychedelic therapy?
39:00 The need for medical supervision in the administration of psychedelic medicines and the importance of identifying ideal candidates for treatment.
40:00 The adverse consequences of allowing the widespread use of psychedelics to proliferate without regulation.
40:30 The US psychedelic drugs market is projected to grow from $2 billion in 2020 to $10.75 billion due to research innovation and the increasing prevalence of treatment-resistant depression and mental health disorders.
41:30 Dr. Nemeroff discusses recent psychedelic company IPO activity and the drive to commercialization.
44:00 How much will companies charge for these new psychedelic therapies once they are approved to make them commercially viable?
45:45 How will the FDA handle the approval of psychedelic therapy in conjunction with psychotherapy?
47:15 How will Psilocybin or LSD microdosing be treated in the context of approved therapies?
48:30 Mescaline, psilocybin, and ayahuasca have be used for thousands of years, administered in cultural contexts that are ritualized with use limited to religious or healing purposes.
50:00 The ethical concern for quality assurance to provide dosing consistency of psychedelic medicines.
51:30 Personality contraindications to taking psychedelics.
52:00 Psychedelics are not drugs of abuse – no one takes them every day.
52:30 Tragic outcomes will quickly change the dialogue on the treatment potential of psychedelics. We must be careful!
53:45 The potential to provide psychedelic medicines in a controlled palliative care setting to help cancer patients deal with end of life.