Depression, anxiety, PTSD and other maladies of the mind are plaguing our societies. Our medicines are now decades old, and their effectiveness is questionable. Around half of those taking antidepressants experience no benefits. Side effects are common, and relapse rates when stopping the pills can reach 80%.
If someone told you we have a remedy with nearly no relapse, no long term side effects, and life-altering potential, wouldn’t you be curious?
Enter Dr Ayla Selamoglu (Newnham 2016). As a Trinity postdoc endorsed by biotechnologist Prof. Christopher Lowe OBE, her research centres on psychedelic medicine and drug development.
Psychedelic medicine has the potential to revolutionise psychiatry. And the revolution is starting here.
Helping others heal
“From a young age, I felt a deep calling to help others heal,” says Ayla. “I knew my purpose was to serve and help people.”
This calling led Ayla to work at the Royal Children’s Hospital, the largest paediatric facility in the southern hemisphere, and The Alfred Hospital, renowned for its trauma and critical care expertise. There, she treated patients with diverse psychiatric conditions. She saw people with extraordinary psychological resilience, including those with multiple sclerosis.
“I witnessed patients suffering in silence, yet holding on with dignity and strength. Mental health is an invisible disorder that emotionally paralyses people. I felt deep empathy for them: they deserved more attention and respect.”
An offer from Cambridge
“When I got a PhD offer from Cambridge, things moved very fast. I wanted to start in the Easter term, which meant I had 10 days to quit my job, pack, say goodbye to friends and family, and get a one-way ticket to the UK.”
Ayla landed on her feet. She became the last PhD student of renowned neuropsychologist Prof. Barbara Sahakian CBE, before she hung up her supervising boots.
Barbara put Ayla to work at Addenbrookes Hospital, Cambridge, investigating the psychoactive effects of cannabis. Here, Ayla could build on her expertise in cannabis-based treatments for multiple sclerosis, which can help manage pain and inflammation.
After her own research into the therapeutic potential of psychedelics, Ayla extended her studies. In 2018, she became one of the first to study psychedelic medicine at Cambridge.
The psychedelic library
Psychedelic research has a chequered history. Associations with hippies, counter-cultural controversies and Nixon’s ‘War on drugs’ led to a scientific moratorium on psychedelics until recent years. But intellectual curiosity has kept underground investigations alive: from Oxford novelist Aldous Huxley in the 50s, to Czech psychiatrist Prof. Stanislav Grof in the 70s, to modern writers like Michael Pollan, with his bestselling book How to Change Your Mind.
In UK universities, Dr. Robin Carhart-Harris and Prof. David Nutt were at the forefront of the psychedelic renaissance. Ayla collaborated with them through the Psychedelic Research Group at Imperial College London.
Since then, Ayla has compiled a library of over 95 psychedelic compounds that exist in nature – in plants, animals or other species. With a Cambridge supercomputer, she’s using AI and machine learning to identify which compounds have the highest potential for drug discovery, and for treating psychiatric disorders.
In this way, Ayla hopes to expand our knowledge of these mysterious substances, and how we can put their effects to use.
Psychedelic therapy
So, what does psychedelic therapy entail? The specifics are still a work in progress, but would look something like this. A certified practitioner will guide patients through several hours of a psychedelic experience. The patient will have taken a substance like LSD, psilocybin, ketamine, MDMA, DMT or 5-Meo-DMT. Each therapy session will be different. Therapists will adapt to variations in past experiences, and the unique way each patient’s brain reacts to the substance.
Some therapists suggest that psychedelics can deal with the source of our pain instead of just numbing it – as antidepressants tend to do.
Psychedelics are different
“Psychedelics offer something different,” Ayla agrees. “Something more transformative. They don’t create dependency, and you don’t have to taper off them. In some patients, one or two sessions is enough to make a profound, lasting difference to their wellbeing.”
“They act on the serotonin system, with some effects on dopamine and glutamate systems. They may improve mood and creativity, and promote neuroplasticity.”
After successful psychedelic therapy sessions, patients report long-lasting benefits. These range from an increased sense of empathy and connection, to an enhanced appreciation of nature and interconnectedness. Some report a stronger commitment to altruistic behaviours (such as donating or volunteering). Meaningful lifestyle changes are common too, from healthier diets, improved mindfulness, to quitting smoking and drinking.
The snow globe effect
Behind these changes is what researchers call the ‘snow globe effect’. This refers to psychedelics’ ability to ‘shake up’ the brain’s communication networks, akin to shaking up a snow globe.
In this analogy, snowflakes stand in for lines of communication (or thoughts). In contrast to a settled, sober state, the psychedelic state allows snowflakes to disperse and float in directions they otherwise wouldn’t.
This is a state where new connections can be made. Sometimes, old patterns of thought can be rewired.
“The psychedelic state resembles that of a dream, allowing free-flowing communication across neural networks. In the sober state, communication between certain brain areas is restricted. For example, visual areas will only communicate with other visual areas. In the psychedelic brain these boundaries are crossed.”
You could think of neural pathways being like well-used roads. The more we use the same routes, the more reinforced they become. By going down paths less travelled, we can make surprising connections and reframe how we perceive ourselves and the world.
Relaxing rigidity
“A lot of suffering comes from thought patterns that are too rigid,” Ayla says. “Psychedelics allow people to relinquish control and relearn.”
Another way to conceptualise this is entropy – the amount of chaos and noise the brain allows for in its normal state. OCD, compulsive, and addictive behaviours could be characterised as ‘low entropy’ brain states, where randomness is tightly controlled. By inducing ‘higher entropy’ states, psychedelics can shake up the snow globe, and raise people out of their ruts.
“By relaxing entrenched mental patterns and rigid thoughts, psychedelics foster creative, divergent thinking and the integration of new neural networks.
“The oppressive feedback loops of negative thought patterns, self-doubt, and spirals of despair dissolve. This can provide patients with clarity and the potential for profound psychological healing.”
What is the experience like?
When trying to describe the indescribable, look to a writer. Here’s Aldous Huxley in The Doors of Perception, after taking mescaline:
“I took my pill at eleven. An hour and a half later, I was sitting in my study, looking intently at a small glass vase … I was not looking now at an unusual flower arrangement. I was seeing what Adam had seen on the morning of his creation – the miracle, moment by moment, of naked existence.”
Huxley notes how the flowers glowed “with their own inner light … quivering under the pressure of the significance with which they were charged.”
Ayla echoes these themes, describing patients’ experiences as being full of “empathy, self-compassion, emotional release (e.g. crying or laughing), interconnectedness, transcendental experiences, spiritual awareness, or ego dissolution.”
Protection from overwhelm
Huxley quotes Cambridge philosopher C.D. Broad (Trinity 1910), who said that “the function of the brain is to protect us from being overwhelmed and confused by [a] mass of largely useless and irrelevant knowledge, shutting out most of what we should otherwise perceive … leaving only that small and special selection which is likely to be useful.”
This view is shared by modern thinkers like Prof. Anil Seth, who says that our everyday sense of reality is a ‘controlled hallucination’. Our brain triages and ignores the vast amount of data it receives, presenting us with a simplified version of the world.
Perhaps mental health disorders are symptomatic of when that hallucination is too ‘controlled’. In Ayla’s terms, psychedelics can be a way to shake up a restrictive snow globe, and let other ideas take root.
The future
Psychedelics are powerful substances, and shouldn’t be used by those whose risks are too high. Ayla’s experience in working at a psychedelic clinic in London gave her an insight into the precautions that need to be taken. To ensure safety and efficacy, any potential psychedelic therapy has strict inclusion and exclusion criteria. A person’s medical history and psychological profile need to be carefully considered before exposing them to a given substance.
Figuring out who can benefit from specific psychedelic therapies will be a long process. After initial studies, researchers have to go through the clinical trial process of drug development, which can take years. Studies are tough to conduct, due to local laws and strict regulations. In the US, individual states have radically different tolerances to this research. Denver, Colorado, legalised psilocybin in 2019, while other states are nowhere near this. Ayla’s native Australia was the first nation to legalise MDMA therapy.
While psychedelic-assisted therapy trials are underway in the NHS, many of these substances are still class A drugs. This makes them incredibly difficult to work with. After gaining a Home Office license, research facilities must meet stringent security requirements. Substances must be kept in wall-mounted, locked, caged fridges, in card-access-only rooms.
What’s more, the nature of psychedelics makes them near impossible to test using the established ‘placebo’ method. Ironically, the substances have too much of an effect. Test groups immediately know they have taken a mind-altering substance, and not an inert control. This makes it even more challenging to demonstrate the efficacy of psychedelics in traditional clinical trials.
Transformative possibilities
Despite the considerable barriers facing psychedelic research in the UK, Ayla is optimistic.
“Through respecting UK guidelines, we can earn the trust of regulators,” Ayla says. “This will ultimately open the door to further experimental research and clinical applications for patients.” Psychedelics are unique substances. Researchers like Ayla are demonstrating how their therapeutic effects can be transformative. The question is: can our depressed and anxious societies afford not to investigate potential remedies?
This article from the University of Cambridge is republished under a Creative Commons licence (CC BY-NC-SA 4.0). Read the original here.
