Many people who struggle with a mental illness or disorder may not know that clinical research data suggests that new treatment options may be just around the corner. On this episode of Mind Dive Podcast, board-certified psychiatrist, physician-investigator with Segal Trials, and assistant professor at The Johns Hopkins University School of Medicine, Dr. David Mathai, joins hosts Dr. Bob Boland and Dr. Kerry Horrell to discuss the importance of understanding the cultural and historical context of psychedelic drugs and why the first FDA-approved psychedelic drug therapy could come as soon as 2024.
Dr. Mathai simplifies the definition of psychedelics as "drugs, whose most prominent subjective effects often involve dramatic changes in thought, in mood and cognition." He says that, historically, these substances have been used in different cultural traditions across the globe for the purpose of healing and connection.
He further explained that the earliest wave of research surrounding psychedelics was focused on LSD, which was discovered in the 1940s. “Realizing some of the therapeutic qualities such as LSD treatment for alcohol use disorder, anxiety and depression related with end-of-life illness...all of that was bubbling up,” said Dr. Mathai.
But the Vietnam War would serve as a gateway to dismantle that research.
For example, Dr. Mathai says there became a “complicated” social association between psychedelic drugs and counterculture, particularly with American protestors of the U.S. involvement with the war, often referred to as “hippies.” Dr. Mathai suggests this clash of cultures led to a growing animosity between proponents of psychedelic use, like American psychologist Timothy Leary, and politicians who were overseeing studies and held different views.
These opposing views, along with cases of reckless use of psychedelics, eventually led to the federal government's effort to combat illegal drug use in the 1970s, which Dr. Mathis credits with “shattering” psychedelic research for several decades -- until the early 2000s.
The resurgence of psychogenic research is often credited to a paper on psilocybin (a hallucinogen in certain types of mushrooms) written by Dr. Mathai’s mentor, the late American neuroscientist, Roland Griffiths. The research shows that users of psilocybin reported their experiences as among the most meaningful or spiritually significant experiences of their life.
Dr. Mathai was involved with trials of psilocybin at Johns Hopkins for people who wanted to quit smoking, which resulted in a 60% to 70% success rate of participants cutting down on tobacco use. Similar results were found in treating individuals with alcohol use disorder.
But it’s the optimism surrounding the drug MDMA that could mean big changes for psychede
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.
Many people who struggle with a mental illness or disorder may not know that clinical research data suggests that new treatment options may be just around the corner. On this episode of Mind Dive Podcast, board-certified psychiatrist, physician-investigator with Segal Trials, and assistant professor at The Johns Hopkins University School of Medicine, Dr. David Mathai, joins hosts Dr. Bob Boland and Dr. Kerry Horrell to discuss the importance of understanding the cultural and historical context of psychedelic drugs and why the first FDA-approved psychedelic drug therapy could come as soon as 2024.
Dr. Mathai simplifies the definition of psychedelics as "drugs, whose most prominent subjective effects often involve dramatic changes in thought, in mood and cognition." He says that, historically, these substances have been used in different cultural traditions across the globe for the purpose of healing and connection.
He further explained that the earliest wave of research surrounding psychedelics was focused on LSD, which was discovered in the 1940s. “Realizing some of the therapeutic qualities such as LSD treatment for alcohol use disorder, anxiety and depression related with end-of-life illness...all of that was bubbling up,” said Dr. Mathai.
But the Vietnam War would serve as a gateway to dismantle that research.
For example, Dr. Mathai says there became a “complicated” social association between psychedelic drugs and counterculture, particularly with American protestors of the U.S. involvement with the war, often referred to as “hippies.” Dr. Mathai suggests this clash of cultures led to a growing animosity between proponents of psychedelic use, like American psychologist Timothy Leary, and politicians who were overseeing studies and held different views.
These opposing views, along with cases of reckless use of psychedelics, eventually led to the federal government's effort to combat illegal drug use in the 1970s, which Dr. Mathis credits with “shattering” psychedelic research for several decades -- until the early 2000s.
The resurgence of psychogenic research is often credited to a paper on psilocybin (a hallucinogen in certain types of mushrooms) written by Dr. Mathai’s mentor, the late American neuroscientist, Roland Griffiths. The research shows that users of psilocybin reported their experiences as among the most meaningful or spiritually significant experiences of their life.
Dr. Mathai was involved with trials of psilocybin at Johns Hopkins for people who wanted to quit smoking, which resulted in a 60% to 70% success rate of participants cutting down on tobacco use. Similar results were found in treating individuals with alcohol use disorder.
But it’s the optimism surrounding the drug MDMA that could mean big changes for psychede
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.
SPEAKERS
Dr. Kerry Horrell, Dr. Bob Boland, Dr. David Mathai
Dr. Bob Boland
Welcome to the Mind Dive podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr. Bob Boland,
Dr. Kerry Horrell
and Dr. Kerry her L. twice monthly, we dive into mental health topics that fascinate us as clinical professionals, and we explore those unexpected dilemmas that arise while treating patients. Join us for all of this, plus the latest research and perspectives from the minds of distinguished colleagues near and far. Let's dive in
Dr. Kerry Horrell
Well, I am personally very happy to have our current guest on as we were talking before we officially started Dr. David Mathai is a friend of mine from our training years together, I was an intern when him as a resident and we got to work together here at Menninger and some of my fondest memories of training have been with him. So, so excited to have you on. Dr. Mathai is a board-certified psychiatrist and physician investigator with Segal Trials, clinical research company based in South Florida that conducts phases one through four--- is that right? One through four, yeah, trials. Those Roman numerals always confused me in areas such as General Psychiatry, Addiction and Psychedelic Investigation, which is a spoiler, that's what we're gonna really focus in today on. He is also an assistant professor at the Johns Hopkins University School of Medicine, where he received advanced training as a behavioral pharmacologist and postdoctoral research fellow with the Johns Hopkins Center for Psychedelics and Consciousness Research. As a researcher Dr. Mathai has studied the complex properties of psychedelic-type therapies like ketamine, MDMA and psilocybin. He also worked as a study physician and session therapist for clinical trials of psilocybin-assisted interventions. These opportunities have highlighted for Dr. Mathai, the unique potential for psychedelics to facilitate healing and enhance well-being when used by certain people under appropriate conditions. I'm already so excited because it's exactly what I want to talk about today. He completed medical school and residency training with Baylor College of Medicine here in Houston, and the Menninger Department of Psychiatry and Behavioral Sciences, which is how we met. Welcome to the podcast. Welcome.
Dr. David Mathai
Thank you. Thank you both for having me.
Dr. Kerry Horrell
We're thrilled to have you. And I again, I feel grateful that you're taking the time to do this, because it's such a hot topic, right now I know, your listeners will know, I am really interested in religion and spirituality and on different listservs I'm on. This is like every other message is something about psychedelic-informed therapies. This just and we do some of that hear men agree with ketamine-assisted treatment. So I'm thrilled, right,
Dr. Bob Boland
and every other patient seems to come in asking about psilocybin and things.
Dr. Kerry Horrell
Its a hot topic. So why don't we start, we usually start with just how did you get interested in this? And if you could tell us a little bit about like, Did you always know this was something you're interested in? Like, how have you landed in this sort of place? Tell us a little bit about your career so far, so not
Dr. David Mathai
not exactly a straightforward journey, I'd say. But a lot of this interest has come from having this interest for both aspects of mental health treatment in terms of psychotherapy, and psychopharmacology. I know I had mentors sort of very early in my career, telling me that I needed to pick and kind of land on this or that. In a really unique way, I think psychedelic-assisted treatments, offered some of the best of both ways that we can tap into psychopharmacology in really powerful ways. And also couple that with really thoughtful, relationally oriented psychological intervention in ways that could build on potential benefit for patients. So I think some of that seed was probably planted a long time ago. And then more specifically, actually, during my my time at Baylor, I had the good fortune of being able to work with Dr. Sanjay Mathew in our department. I remember being a medical student and meeting with Dr. Stoler, who was Program Director of the psychiatry residency program at the time, just wondering how to get more involved in research. You mentioned Dr. Matthew, and next thing I knew it, I was writing a chapter on ketamine with him learning more about this. Yeah, learning more about this antidepressant that was taking psychiatry by storm at the time and he'd had a really unique background at Sinai working with folks like Dennis Charney and others on some of these early ketamine trials. So getting to learn more from him. That experience taking me to a lot of ketamine practice that was happening in the community, both more sort of a drug-only intervention and then also other therapists who are working within more of a drug-assisted therapy model with ketamine as well. And seeing as a student as a resident just how profound these experiences were for people. We're talking about areas that have been sources of difficulty of rigidity for for a long time where, where there could be some softening. And of course, this is the kind of thing that we see in psychotherapy, but not always, you know, often this is the process of long conversations, a lot of effort and these moments that some people have described almost as quantum change or shift, where there's some new insight or some new potential to build, build on something there. And being up close and personal getting to see this happen with individuals receiving ketamine-assisted treatment, just planted to see that there is something here that could be really meaningful for patients. And one thing led to another towards the end of residency, I wanted to be a part of this work happening, including newer medications that are being explored like psilocybin. That took me to the Psychedelic Center at Hopkins, where I got to work with my mentors, Al and now the late Roland Griffiths, who really had a tremendous legacy on this field and on this work, and that's sort of where I'm at today.
Dr. Kerry Horrell
Wow, I just think that's so cool, David, and I've been really admiring again, you're because I know even when we work together, you're really interested in like psychoanalytic thinking. And like in some of the depth-oriented ways of, you know, treating some of these complex psychiatric presentations. And I'm, I am not surprised that you landed somewhere that's looking at something that is again, novel, I don't know that it's novel in our field, but it certainly depends on
Dr. Bob Boland
how you look at it. Right? And maybe we should talk about that. I mean, in a sense, it's, it's vogue and novel now, but it has a long history, right? And I remember as like, hey, gosh, just like a college student. So that'd be a while back.
Dr. Kerry Horrell
What did you do in college? Bob?
Dr. Bob Boland
What do you remember if I wasn't gonna talk about that, but what I was gonna talk about was hearing, like, at that point, pretty old Timothy Leary, talking about, like, you know, how we had been on the right track, and then missed the boat by making LSD illegal and no longer doing research on it and such. And so just as a reminder that I mean, people have been kind of doing some of this stuff for quite some time. And, and they were experimenting with MDMA, I think when I was in med school, and I'm experimenting, you know, in a legitimate way.
Dr. Kerry Horrell
As a field, it seems like we definitely are, like, historically, we've been really like, Oh, this is just a problem. Like, you know, if patients come in and worse, and they're like, yeah, like, really felt like I learned something and point about myself at an Ayahuasca session where I was just like, eye roll, drugs, hippie, this isn't real, you know, just like it feels like a real,
Dr. Bob Boland
but it's always been there. So I don't know, maybe, but you obviously know more about it than we do. Can you like, take us through the literally, since we've already said everything we knew. So maybe it'll be more
Dr. Kerry Horrell
clear. Like, what? The history Yeah, like, how is this developed? And also like, what is? What is psychedelic treatment in our field looks like now and where is it going? That's a big question. Yeah, I like to throw this out
Dr. David Mathai
there, where to begin. So maybe I'll start with a quick definition of psychedelics just to have a working. So I, I think they're probably best understood in terms of their subjective effects that really seems to be a unifying characteristic of not just one class, but multiple classes of drugs that I think are often grouped within this category. And these are drugs, whose most prominent subjective effects often involve dramatic changes in thought, in mood and cognition for many shifts in sense of self or sense of meaning, attributed to these these experiences. And when we think about those, I think we most commonly think of what's called the classic or serotonergic psychedelics. So drugs like psilocybin, LSD, DMT, Ayahuasca, but I think more and more we've seen other classes get include drugs like MDMA, which is a amphetamine derivative that has these powerful and pathogenic properties, properties of feeling deeper feelings of connectedness, empathy. People have also more recently thought of dissociative anesthetics are used in sub-anesthetic doses, like ketamine, within this category as well. You could go on and on about the semantics and different people will feel differently, but I think, historically, our thinking of these drugs as really come from our understanding of their subjective effects, so much so that the term comes from the writer Aldous Huxley and British psychiatrist Dr. Azman, who use these Greek roots for mind manifesting, soul manifesting, being a property of what these drugs do. So when when we think about this, these drugs more broadly, Bob mentioned some of the history that that does go back a long time, but I think it's fair to say even further back. We can look back millennia and see how these drugs and substances were used in different cultural traditions across the world. And this is something we're learning more and more about from different fields from ethnobotany, from looking at old samples and vessels and trace chemical elements in them, and have a pretty good sense that these drugs were used in rituals, for medicinal value for for sacramental use as kind of a right and spiritual traditions across miso America, across Eurasia, really all over. And I think we're only beginning to understand some of that history. And there is a long history of there being very specific infrastructures for using these drugs for the purpose of healing, for connection. And I think the more recent history, I'm more or I'll say the early wave of research history, is initially a story of LSD, which was discovered, I believe, in the 40s. And then, throughout the 60s 50s 60s, early 70s, there was a lot of dedicated research happening on a national level, internationally even in places like Canada and Europe, where there were research trials happening and initially looking at drugs like LSD as a model for psychosis. What was often thought of as this like psychotomimetic model of abusing drugs to understand the experiences of what people suffering with schizophrenia were going through.
Dr. Bob Boland
Yeah, forgot about that area of research. Yeah, exactly.
Dr. David Mathai
And then with time, also realizing some of the therapeutic qualities, thinking about LSD for alcohol use disorder, for anxiety and depression related with end-of-life illness, and all of that was bubbling up. And at the same time, there became this really complicated social association, where psychedelic drugs became increasingly linked with a lot of the counterculture, and particularly in the protest of the US involvement in the Vietnam War. And then we start to see this dismantling of psychedelic research. And I think the reasons are complex, but probably had something to do with a lot of the proponents for psychedelic use…Timothy Leary, and others, holding us that were very different from politicians that were in charge of studies. Exactly, exactly. And then I think we also started to see some really high profile cases of adverse effects that were a result of poor education. You know, people using psychedelics without really knowing what they were doing, without knowing how to use them. And these becoming highly televised, and also becoming part of this drug campaign. You know, we also see an expansion of federal regulatory powers that characterize the war on drugs when we think about that. And lo and behold, we get to the early 1970s. And there's the Controlled Substances Act, these drugs are placed in schedule one, the most prohibitive care category, saying there's no accepted medical use, and there's high risk for abuse. And this effectively shatters psychedelic research for several decades, really, until the early 2000s. So I think it is completely accurate to say there's a long, long history and right now we're sort of looking at just the tip of the iceberg here with this most recent resurgence.
Dr. Bob Boland
That was a great summary. Thanks. I also in context of like, why did it stop?
Dr. Kerry Horrell
And I mean, like, we don't have time to really delve into this, but I can't help but just want to flag or note that like, surely issues related to like, race discrimination, power control, like must have played a huge part in some of this as well. Of why then it got sort of shifted.
Dr. Bob Boland
I think you're I think your part of the counterculture movement. Yeah. Especially that like, all these hippies were doing it. And you know, that can't be good. Yeah. Yeah.
Dr. Kerry Horrell
And just again, like the ways in which again, I'm just, I'm just reflecting on that. How, again, like this idea, you said this at the beginning that like, we missed the boat like this, this thing that was like that was again, an is so helpful. We just got for reasons I feel political and power laden, just sort of like shoved to the side. And I'm so glad there's a resurgence of it.
Dr. Bob Boland
Well, why is there what happened? Why, why why are we able to do it? I mean, limited ways. Now. It is really well, it's a good,
Dr. Kerry Horrell
it's a good question.. Bob actually had a good question for one. So that's,
Dr. David Mathai
it's a great question. And I would say that while these drugs were in schedule, one turning into seven is theoretically it was still possible to do research. But the barrier to getting involved in making these studies happen was so high that it was often prohibitive for people to get involved. And that was also complicated by the stigma. You know, as we saw these associations with psychedelic use with this really concerted drug campaign against psychedelic drug use and psychedelic drug users, so much so that it kept a lot of people out of this space and made it incredibly difficult to obtain funding to make these studies happen. And that started changing in the late 90s, with the organization of different groups like the Hefter Institute, MAPS - , the Multidisciplinary Association of Psychedelic Studies, and a few researchers who were curious about making this work happen. There's Rick Strassman, in New Mexico, who did some of his work with DMT in the late 90s. And then my my mentor, Roland Griffiths, who I think is a huge reason why this work is happening now. And Roland, he was an incredible human being, and he just recently passed away. But I think one of the most remarkable aspects of his legacy was to be a completely levelheaded, sober minded researcher in the face of this incredibly controversial, polarizing area of investigation. And he came in with this extensive background and pharmacological research. Had already studied other drugs before approaching psychedelics. And he also came in as a lifelong meditator, so someone who was deeply curious about introspection and the nature of mind. And I think all of that built his case, in terms of doing this research in a really rigorous way, was able to navigate some of the regulatory hurdles, and make the case for why he was doing what he was doing. And a lot of this renaissance kicked off with his 2006 paper on psilocybin use. And this was a seminal work that found users of psilocybin, moderate high doses of psilocybin, reported their experiences as one of the five most personally meaningful or spiritually significant experiences of their life-- some even reporting it as the top or top two most meaningful, akin to the birth of a child or the loss of a parent, or something like that. And this is something that is seen in 60- 70% of people who use suicide. And and I think this is the study that really shifted the discourse in terms of what are psychedelics, what are their potential applications here, and we start to see this thawing of a lot of the stigma as well, more and more research and interest. And especially, I would say another cultural inflection point would be maybe five or so years ago, author Michael Pollan writing his book, “How to Change Your Mind.” And in this case where the conversation just dramatically shifted where everyone, you know, my mom and dad, are starting to talk about psychedelics. Yeah. So like those things, none of
Dr. Bob Boland
A number of high-profile people like Steve Jobs, people like that talk about how it like, transformed their lives.
Dr. Kerry Horrell
I also just want to say I appreciate you honoring the legacy of your advisor and mentor and continuing his work. That's really cool. Yeah, I do you you alluded to this earlier, but I want to circle back to, you know, at this point, who is this treatment intended for? Slash who? Maybe not who, but like what disorders or difficulties? Yeah, cuz I think ultimately, there's a lot of, again, this is anecdotal. My sense is, there's a lot of concern, especially using it with people who have had past substance misuse. And what I've heard or again, even I heard you say it's a little bit, that that sometimes this can actually be useful in working with folks who have, you know, a history of alcohol misuse, or, anyways, I'm curious to hear like at this point, you know, who, and I hear there's also a lot of research still happening. But yeah,
Dr. Bob Boland
let's start basically, yeah, like who
Dr. Kerry Horrell
who would benefit? Would it be
Dr. Bob Boland
who would benefit from this?
Dr. David Mathai
It's important to tease apart real quick, I think that there is a difference between decriminalization, recreational use, and use and clinical context, because I think those are two very different use cases with different degrees of support, supervision. So I would say that, you know, many of the concerns that we might imagine for someone who at home is thinking about using psilocybin could be mitigated, some of those risks could be protected against by having really careful monitoring and support. And as a quick example, I think that the abuse liability of, o at least classic psychedelics, and some of the other psychedelics also, is overall quite low compared to many other substances. But I do think there is a potential, like there's a potential for anything, really, for people to develop an unhealthy kind of relationship with the drug that may explain a lot of the caution around those with histories of substance use disorders, using psychedelics. And at the same time, there's a lot of promising data coming from medical clinical research setting that drugs like psilocybin add value for individuals with moderate to severe alcohol use disorder. I got to be involved with some of the trials of psilocybin for smoking cessation at Hopkins, and really remarkable outcomes. We're talking about, you know, like a 60 to 70% success rate of cutting down on tobacco use, compared to rates that are, like 20 to 30%.
Dr. Bob Boland
Probably hard otherwise, to the treatment. Yeah, absolutely.
Dr. David Mathai
So I'd say there, there are some differences there, to kind of narrow and focus more on on the medical, clinical sort of context, I would say, these drugs are going to. We'll start at least with what the people for whom they're indicated. MDMA is, is the closest, separating ketamine for a moment, MDMA is the closest to approval, it's further ahead in drug development than psilocybin, LSD, some of these other drugs, so much so that all the phase three trial data has actually been published, has been incredibly promising. We're talking about an almost 70% rate of remission in individuals with PTSD. So in other words, 70%, who no longer carry a diagnosis of PTSD, right after receiving MDMA-assisted therapy, and some of the long term analysis from the phase two trials has also suggested that these affects are fairly robust and endearing. So much so that a lot of that efficacy is maintained even a year after treatment, you know, the kind of effects that we typically see more with effective psychotherapy, rather than pharmacotherapy. So I think that's kind of where the data is going to lead us. First, that'll require a new drug application to the FDA FDA review, which might take six months or a year for review, approval of MDMA, you mean, yeah, just
Dr. Kerry Horrell
like dealing with the FDA. Lot of work, lot of money.
Dr. Bob Boland
But it is astounding when you sick, you, you mentioned it, but it's like, just to underscore it's like, because it's almost any other drug like we currently use, you know, you kind of expect once you stopped the drug, the benefits of the drug pretty much stopped as well. Right? I mean, the notion that you could give something in there, presumably not using MDMA long term, this is like a, like a particular treatment they got that could have any benefit that far out is kind of amazing. I mean, just doing something different, I guess.
Dr. David Mathai
Its remarkable. And I think this goes back to how psychologically involved and deliberate the therapy is. And I was able to do some training with MAPS as an MDMA-assisted therapist as well and got to see their process from from the inside. And I would say, it is very much a therapeutic process of building rapport, building the kind of alliance that makes it possible to talk about these unspeakable things. And then you have these drug sessions where the drug in a really unique way, reduces some of that hyper arousal, some of that fear all of those barriers to trauma work that are always there, combined with the safety of that relationship, not with just one therapist, but two. It actually happens in the sort of dyadic container. And in that space, typically involving several doses of drug, volunteers are able to find some version of healing… are able to go back there. These aren't always easy experiences. You know, we've watched the video footage of those with military trauma, sexual trauma, who are willing to share their stories with us and how intense that can be for some people, maybe you've been navigating dissociative phenomena that are related to the trauma and for those of you have worked with that, those are not easy sessions with clients, you know, but in that space and with that psychological with that degree of psychological support for there being an opportunity to move through some of the trauma in ways that lead to a different kind of relationship with self. Maybe this old story diminishes, and it's kind of power over and over an individual. And I think in the aftermath of that kind of process, there's space for a whole lot else, a whole lot of change, different ways of being and moving through the world in ways that I think can be endearing and really powerful.
Dr. Kerry Horrell
So trauma, clearly, that's a big focus. I've also my sense is that there's a big focus on treatment resistant depression, which is a phrase we hear a lot. But that's that's another area where I My sense is this is part of the work of psychedelic-informed therapies.
Dr. David Mathai
Yeah, I would say that the studies of classic psychedelics that are for this long there are for psilocybin, so there are companies Compass, and USona who have been looking at psilocybin and proprietary versions of psilocybin for treatment resistant depression, in conjunction with psychological support. And it's interesting there, because there are studies that have happened both and patients with major depression and in patients with treatment resistant depression that have different effects in terms of how endearing they are. So Natalie Gukasyan, and one of my colleagues and some of our other members of our team at Hopkins, were able to look at long term effects of psilocybin for major depression, and found these enduring effects lasting around a year, kind of like we were seeing with the MDMA assisted therapies. But then when we looked at some of the larger scale trials for psilocybin for treatment-resistant depression, we tend to see a powerful effect. But that lasts more than the timeframe of three months or so before it starts to diminish and resemble more of a placebo type effect those arms and the trials. And you know, not to take away from how meaningful even that kind of effect can be for people. And I think there's lots of opportunity, once these become real world to think about how to harness that with psychotherapy, and ongoing building momentum and progress. But I do think part of this has to do with the complexity of treatment resistant depression with which I know I don't have to talk to folks at Menninger about, the many determinants of that.
Dr. Bob Boland
Yeah by definition. I know. I'm, oh my lord, look at the time, where are you getting,
Dr. Kerry Horrell
I don't care about the time.
Dr. Bob Boland
I know, I know, I didn't say we're gonna stop. But I, I didn't want to kind of like hear more about the things you're working on now and what you're excited about.
Dr. David Mathai
So my primary job right now is working with a company called Segal Trials, which works as a research site here in South Florida and conducts all kinds of central nervous system trials for different companies. And we do have a psychedelic group. And we're building studies, they're looking, working with some of the companies that I've mentioned, looking at things like psilocybin for depression, LSD for anxiety, shorter acting psychedelics, like DMT, or five Meo DMT, for different indications that I would say is more of a kind of running the trials sort of role, in terms of what I'm writing about, and thinking about, a lot of that recently has had to do with challenging experiences that are possible with psychedelics. Thinking a lot about things like psychological vulnerability, because I think there is this tendency, for example, to equate the experience of someone who's, quote unquote, healthy, and has this amazing psychedelic journey to what might be expected for anyone in that space, which I think is not true. And I think is actually a dangerous assumption, because I think that sort of assumption can lead to a lot of shortcuts. I think there will be a tendency for pharmaceutical companies to try to subtract aspects of psychological support to figure out how to make this a more compact, scalable package. And I think well, that could be okay for many people, I think some of the most vulnerable will suffer. And one of the areas I've been focused on are thinking about experiences of shame and guilt, which are ubiquitous right and affect so so many of us, but I think can play out in a really interesting way with psychedelic experiences too. Many people were talking about these encounters with self that I think on some level, it's inevitable to kind of see aspects of self that can be really difficult to sit with. And it's very up close, and personal way. And some people are able to move through that and with new insights and are able to integrate that into the fabric of everyday existence, and for other people, you know, we haven't talked about neuroplasticity much. But I think that these psychedelic experiences are experiences that are sensitive to input and can unfold in any number of ways. When we think about something that's highly plastic and malleable, of course, there's that potential to create healthy kinds of learning, pro social learning, that are in line with the kind of person that someone is trying to be. And at the same time, we can think about things like the potential for retraumatization, or maybe affirming these deeply entrenched ideas of oneself as a failure or falling short in some way. So I think that, you know, with this tremendous potential that psychedelics seems to offer, it's really important to be cognizant of how sensitive that is to everything happening around.
Dr. Kerry Horrell
Well, you, you answered one of the questions on my mind, which is what are we? What are we know about why this helps? Because I will say, as you know, I'm not a psychiatrist, and as somebody who, you know, works with patients in therapy, one thing I've noticed is that our patients who are using ketamine, which it sounds like maybe it's a little bit of a different thing, or I don't know, I'm not totally sure what ketamine fits into all this, but my patients who are doing ketamine treatment here, I think the patients that I've noticed the biggest shift for our folks who are kind of rigid, they've had trauma where they really feel stuck in some patterns of thinking, especially around things like shame, and their sense of self. And that one of the things I've noticed is as they're going through ketamine treatment, and this is anecdotal and sort of broad level, but the for good number of patients, what I've noticed is there's like some additional flexibility and how they're thinking about something like all this sudden, there's this introduction of like, I guess maybe I could think about this a little bit differently, in ways where something felt so sticky before, where there was like, no space to open up the door to that. And so my sense is that, you know, part of what seems to be some of the goal and can you tell me if I'm wrong is like, like opening new neural pathways and ways of thinking where it's like, all of a sudden, there can be maybe some additional space for new ideas, new perspectives.
Dr. David Mathai
Yeah, I think it is incredibly powerful. And your, your sharing made me think back to one of the first patients I got to see receiving ketamine, a man with effort to put labels on his experience, OCD and OCPD, maybe, who really struggled with rigidity, came and was dosed with ketamine. And one of the things that was most dramatic was his need to kind of catch himself, you know, every thought had to come out precisely. If things didn't come out a certain way, there'd be consequences of that too, you know, and that led to this really halting, burdensome, effortful kind of way of conversing. And just seeing that dissipate during the course of a ketamine session and to visibly see this man relax in his chair, be able to let me and not only that, but to be able to access these really deep emotional experiences.
Dr. Bob Boland
Bet that was interesting. Yeah, the seeds kind of peel away when as you did,
Dr. David Mathai
yeah, yeah. Remarkable. He was able to, with with the effects of ketamine go to this, this image, this sort of visionary kind of experience of seeing a rose growing out of these cracks in the ground. And I think he, he quoted a Tupac poem to me, which, which I would, I would have never imagined. This man would be quoting poetry to me during his session, and just started crying with me as he could see himself in that image with some grace, a little bit of hope and growth in the midst of really hostile surroundings.
Dr. Kerry Horrell
Alright, well, I think that again, it and I say this as someone who maybe started as a skeptic and I when I came in Menninger as an intern, if brash, in my right out of grad schooll, you know, I was really skeptical at ECT as well. I'm skeptical. ECT t is really Yeah, Cuz I don't know it. Just all of it just sounded kind of scary to me and sort of like, what's happening actually remember Dr. Puri, who's one of our directors of the brain stimulation center here, Menninger? He was like, Well, what free chat about AC T? And I was like, well, we don't know why it works. said to me, I'll never get this. He goes, “Well, Kerry, then you better you better start looking at everything in psychiatry because we don't actually know why anything worse. Why is more serotonin in the synapse is making people less depressed. We don't know…”
Dr. Bob Boland
what's going on how aspirin works, right? Yeah, it's
Dr. Bob Boland
like, yeah, I
Dr. Bob Boland
mean, it's, well, I guess what they have in common is that they're both Things are spoiled with long histories, but they've kind of gone in and out of favor. And probably because some people always had a feeling that it just seems too good to be true. Well, and again, like, how can it be you just shock a person a few times, and they're better than just us? You know? And the same thing here, how can you do this and get these amazing changes, it just, it does kind of defy CRE, I mean, you know, you know, proof is in the pudding, but it does sort of defy kind of, like our understanding of how things work.
Dr. Kerry Horrell
And maybe also our stigmas is like, for me, I know, for it was like stigmas, it's like, those are drugs, okay, street drugs, like, you know, and just sort of the unpacking of that. And, and again, seeing it with my patients and how it's helped has been skeptical
Dr. Bob Boland
of what seemed like easy cures where we have this feeling of I think it would be hard, though, it sounds like actually what you're doing is not exactly easy.
Dr. David Mathai
It's not. And I think there is a flip side of what could be difficult, what could go wrong, you know, I think for those who are predisposed to manic or psychotic dates to be in that incredibly plastic, confusing, yeah, you know, very frightening, exactly frightening, disorienting for some people… having to reexamine aspects of their philosophy, their their way of being some people have these experiences of ontological sort of shock, for some people can trigger this dark night of the soul. All of these things don't always get talked about. But I think it's important to hold the two together-- both the remarkable potential and some of the complexity there.
Dr. Kerry Horrell
David, as we wrap up, maybe there's other skeptics or other people who are huge fans out there, I wonder if you would like to give the last word on, on what people should be, especially mental health providers be considering in this continuing and emerging area of research,
Dr. David Mathai
I would say that there's a lot of nuance. And I think it's worth trying to hold both of these parts for our clients. And realizing that just because these treatments aren't medically approved, yet, that's not going to be a reason that stops many people from trying to access them on their own, especially as there is more and more attention, more and more availability. So I think it'd be worthwhile for clinicians to educate themselves on these drugs, especially on some of the risks that are involved, maybe some of the things that can be done to minimize harm, because at the end of the day, or clients have autonomy, and are people with agency and in respecting that aspect as well. And you know, there there are always people who are in this space, too, who have been studying psychedelics, you know, I'm one of those people, but I think more and more we're starting to see from from all different disciplines, you know, from psychologists, to psychiatrists to neuroscientists, to anthropologists, to historians, who are sort of converging on some aspect of, of what psychedelics do, and bringing that expertise and that richness to this, this dialogue. So I think seeking out these kinds of people to as we inform what society with psychedelics can look like in ways that promote health and really minimize harm.
Dr. Kerry Horrell
Well I'm glad that we sought you out to come talk to us because you're a wealth of information. And I'm, I'm so grateful that you're doing the work you're doing. David,
Dr. Bob Boland
You're following the footsteps because you're describing it in a very scientific and yes, you know, very, you know, taking a controversial thing and making it very accessible. And I appreciate that.
Dr. Kerry Horrell
Thank you for for coming on.
Dr. David Mathai
Thank you, Carrie. Thank you.
Dr. Kerry Horrell
So you've been listening to the mind dive podcast with Dr. David Mathai. We've been your hosts. I'm Dr. Kerry Horrell Dr. Bob Boland. Thanks for diving in. The mind dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.
Dr. Bob Boland
For more episodes like this, visit www dot Menninger clinic.org.
Dr. Kerry Horrell
To submit a topic for discussion, send us an email at podcast@menninger.edu