NOVA-S49E15-Can Psychedelics Cure
NOVA-S49E15- Os psicodélicos podem curar
Os psicodélicos podem curar?
As drogas alucinógenas – popularmente chamadas de psicodélicos – têm sido usadas pelas sociedades humanas há milhares de anos. Hoje, os cientistas estão analisando uma segunda vez essas substâncias que alteram a mente – naturais e sintéticas – e descobrem que podem ter impactos clínicos profundamente positivos, ajudando pacientes que lutam com uma série de aflições, desde o vício até a depressão e o TEPT.
NOVA PBS – 2022
NOVA-S49E15- Os psicodélicos podem curar
Os psicodélicos podem curar?
As drogas alucinógenas – popularmente chamadas de psicodélicos – têm sido usadas pelas sociedades humanas há milhares de anos. Hoje, os cientistas estão analisando uma segunda vez essas substâncias que alteram a mente – naturais e sintéticas – e descobrem que podem ter impactos clínicos profundamente positivos, ajudando pacientes que lutam com uma série de aflições, desde o vício até a depressão e o TEPT.
NOVA PBS – 2022
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00:00To me, peyote is a very intimate medicinal herb.
00:23Psychedelic assisted treatments allow us to reinvent ourselves.
00:27They're allowing the brain to see itself.
00:31In the 1960s, psychedelic drugs were famous for their mind-bending recreational effects.
00:38But today, they might offer hope for treating devastating conditions,
00:42from addiction to PTSD to depression.
00:46I did take psilocybin to go find Martians,
00:49and I needed to work with scientists to be able to stop smoking cigarettes.
00:55I was on antidepressants for about four years prior,
01:00and I haven't been on any since.
01:03I haven't felt sadness.
01:05How is this possible?
01:07Scientists are searching for answers within the brain,
01:11where psychedelics alter consciousness and can open the mind to positive change.
01:16It's like reprogramming the operating system of a computer.
01:20You're getting down to very basic code-level changes.
01:24We observe a radical change in the way that brain regions talk to each other.
01:30It's not only that these states of consciousness are beautiful and inspiring,
01:36they seem to have therapeutic power.
01:40The psilocybin shifted my perception from negativity to positivity.
01:47The research is cutting edge, but early results from clinical trials offer hope.
01:53You don't forget the breakthrough moments that you had,
01:56and you don't forget what you learned.
01:57They stay a part of you.
01:59I haven't drank since my very first session.
02:02It worked almost like an antibiotic, where I did this treatment,
02:06and then I was done.
02:08Can psychedelics cure?
02:11Right now on NOVA.
02:23Psychedelics.
02:33LSD.
02:34Magic mushrooms.
02:36Peyote.
02:37These powerful, mind-expanding substances fueled the 60s counterculture.
02:44For some, they're powerfully transformative, even spiritual.
02:50It was a spiritual experience that I'd never had in my life.
02:54It was probably changing me forever.
02:59But for others, terrifying and dangerous.
03:02They felt that I was having a psychotic episode.
03:06I was hospitalized.
03:09And ultimately, they were criminalized.
03:11We must wage total war against public enemy number one,
03:15the problem of dangerous trucks.
03:17But today, a growing number of clinicians argue
03:21that there's another side to psychedelics.
03:24The psilocybin therapy has been the most powerful tool I've seen.
03:27I said, wow, I feel like I've been treating trauma with stone tools,
03:32and there's the state-of-the-art treatment.
03:35That they have the potential to heal the mind as a treatment
03:39for addiction, depression, and PTSD.
03:42They have this big effect, opening the mind and the brain up for change.
03:48The good that can come out of the responsible use of these substances
03:53is quite amazing, really.
03:55It's an about-face that few saw coming.
03:59How do you shift from a position of these drugs are illegal,
04:04these drugs are bad for you, to these drugs are therapeutic.
04:10This is the way that you heal from mental illness.
04:14What are these drugs doing to patients' minds
04:16to give some doctors such hope for their potential?
04:19I grew up in New York City.
04:33It was fairly easy to get access to alcohol through friends.
04:40We'd go to a corner deli.
04:43And that all started probably around 12, 13 years old.
04:48It would take a couple of drinks to feel anything or feel good.
04:52But then, a couple of years later,
04:54those two drinks wouldn't cut it or three drinks wouldn't cut it,
04:57and I'd need more to get to where I was before,
05:02when I first started drinking.
05:05I wouldn't drink every night.
05:06I was more of a binge drinker, so I'd pick my battles.
05:10But during one of those nights,
05:12it would be about 23 drinks in a night.
05:18Over the years, John Costas struggled to quit.
05:22I went to my first AA meeting at 16.
05:26I tried AA for years.
05:28I tried rehab.
05:31I tried different pharmaceutical drugs.
05:34I've been practicing psychiatry for 21 years,
05:38focusing on addiction,
05:39and John came to me in his early 20s,
05:42and he probably was the worst case
05:44of alcohol use disorder I'd ever seen for someone his age.
05:48He'd go on these terrible benders
05:49that he was starting to experience alcohol withdrawal,
05:51which is very rare for somebody in their early 20s,
05:54and I was very scared
05:56that he was going to have a premature death
05:58because of how much he was drinking.
06:01Worried that John was at risk of death,
06:03psychiatrist Steven Ross helped him enroll
06:06in a clinical trial at NYU
06:08with his colleague, psychiatrist Michael Bogenschutz,
06:11who was testing a controversial experimental treatment
06:14for alcohol use disorder using psychedelics.
06:18During a series of carefully designed therapy sessions
06:23over 12 weeks,
06:25John received two doses of a hallucinogenic drug.
06:28His addiction to a recreational drug
06:31would be treated with what most people think of
06:34as another recreational drug,
06:36psilocybin,
06:37psilocybin,
06:38which is classified as a Schedule I narcotic
06:41right alongside heroin.
06:46Psilocybin is the mind-altering molecule
06:49found in magic mushrooms.
06:52They were introduced to American popular culture in 1957
06:56by a Wall Street banker named R. Gordon Wasson,
07:00who wrote about them in an article from Life magazine.
07:04These fungi have been used by indigenous peoples
07:07in the Americas for thousands of years.
07:11Psilocybin is just one of a family of substances
07:14often called psychedelics.
07:17They include mescaline,
07:19found in the North American cactus peyote,
07:21as well as synthetic chemicals like LSD and MDMA.
07:26Users report that these drugs bring about an altered state
07:31of consciousness,
07:32sometimes accompanied by hallucinations
07:35or heightened sensitivity to colors, sounds, and patterns.
07:39The entire range of possible visual experiences
07:42can be encountered.
07:44Walls breathing,
07:45illusory movements,
07:46seeing movement in a carpet
07:48when the carpet's not really moving.
07:51Many also report a loss of ego accompanied by profound
07:55feelings of empathy and connection to others,
07:59even the entire universe.
08:02And what's perhaps most unusual about these drugs
08:05is that after the experience of the so-called trip,
08:08users often feel changed in positive ways.
08:14Though there are clear differences between psychedelics,
08:16they all, with the exception of MDMA,
08:19act in a similar way in the brain.
08:22Each of the active molecules fits like a key into a lock
08:27by binding to a specific protein in the nerve cells
08:30of the human brain,
08:31called the serotonin 2A receptor.
08:35And this can alter perceptions and even consciousness itself.
08:40And that's central for producing their subjective states,
08:42including mystical states of consciousness
08:45and these unusual states of mind.
08:48The drugs are very powerful.
08:51And for some people,
08:52the experience of going on a consciousness-altering trip
08:55that they can't control or stop
08:57can be very challenging or frightening.
09:01I was afraid of psychedelics.
09:02I never experimented with them growing up
09:05because I was too afraid.
09:07I heard all the bad stories of having a bad trip,
09:10or I thought I could go permanently crazy,
09:13or if you stare at the sun, you'll go blind.
09:16And so when I raised those concerns with the doctors at NYU,
09:20they said, listen, that's totally normal going into it,
09:23but this is incredibly safe to do.
09:27We've already properly screened you,
09:29and you're mentally and physically fit to go through this.
09:34Patients with a personal or family history of psychiatric disorders
09:38like schizophrenia, bipolar, or psychotic disorders
09:42are deemed to be too at risk for the treatment.
09:46There's a possibility that classic psychedelics
09:48could precipitate a psychotic episode
09:51or a psychotic disorder in someone who was predisposed.
09:54And that hasn't happened in any of the trials to date,
09:57but it remains a concern.
10:00Would you like to state your intention?
10:03In trials like this one,
10:05the drug is part of a larger plan
10:07to help participants address specific issues,
10:10and each psychedelic trip is facilitated by a therapist.
10:16When John took his first psilocybin trip
10:19in an effort to curb his cravings for alcohol,
10:22the experience was powerful.
10:24There were a few monumental experiences
10:28that I saw during this.
10:34There was a glass bottle, a liquor bottle,
10:37in the middle of the desert,
10:39and all of a sudden,
10:42the glass disintegrated into the sand,
10:45back into the desert, and just vanished.
10:49And I thought that was pretty powerful symbolism
10:53that my addiction was leaving me.
10:56And pretty much after that,
10:58I had felt, this is going to work.
11:03John stopped drinking after his first dosing session.
11:07It worked almost like an antibiotic,
11:09where I was sick, I had a disease,
11:12I went in, saw the doctors, did this treatment,
11:15and then I was done.
11:17I don't have to see doctors,
11:19I'm not on any prescriptions,
11:21I don't go to any support groups.
11:23I live without the addiction,
11:26which I never thought would be possible.
11:30The NYU study recruited 93 patients
11:33who were randomly assigned psilocybin or a placebo.
11:36All the participants received psychotherapy
11:39over the 12-week treatment period.
11:42John's case is particularly dramatic,
11:45but the results overall have been encouraging.
11:48The psilocybin plus psychotherapy group
11:51had a 50% reduction in drinking
11:53compared to just the group that got psychotherapy alone.
11:56It's a large difference,
11:57it's a clinically meaningful difference,
11:59and if these effect sizes hold up,
12:02it's a much larger effect than we've seen
12:06in any of the medications that are currently approved
12:10or alcohol use disorder.
12:13Doctors are trying to understand
12:15why psychedelic-assisted therapy
12:17might be more effective
12:18than currently available treatments.
12:20They think that the key difference
12:22may be in the way that psychedelics
12:24can allow the brain to change
12:26rather than simply suppressing symptoms
12:28such as craving.
12:33Our brains are composed of billions of nerve cells
12:36that branch out like trees.
12:39They carry messages between each other
12:41and connect different regions,
12:42which are like departments with different functions,
12:45such as the amygdala,
12:47the department where the emotions
12:49associated with memories are stored.
12:52The striatum,
12:53the office of reward and habitual behavior.
12:56And at the highest level,
12:58the prefrontal cortex,
13:00like a front office overseeing them all
13:02and making decisions.
13:04So, in the normal brain,
13:06you can say, especially in adults,
13:09the prefrontal cortex has this top-down control.
13:13We control our emotions,
13:16we control, you know, our habits
13:19through very strong prefrontal cortical activity.
13:24Yasmin Hurd is a neuroscientist
13:26who studies the effects of drugs on the brain.
13:31She's found that alcohol can erode
13:33the nerve cells that connect departments.
13:35With alcohol, these branches retract.
13:38They shrink.
13:39And that then diminishes communication
13:42between the brain regions.
13:44So, the amygdala is much more hypersensitive
13:48to context associated with the drugs,
13:51which is alcohol.
13:52It's like acting on its own.
13:55If the amygdala goes rogue,
13:58the result can be irresistible cravings
14:01leading to decisions
14:02that put alcohol ahead of everything else,
14:05even ignoring pleas
14:07from the front office to stop.
14:10Habitual behavior takes over.
14:12They stop thinking about
14:14what may be the bad outcome.
14:16So, their executive control is diminished.
14:19But when John took psilocybin,
14:24he seemed to get control over his cravings.
14:27Somehow, the front office
14:29reestablished its authority.
14:33The research is still early,
14:35but scientists do know
14:37that psychedelics activate specific
14:39serotonin receptors in the brain
14:41involved in mood
14:42and unusual states of consciousness.
14:46One idea is that activating these receptors
14:48may also lead to new nerve cell connections,
14:51even growth.
14:53Perhaps that is the key.
14:56It's hypothesized that psychedelics
14:59will restore the branches in these trees
15:03that we know are impacted by alcohol use disorder.
15:08So, by restoring and allowing the branches to grow again,
15:13that improves communication once again in the brain.
15:16But stimulating serotonin receptors,
15:19or expanding nerve cell connections,
15:22can't be the full explanation.
15:25After all, the drug cocaine
15:27also increases nerve cell connections.
15:29But there may be a critical difference.
15:33Cocaine will also increase the projections,
15:36these branches, but it's too many.
15:38One thing about how psychedelics are used
15:41as compared to cocaine,
15:43is that cocaine,
15:44it's habitual behavior,
15:45they're using it chronically.
15:47It can produce perhaps too much growth.
15:50So, with psychedelics,
15:51it seems that the growth may be,
15:53you know, it's not too much,
15:54it's not too little,
15:55it's just right.
15:56Like the Goldilocks effect in a way.
16:01One factor that John attributes his sobriety to
16:04is the mystical experience he went through,
16:07which is often a hallmark of a psychedelic journey.
16:11Something definitely happened
16:12because my relationship with alcohol changed
16:16and I don't think about it
16:17and have the same emotions
16:19I used to have towards alcohol.
16:22People ended up having experiences
16:26that they rated as among the most personally meaningful
16:30and spiritually significant experiences
16:32of their entire lifetimes.
16:35And I think that's a really important element
16:38that kind of stamps in the enduring attributions
16:43made to these experiences
16:45because their profound experiences felt to be precious,
16:49felt to be absolutely true.
16:52And that accounts for why months, years later,
16:56people are often reflecting back on that experience
16:59and can tap in and draw from it.
17:03The idea that one or two doses of a mind-altering drug
17:07could create such a profound impact
17:09with potentially beneficial results is not new.
17:14Western medical research into psychedelics
17:16began in the 1940s,
17:18not long after the accidental discovery
17:20of lysergic acid diethylamide, or LSD.
17:25In 1943, Swiss chemist Albert Hoffman was working with ergot,
17:29a potentially poisonous fungus
17:31sometimes found on wheat, oats, and rye,
17:34which had been used for medicinal purposes for centuries.
17:38Ergot poisoning was known to constrict blood vessels.
17:41Hoffman was hoping to isolate a chemical compound
17:44that would reduce the risk of fatal bleeding in childbirth.
17:47In the process, he accidentally absorbed a minuscule amount of LSD,
17:53possibly through his fingertips,
17:55ultimately launching him on what some would call
17:59the world's first acid trip.
18:01Kaleidoscopic, fantastic images surged in on me,
18:07alternating, variegated, opening,
18:10and then closing themselves in circles and spirals,
18:14exploding in colored fountains,
18:16rearranging and hybridizing themselves in a constant flux.
18:23Word got out about this mind-expanding substance,
18:26and the lab began synthesizing and shipping samples
18:29to research centers around the world.
18:32Initially, scientists thought psychedelics like LSD
18:35could be used to explore schizophrenia,
18:38since a person's tripping experience
18:40mimicked some aspects of psychosis.
18:43But then they observed that some patients,
18:45including those with alcohol use disorder,
18:48reported feelings of transcendence or spiritual epiphanies
18:51that helped them to quit drinking.
18:54I was so curious that the most studied indication
18:56was the use of LSD to treat alcoholism.
19:00It turns out there was this huge body of research
19:02from the 1940s to the 1970s,
19:05and it was a big part of psychiatry.
19:07There were over 40,000 participants treated.
19:10It was hailed as a wonder drug.
19:14But as scientific research continued,
19:16some efforts took a dark turn.
19:18The CIA attempted to weaponize LSD
19:22with top-secret projects like MKUltra,
19:25in which they experimented on volunteers
19:28and unsuspecting government employees
19:30to see if minds could be controlled,
19:32memories erased, people programmed.
19:37And then LSD escaped the lab.
19:40Ken Kesey, the author of One Flew Over the Cuckoo's Nest,
19:47was one of the CIA research volunteers.
19:50Ken Kesey first got exposed to LSD in a CIA experiment.
19:55And then later, he became one of the leaders of the hippies.
19:59You know, he helped the Grateful Dead,
20:01began at the acid tests, the Merry Pranksters.
20:04So the history of the CIA and the mind control
20:07and the nefarious uses of psychedelics
20:09are interwoven into the cultural story of psychedelics.
20:14The first experience I had was with
20:16seven little mushrooms in Mexico.
20:18In 1966, the former Harvard psychology professor,
20:22Timothy Leary, promoted psychedelic drugs
20:25as a means of personal and cultural transformation,
20:28urging youth to...
20:30Turn on, tune in, drop out.
20:34Timothy Leary became the Pipe Piper of psychedelics,
20:37and it so alarmed the Nixon government at the time.
20:40Nixon declared Timothy Leary
20:42the most dangerous man in America,
20:44declared war on drugs.
20:46America's public enemy number one is drug abuse.
20:50And enacted the Controlled Substance Act in 1970,
20:53which kind of erased them from the history books.
20:57The act classified drugs like heroin,
21:00cannabis, and psychedelics
21:02as having the highest potential for addiction and abuse.
21:06The whole war on drugs wasn't really a war against,
21:09like, stopping people from using drugs.
21:11If you declare war on drugs,
21:12you should declare war on alcohol and tobacco,
21:14the most damaging ones.
21:15They were absented from the Controlled Substance Act.
21:18You went after psychedelics,
21:20which are really not addictive at all.
21:22The latest revelations about the benefits
21:26aren't surprising to many indigenous populations,
21:29who have venerated plant-based psychedelics
21:31for thousands of years.
21:33In many cultures,
21:36psychedelics have been used in rites of passage
21:38and to gain wisdom,
21:40usually administered in specific religious
21:42and healing ceremonies.
21:44In North America,
21:48some indigenous peoples use peyote,
21:51a cactus that grows in northern Mexico
21:54and a small region of South Texas.
21:56I'm Adrian Primo.
21:59I come from five generations of peyote people,
22:05myself being the sixth
22:06and then my son being the seventh generation.
22:09To me, peyote is a very intimate medicinal herb.
22:18We use it as a guide.
22:20We use it as a means to synchronize with the universe.
22:24My grandparents explained to me at a very young age
22:28that we could acquire any means of success
22:31through medicine and peyote if we approached it
22:34with the right intent.
22:36Peyote use can touch on many aspects of life.
22:41How this medicine is able to heal,
22:44there's a lot of complex facets.
22:47Within indigenous forms of thought,
22:50we believe that, like, the spirit exists
22:53somewhere back there in the subconscious
22:55that's connected to the universe.
22:57So this plant medicines helps you reach those depths
23:01of your ability to manifest whatever it is
23:04you can picture in your mind.
23:05Maybe you're picturing pain going away.
23:08Maybe you're picturing your cancer going away.
23:10Maybe you're picturing your body being healthy.
23:12Maybe you're picturing education.
23:13Whatever it is that you're picturing,
23:15your subconscious brain has that power
23:18to create that for you.
23:20And this medicine is just a tool
23:21to help you to reach that point.
23:27When we think about how native people
23:29have used these substances, it was a ritual.
23:33So there's something still really important
23:36about the setting, the ritualistic aspect.
23:40You can see this positive outcome.
23:42You can hear the positivity around you.
23:46All of that then gets encoded into the brain
23:49in a manner that when you're not in that hallucinogenic state,
23:53it still stays with you.
23:55A peyote cactus can take over 10 years to reach maturity.
24:02Since the arrival of Europeans,
24:04Native American tribes have often been persecuted for peyote use
24:07and had limited access to the plant.
24:10Now, commercial interests and poachers are putting pressure
24:14on peyote's fragile ecosystem.
24:19Recently, a philanthropist purchased 605 acres of peyote land
24:24here in South Texas to provide access for members
24:27of the Native American church,
24:29which teaches Native American traditions,
24:31sometimes elements of Christianity,
24:33and regards peyote as a sacrament.
24:36In order to assure that this medicine is going to be available,
24:42we have to have some kind of direct connection with this land.
24:48And this land, I think, is an answer to a prayer from years ago
24:55that there will be medicine for our children.
25:03This land means the world to all of us.
25:07Mother Earth and what she has provided us.
25:10This represents the future.
25:12It's about what you are going to teach your children,
25:15your grandchildren,
25:16and what you're going to leave behind,
25:19the essence of generational responsibilities.
25:23Words cannot suffice what the spirit feels
25:27in connecting with this land.
25:32Psychedelic assisted therapy is still in its early stages,
25:36but scientists are inspired by Indigenous practitioners'
25:40careful and non-recreational use of these powerful substances.
25:45One concept that the emerging use in therapy shares
25:48with Indigenous practices
25:50is the importance of taking these psychoactive substances
25:53only in the right environment and frame of mind.
25:56We know that like any drug, including aspirin,
26:01that is in our medicine cabinet,
26:03the use of any drug not in the way it was designed to be used
26:07can be harmful and even catastrophic.
26:11So when we talk about psychedelics, the setting is very important,
26:15not just the preparation, not just the integration,
26:18but your safety, who you're with, what your intention is,
26:22what is the physical environment.
26:24The setting plays a crucial role in a psychedelic assisted therapy experience.
26:30No detail is overlooked in this physical space,
26:34and the mindset or intention a person brings to the session
26:38is of paramount importance,
26:40just as it is when Indigenous people prepare for the use of peyote.
26:45My intentions were just to go in with an open mind,
26:50whether it be a good trip or a bad trip, just experience it.
26:54My intention was self-exploration, self-understanding, and openness.
27:04My intention was to see the face of God.
27:09My intention was to take my experience of having cancer at age 11
27:14and transform it into something neutral or even something positive.
27:20My intention was to have no intentions.
27:23I wanted to be open to accepting whatever the experience would give to me.
27:28What draws these patients together is a common enemy, cancer.
27:43I've had the privilege of being with you guys all this last year.
27:46Here in Rockville, Maryland, oncologist Manish Agrawal
27:50is the first doctor in the country to run a psychedelic assisted clinical trial
27:54treating depression and other mental health impacts of cancer with group therapy.
28:00I was having really bad monthly depressive episodes
28:03where I would just cry all day.
28:05As many as a third of patients with a cancer diagnosis
28:09will experience major depressive disorder.
28:12But perhaps because it exists in the shadow of a cancer diagnosis,
28:17the condition is rarely acknowledged.
28:20I've been an oncologist for almost 20 years,
28:23and I've been taking care of patients,
28:25and there's an aspect of their care that was really missing.
28:28You know, we take care of the physical aspects,
28:30but then I close the door,
28:31and I know so many important issues are really unaddressed.
28:36I wanted to start with something to help us center.
28:39I'd just like to invite you to close your eyes.
28:42I think healing is bringing the body, the mind, the emotion,
28:46the spirit back home to where you feel comfortable with it again.
28:50And so you can't just fix the physical pain and then people are healed.
28:56It doesn't work that way.
28:59Building on pioneering clinical trials at NYU, UCLA, and Johns Hopkins,
29:05Manish saw that it was important to treat the depression as part of treating the cancer.
29:10Okay.
29:11Manish was surprised by the results.
29:23To be honest with you, the numbers were so good that I wouldn't believe it if I wasn't with every session.
29:29I saw every person go through here.
29:32We treated 30 people and 82% had more than a 50% reduction in their depression symptoms.
29:40When we measured quality of life, we measured anxiety.
29:43All of those were improved.
29:45The experience just kind of made me more aware of myself and the space that I take up in the world,
29:52and the energy that I put out into the world, and how that affects people too.
29:56Prior to the dosing, I had this tendency to get caught up in distressing thoughts related to the cancer.
30:04I noticed a subtle shift in that while distressing thoughts would still come up,
30:10I was able to let them go for the first time ever.
30:13I don't feel the need to follow them.
30:16While Eric's endless distressing thoughts and John Costas' alcohol use disorder may seem to have nothing in common,
30:24some see a possible similarity at work in the brain.
30:28These different disorders, I've really thought of them all as forms of addiction.
30:34So whether we're talking about depression or what we normally think of as addiction,
30:39these are all just forms of being stuck in a suboptimal pattern.
30:43It's being stuck in a narrowed mental repertoire, a narrowed pattern of behaviors.
30:51In patients with depression, scientists have noticed an abnormal increase in activity
30:56in a network of different regions in the brain called the default mode network.
31:01The default mode network refers to this pattern of activity across a number of brain areas
31:09that is strongly associated with thinking about oneself, thinking about one's past,
31:17projecting oneself mentally into the future.
31:21The default mode network activates when a person is introspective,
31:26and under normal circumstances becomes less active when a person shifts their attention to the outside world.
31:34But brain studies show that under the influence of a psychedelic,
31:38the default mode network is quieted,
31:41while other regions of the brain increase communication with each other.
31:45A mathematical model captures a normal brain's activity.
31:50In contrast, a brain under the influence of psilocybin reveals a dramatic increase in global communication.
31:57Thousands of new connections form, linking brain regions that don't normally talk to each other.
32:03One analogy I've used for how psychedelics work in the brain is a snow globe.
32:10When you pick up a snow globe, you know, the snow's settled at the bottom,
32:15it's sort of fixed, and then you pick it up, shake it,
32:18and things jiggle around and there's randomness and a kind of chaos, if you want, in the system.
32:24The user experiences this as an altered and heightened sense of awareness.
32:30But what causes this?
32:34Early in our functional brain imaging studies of psychedelics,
32:38scientists were finding that the default mode network was turning down or turning off during these experiences.
32:43And that was a really good place to start.
32:46But we began to then look one layer deeper.
32:49Why was the default mode network turning off?
32:52New research led neuroscientist Fred Barrett to investigate a region of the brain called the claustrum.
32:59The claustrum is a really thin sheet of gray matter in the brain,
33:04tucked deep within each of the hemispheres of the brain.
33:08Recent animal models have shown that it is incredibly highly connected to just about every other region of the brain.
33:15Understanding that the receptors targeted by psychedelic drugs are also really densely expressed in the claustrum,
33:23we began to wonder whether the claustrum may be at the center of psychedelic effects.
33:30Fred believes the claustrum's central location and shape suggest it regulates communication between the departments.
33:38When it's functioning normally, the claustrum is essentially acting like a switchboard.
33:44It's trying to help other brain regions figure out when to turn on and when to turn off.
33:49But when we experience a psychedelic drug, we believe that it's binding to specific receptors in the claustrum
33:57and somehow disrupting or disorganizing the claustrum.
34:01It's almost as if the switchboard walks away.
34:05What happens next is that we seem to observe a radical change in the way that brain regions talk to each other.
34:14And it may be within this context that we're experiencing learning and a possible even rewiring of the circuits that govern our behavior.
34:25And it may be that it's that radical reorganization that allows people to encounter new psychological insights that they hadn't encountered before.
34:33Fred thinks the claustrum's sudden abdication of control may help explain why rigid behavior and thought patterns have a shot at resetting.
34:43It's almost like they've seen this kind of grand menu within their mind that they weren't aware of,
34:48that this greater number of possibilities that they can explore.
34:53It took a while to recover.
34:55I was having headaches and muscle pains, but it was the best headache I'd ever had in my life
35:02because it told me that the psilocybin was working.
35:07It was actually physically restructuring my brain, something that I never imagined could happen before.
35:13It's like reprogramming the operating system of a computer.
35:19You're getting down to very basic code level changes that can enduringly change someone going forward.
35:26As of 2022, there were more than a dozen clinical trials underway involving psilocybin and MDMA.
35:34Early efforts to revive this research began with individuals like Rick Doblin, who founded the Multidisciplinary Association for Psychedelic Studies, or MAPS, in 1986,
35:49to facilitate research into the therapeutic benefits of psychedelics with a focus on MDMA, or ecstasy, for post-traumatic stress disorder.
35:59One of the reasons that MDMA is so successful in therapy is the way in which it builds a certain self-confidence, a self-acceptance.
36:09MDMA can increase the hormone oxytocin, and that oxytocin is really important for bonding.
36:17That may be why that therapeutic bond, the setting that they have, all induce these positive emotional mood states.
36:26People under the influence of MDMA are able to feel more connected, both to themselves, to their inner world, and also to the people that they're with.
36:36But these feelings of connectedness and love, paired with an altered mental state, can make participants uniquely vulnerable.
36:47There is concern among researchers about how to ensure patient safety, and there are not yet universal guidelines or a code of ethics for administering this kind of therapy.
36:59In addition, unlike LSD and psilocybin, MDMA has stimulant properties that can lead to toxic side effects.
37:08MDMA, because it impacts on dopamine or adrenaline, it has a stimulant properties to it.
37:14It can induce chills, it can induce nausea, it can increase heart rate, people even thinking that they're having heart attacks.
37:24Since 2000, more than 200 PTSD patients, including survivors of interpersonal violence, disasters, and combat, have received MDMA-assisted therapy in MAPS clinical trials.
37:39One of those patients is Scott Ostrom.
37:43In 2006, he was deployed to Fallujah, Iraq, where he engaged in multiple combat missions.
37:50Real war is scary.
37:54You play for keeps, and everything's unexpected.
37:57You know, you go there highly trained, and as physically fit as you can be, but a lot of it's, you know, luck.
38:05On the front lines, Scott was under constant threat, and would go on to develop PTSD.
38:12We know that, at its core, PTSD involves the amygdala, an over-activation of the amygdala.
38:19The amygdala is the fear center of the brain, and it keeps us alive.
38:23It keeps us away from being killed.
38:25But it's the main pathological construct in PTSD.
38:29You have an over-active amygdala.
38:31People respond to neutral stimuli, like a door slamming can remind them of being in combat.
38:38So, innocuous stimuli trigger this exaggerated fear response.
38:43MDMA seems to calm the amygdala.
38:48By having people not be so hypersensitive to negative emotional state, the prefrontal cortex now can dampen the amygdala, reduces its hypersensitivity to the stress, to old memories that would cause the amygdala to be overactive.
39:09Your prefrontal cortex is really important. It's the most evolved part of our brain.
39:15And it helps you say, you know what, the trauma's in the past. It's not happening now.
39:19And it allows you to rationally think through something and make executive decisions.
39:24People with PTSD, they're just stuck in this, like, fight-or-flight reactive thing.
39:30Scott qualified for a clinical trial with MDMA-assisted therapy, which helped him to confront traumatic memories.
39:39If you think of your mind as kind of a hallway where there are a lot of doors, and you try very hard to walk down the hallway and not be triggered by bad stuff that you know was behind those doors.
39:53One of the things that happens with MDMA is you say, I wonder what would happen if I opened that door?
39:58Maybe it's not so terrible.
40:02I started seeing this, like, spinning black, oily ball.
40:08And it started off in the distance, and then it would grow and get closer to me and closer to me.
40:13And then when it would get close enough for me to kind of realize that it was this spinning black ball, I would say, like, what are you?
40:19What are you doing here? And it would retreat away.
40:22Instead of asking it what it was, as soon as I surrendered to it,
40:25and I surrendered to the feeling that it gave me on the inside, and I let that anxiety grow,
40:30it started to open up in different layers like an onion.
40:35And when I got to the center, I relived a memory of a phone call that I had with my dad when I was overseas in Iraq.
40:44What I had said to him was, Dad, I'm really scared.
40:47They said some of us aren't coming home.
40:49And my dad had said to me, don't worry, Scott.
40:53You're highly trained.
40:55You're with the best guys the Marine Corps has to offer.
40:58And don't worry, your training is going to take over.
41:01All of a sudden, I realized that's where this shift happened.
41:06I had become this other person that I needed to become, that I had to become, to survive those combat deployments.
41:14The only thing that I could think to name that person was the bully.
41:19Taking his father's words to heart, Scott let his training take over to become the bully.
41:25But the bully could not shield him from the pain of loss.
41:30One thing that was really tough was not being able to save someone that I felt close to.
41:35The vehicle that he was riding in ran over an anti-tank mine.
41:44I had ran up to the vehicle shortly after that explosion, and the vehicle had caught fire.
41:51My friend was trying to get out of the passenger seat, and he couldn't, and I couldn't get to the passenger door.
41:59My body wouldn't let me get any closer because the fire was too hot, and he burned alive.
42:06There was nothing I could do.
42:10Nightmares of the war followed Scott home, along with painful regret.
42:15I felt a lot of guilt for not being able to save him, and for a long time I punished myself for that.
42:28My interpersonal relationships were completely down the tubes.
42:32I had high-risk behaviors like getting into fights, self-medicating with drugs, alcohol, being just aggressive and martial in general.
42:41And after like three and a half years of having nightmares every night, I really started to kind of fall apart.
42:51Scott wasn't alone in his desperation.
42:54Every day, almost 20 military veterans die by suicide.
42:59Current treatments for PTSD are of limited benefit.
43:02After identifying the bully within him, after the first MDMA dosing session, Scott had another breakthrough in a subsequent session with his therapist, Marcela Otalora, and Scott's dog, Tim.
43:18Marcela was sitting in her chair, and I was spooning Tim on the rug, and Marcela had just told me, well, would it be okay if you asked the bully if Scott can take over for a little while?
43:34And being in the state that I was in, I was like, hmm, I don't know, I guess I'll give it a shot.
43:41So I had an unconscious conversation with the bully, where I was able to ask if it was okay if I took over for a little while. Scott took over.
43:50Right. And it was more like, can he step up to the side for a moment to see who else is there, to see what other parts of Scott are there.
44:02And it was just this beautiful time of being able to connect.
44:06And I think after that, you didn't call him a bully anymore.
44:10The MDMA helped Scott to reframe the guilt he felt over not being able to save his friend's life.
44:19You don't forget the breakthrough moments that you had, and you don't forget what you learned. They stay a part of you.
44:25So no, MDMA is not something you microdose. It's not something you have to take all the time.
44:31It's just the key that fits into the psychotherapy lock.
44:36The psychedelic-induced experience can help a person get unstuck in a way that's not just being told it, but really experiencing it firsthand.
44:47And I think that's where there's a lot of power in these experiences.
44:51Remarkably, nearly 70% of participants in Phase 3 of the MAPS MDMA-assisted therapy trials no longer qualify for a PTSD diagnosis.
45:02We learned that MDMA-assisted therapy works in combat-related PTSD. It works in the hardest cases, and it works regardless of the cause of PTSD.
45:12So our Phase 3 studies are PTSD from any cause, and if we manage to get FDA approval, it will be for PTSD from any cause.
45:21Rick Doblin thinks that the treatment could be beneficial to many more people, including some who struggle with stressful experiences that aren't easily associated with PTSD, like bullying and systemic racism.
45:37But introducing psychedelic therapies to communities of color brings a special set of challenges.
45:45Because this is a new treatment, because it's connected to research, and because it's connected to a substance that's been stigmatized due to being illegal, a lot of people of color are very wary.
45:56The African American community has suffered a great deal from the war on drugs and having their communities targeted due to drugs.
46:05Just growing up, I was always taught, stay away from drugs. This is a trap. This is a way that people are going to get you and put you behind bars.
46:14Aware of abuses in the past, MAPS teamed up with therapists from communities of color to offer them training in the use of MDMA-assisted therapy.
46:23One of the participants, Sarah Reed, chose to experience an MDMA dosing session as part of her training to become a psychedelic-assisted therapist.
46:35One of my therapists made a comment about, there's a part of you that doesn't want to be understood.
46:41As a black woman, there is nothing more that I want than to be understood.
46:46I felt that so deeply in that moment.
46:51Particularly with problems like racism, I mean, one of the ways that it hurts people so much is that you're experiencing it all the time, but other people don't see it.
47:01And even when you point it out, they're like, oh, are you sure that's what happened? Or that didn't really happen. Or maybe you're being too sensitive.
47:07So your whole experience is one of being invalidated and of being not seen and not heard.
47:13Learning from this experience, Sarah went on to provide one of the first MDMA-assisted therapy sessions for a participant of color experiencing racism and post-traumatic stress disorder, or PTSD.
47:25From a young age, Kanu Kaplash had been the target of racist remarks and bullying.
47:41With racism, often it's not necessarily one big problem.
47:46It's not necessarily like, oh, the Ku Klux Klan came and burned a cross on your lawn, and now you have trauma.
47:52It's usually a lifetime of smaller things that may have some big things here and there, but at some point, the stress becomes overwhelming and it tips into PTSD.
48:05We call that racial trauma.
48:09Kanu was already experiencing racism when, as a swimmer, he was sexually assaulted in the locker room, tipping him into PTSD.
48:18So the nightmares and the symptoms really started to take effect after the sexual assaults, which happened when I was 13.
48:25I was sexually assaulted four times.
48:28If it wasn't for the study, I don't know if I'd be, you know, alive today.
48:30Because there was times, kind of right before the study, where I was really, really struggling, where I really wanted to kill myself.
48:35Our site was focused on providing participants with a culturally informed experience with MDMA therapy.
48:43And as one of his therapists who was attuned to his racial background, his religious background, his childhood upbringing, I wanted to incorporate chants.
48:55During one of his dosing sessions where one of those chants played, I just remember it seemed like something really resonated with him in that moment.
49:08He was actually able to go back to a childhood memory.
49:14I'd be transported to, like, a different galaxy.
49:21Look down, and I see this long set of piano keys going on to infinity.
49:27And it's crazy, because as I'm going down the keys, I can see different parts of my life.
49:32I find that sexual assault, because I'm like, that's the big one.
49:36That's the one that I had trouble remembering and kind of trouble processing.
49:40I remember I jumped in and I woke up on another world.
49:45I sat there and I meditated on that planet for, like, a thousand years.
49:49And I was able to go through my memory and walk through it like a museum and, like, walk through each of the incidents and remember vividly everything that happened.
49:57I was, like, flexing my arms really, really hard and just getting out all of the, effectively, like, pain.
50:02You know, I was just kind of stuck in my arms, stuck in my body.
50:06The one thing I learned through the study is, like, there's no other way but through.
50:12The only way to handle the beast is to confront it, to recognize it is what it is.
50:17It's a part of you, but it doesn't necessarily have to define you.
50:21And when you do that, eventually, you know, you will accept more of yourself, but also you will accept, like,
50:26the larger world in a more kind of positive light.
50:32As of 2022, MDMA-assisted therapy for PTSD is in the final stages of the FDA approval process.
50:42Psilocybin-assisted therapies for major depression and other conditions are also in the FDA pipeline.
50:47While hope runs high for psychedelic medicine, scientists are quick to point out the inherent risks.
50:55People think about psychedelic drugs and they think, oh, you know, you're going to kind of zone off into a world with clouds and unicorns.
51:03But I see them more as medicines, as tools for healing, and they are powerful tools.
51:10And so I think as such they require a lot of respect because I think something that has that kind of power to heal could also cause harm.
51:20You got to use it safely.
51:22Scientists are cautiously moving forward.
51:24The psilocybin therapy has been the most powerful tool I've seen.
51:29It's not for everybody.
51:31It's not to be, it's not a magic bullet.
51:33But it does change things meaningfully for many patients.
51:37It's so different than any other intervention we have within psychiatry.
51:42Because it's changing the very narrative structure about how people tell their own story, what they believe going forward.
51:54We're not going to have this whole jigsaw puzzle completed for a while.
51:59And I think that we want to stay a little humble about that.
52:02The less we kind of interpret and the more we just state what our observations are, I think the better off we're going to be.
52:32We are going to be.
52:33We're going to be.
52:35Time to see.
52:37Now, the last part of this is a description of the questions together in the chat.
52:40Oh, how did you watch this?
52:41Oh, how did you define that?
52:44Well, there you go.
52:46There's definitely something we can protect about.
52:48Hang on out.
52:50Hold on.
52:52Hold on to.
52:56Then second chapter of this is the situation.
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