You may have heard that psychedelics are now available from doctors as treatments for people with mental illnesses.
If you or someone you care for is suffering from mental illness and existing treatments are not working or have bad side-effects, it’s understandable that you want to look for alternative options.
However, before you spend time and money trying to get an appointment with a psychiatrist for psychedelic therapy, there are some important things you need to know.
What are psychedelic drugs?
Psychedelics are a type of drug called hallucinogens. Drugs in this class include psilocybin and LSD. In psychedelic therapy, MDMA is described as a psychedelic drug even though it is slightly different.
The drugs used in psychedelic therapy are tested and available only as pharmaceutical-grade products. These are safer than street drugs, or those available in natural forms (for example ‘magic mushrooms’).
What is psychedelic therapy?
Psychedelic therapy is a treatment overseen by approved psychiatrists. The treatment involves the use of a measured dose of a psychedelic drug to support psychological treatment (talk therapy).
It is thought that the psychedelic drug increases your ability to access deeper insights and awareness of your own thoughts and feelings. This may help you and your therapist to better understand your experiences and your illness.
The psychological treatment talk therapy is just as important as the action of the psychedelic drug.
It is a very intensive treatment that usually involves 1–3 sessions over a few weeks. Each session lasts around 6–8 hours. Discussions during treatment may explore trauma, so additional support and therapy will be offered.
Will psychedelic therapy cure my illness?
This is unknown, as every person is different and will respond differently. The number of studies on this treatment is small, and very few people have been included in the trials.
Not everyone who receives psychedelic therapy will get better. Even if the treatment works, it is not clear how long the benefits will last.
It is not known how much of the benefit comes from the psychedelic drug, and how much from the type or amount of psychotherapy or other family supports.
For some people, the experience may be healing, for others reliving trauma may be distressing and harmful.
More research is needed to find out which people will respond best, and which people may be at risk when using the treatment.
Who is suitable for psychedelic therapy?
Psychedelic therapy is not a first-line treatment. It is a possible treatment option for some people who have tried all other treatment options without improvement.
You may not be suitable for psychedelic therapy if you have:
- a personal or family history of psychosis
- personal history of mania
- repeated history of violence towards others
- recent personal history of a suicide attempt requiring hospitalisation
- certain health conditions such as metabolic liver disease.
Your psychiatrist will help you to understand whether you are suitable for this treatment, and the risks and benefits to you.
Is psychedelic therapy safe?
Psychedelics may appear to be less risky or more natural than other medications because of their organic origins. This is not true, and in fact, psychedelics have proven very risky for some people.
Scientific studies have shown that at low doses and in a medically controlled setting, psychedelics are generally safe as psychiatrists help manage the risks and side-effects.
However, the number of studies is small, and very few people have been included in the trials. People with psychosis or a family history of psychosis have not been included in any studies.
More research is needed to find which people may be at risk when using the treatment, and whether there are any long-term risks.
Emotional side effects
The biggest risk is that psychedelics may make you more sensitive to emotions that could cause bad experiences (e.g. fear, panic, and reliving trauma) and harm (e.g. suicide risk, worsening of illness).
You may also feel stress during treatment if your experience does not match your expectations.
Physical side effects
Common physical side effects of psychedelic therapy are generally minor and may include:
- anxiety
- restlessness
- tiredness
- jaw-clenching
- headache
- temporary increases in blood pressure.
Existing medications
Psychedelic drugs are known to interact badly with other drugs used to treat mental illness.
You may need to gradually reduce and then stop your use of these medications under medical supervision prior to commencing treatment. This may not be possible without severe relapse.
Safety monitoring
Psychedelic therapy in medical setting is offered as part of an overall treatment plan. This requires a psychiatrist to:
- get informed consent to ensure you have a detailed understanding of the risks and potential benefit of the treatment
- take account your emotional state, expectations, family support, and existing medicines
- discuss ongoing support after the treatment is over
- ensure that the intensive therapy sessions are provided by well-trained professionals as part of a team to reduce risks and maximise benefits from the therapy
- record any benefits and all side effects.
How do I access psychedelic therapy?
In New Zealand and Australia, access can be via a clinical trial. You can find trials listed on a Clinical Trial Registry such as the Australian New Zealand Clinical Trials Registry.
In Australia, from 1 July 2023, a new pathway opened to allow access to:
Only psychiatrists who have been approved by the Therapeutic Goods Administration (TGA) may prescribe these drugs and offer psychedelic therapy outside of clinical trials.
Psychedelic therapy is not widely available under the TGA pathway because:
- this is a new and experimental treatment with very strict access controls
- there are only a small number of psychiatrists with the relevant skills and experience
- it is an intensive treatment meaning psychiatrists will not be able to treat many patients at the same time
- you should have tried all current treatments for PTSD and depression first, including talking therapies and medication, as well as other evidence-based treatments for depression
- even if you have a diagnosis of PTSD or difficult to treat depression, you may not be suitable.
You can ask your psychiatrist for advice, or speak to your GP. Your GP will not be able to prescribe psychedelic therapy for you.
The RANZCP Find a Psychiatrist database includes details of the small number of psychiatrists who can advise on psychedelic therapy in both Australia and New Zealand.
Is psychedelic therapy expensive?
If you are part of a research trial in Australia or New Zealand, you will have your costs met by the trial.
In Australia, the cost of psychedelic therapy outside of research trials (i.e. under the TGA pathway) is unknown, but it is likely to be expensive.
Some of your consultations may be eligible for funding under Medicare, but this will only form a very small part of the overall costs. This may mean that even if you are suitable for treatment and find a psychiatrist offering the treatment, the cost may be too high. This may limit access to only those people who can afford it.
Why should I see a psychiatrist for this treatment – what about other psychedelic retreats?
The use of psychedelics is ancient and embedded in some cultures, but in western medicine this is an experimental treatment. Safety is a priority until more is known about this treatment.
The TGA announcement that psychedelics could be prescribed by a psychiatrist may lead you to believe that all psychedelics are safe. This is not the case.
Self-administering or going to ‘underground’ retreat-like clinics remains very risky as:
- it is illegal
- there are very few controls or safeguards to monitor risks and benefits from the therapy, and follow up care may not be available
- many settings have no skilled medical professionals on hand to handle emergency situations and are often located far away from emergency health services
- the drugs used will not be tested to the same level as required in medical setting – illegal drugs may contain contaminants and/or higher levels of active ingredients that can be dangerous.