A Connecticut legislative committee’s recent action to provide $3 million to explore psychedelic-assisted therapy using doctor-supervised MDMA or psilocybin is a great step forward in the field, according to two Institute of Living physicians.
Both Dr. Godfrey Pearlson, founding director of the Olin Neuropsychiatry Research Center at Hartford HealthCare’s Institute of Living and an expert in the fields of marijuana and of psychosis, and Dr. Mirjana Domakonda, Director of the Clinical Trials Unit at the Institute of Living, greeted the action by the legislature’s Public Health Committee.
“This area is really promising, but it’s still really only partly understood,” said Dr. Pearlson. “There are a number of unanswered questions.”
MDMA (short for 3,4-methylenedioxymethamphetamine), most commonly known as Ecstasy or Molly, and psilocybin, an active ingredient in some species of mushrooms, have been used for patients with treatment-resistant PTSD or depression.
Clinical trials have shown great results among a number of patients, said Dr. Domakonda. Her research interest is the use of neuroimaging and psychopharmacology, specifically ketamine and MDMA, to study the neurobiology of eating disorders, obesity and substance use disorders. She hopes to use this knowledge to develop improved treatments for patients with these severe and difficult-to-treat illnesses.
“Randomized controlled trials of psychedelic-assisted therapy have found that MDMA is safe and efficacious in severe and chronic post-traumatic stress disorder, while psilocybin has shown promise in treatment-resistant depression and end-of-life anxiety and depression,” she said.
The bill that advanced out of committee creates a pilot program within the Department of Mental Health and Addiction Services and establishes an advisory panel to help craft state regulations in advance of possible federal action expanding access to the treatments.
A major question for Dr. Pearlson in these types of treatments: “Is the psychedelic part of the experience — the part where someone feels one with the universe and all that – is that necessary? Or can we figure out a way to take that part out by redesigning the medication?”
Removing the “trip” aspect of the drug might make it more appealing to patients who are otherwise hesitant to take something that will bring about an hallucinogenic experience, he said.
“So for example, the grandmother who otherwise would never touch drugs, could it work for her?” he said. “The trials need to be expanded beyond people who want that experience. Sometimes, the experience can be disturbing, in part because it can’t be controlled.”
Dr. Domakonda is going through psychedelic-assisted therapy training, and she said the evidence so far is strong that these treatments work and the effects are long lasting. The Multidisciplinary Association for Psychedelic Studies (MAPS) has been running trials for some time, and has created a treatment model that Dr. Domakonda thinks can be easily applied in Connecticut when the time is right.
MDMA is given to patients with chronic, severe treatment resistant PTSD. Treatment lasts three months, with preparatory sessions followed by once a month MDMA treatment. With the MDMA, two therapists are with the patients for the duration of the drug’s effects, typically six to eight hours. The following day, the patient has an “integration session” for follow up.
“They have seen sustained recovery after these three treatments,” she said. “The results are unheard of compared to what we see using what we currently have. It is incredible to watch people as they go through the spectrum of treatment.”
Dr. Pearlson said the “bad reputation” that psychedelic drugs have left over from the excesses of the 1960s and 70s “needs to be reframed. In the same way that we have worked on cannabis, we have to rethink psychedelic drug therapy.”
Both doctors see IOL and Hartford HealthCare playing a role in the next steps as the state moves toward approving psychedelic treatments (which still are not legal at the federal level, and that has to happen first). Dr. Domakonda was an integral part of esketamine studies at IOL that led to the 2019 FDA approval of Spravato, an esketamine-based nasal spray for treatment-resistant depression.