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The Science of Psychedelics for Mental Health | Dr. Robin Carhart-Harris

Episode 125 May 22, 2023 2h 32m 20 insights
In this episode, my guest is Robin Carhart-Harris, PhD, distinguished professor of neurology and psychiatry at the University of California, San Francisco. He is one of leading researchers in the study of how psychedelics such as psilocybin, LSD and DMT can change the human brain and in doing so, be used to successfully treat various mental health challenges such as major depression, anorexia, obsessive-compulsive disorder (OCD) and addiction. He explains how psilocybin induces sustained changes in adaptive brain wiring and cognition. We discuss the key components of safe and effective psychedelic journeys, the role of hallucinations, the use of eye-masks to encourage people to “go internal,” and music, as well as what effective therapist support consists of before, during and after the session (also known as integration). We discuss micodosing vs. macrodosing and how researchers control for placebo effects in psychedelic research. We also discuss the current legal landscape around psychedelic therapies. Psychedelic therapies are fast emerging as powerful and soon-to-be mainstream treatments for medical health disorders, but they are not without their risks. As such, this episode ought to be of use to anyone interested in brain plasticity, mental health, psychology or neuroscience. For the full show notes, visit hubermanlab.com.
Actionable Insights

1. Avoid Street Psychedelics

Exercise serious caution when considering purchasing MDMA or psychedelics from street sources, as they are increasingly being laced with dangerous contaminants like fentanyl, posing significant health risks.

2. Morning & Exercise Hydration

Dissolve one packet of Element in 16-32 ounces of water and drink it first thing in the morning and during any physical exercise to ensure adequate hydration and electrolyte intake for optimal brain and body function.

3. Daily Meditation & NSDR

Practice meditation, Yoga Nidra, or Non-Sleep Deep Rest (NSDR) regularly, even for short 10-minute sessions, to explore different states of consciousness and restore cognitive and physical energy.

4. Adopt “Trust, Let Go, Be Open”

During psychedelic therapy, cultivate a mindset of “trust, let go, be open” by building therapeutic rapport, surrendering to the experience without resistance, and being willing to confront difficult emotions and insights.

5. Sustain Psychedelic Integration

After psychedelic therapy, engage in ongoing integration work, viewing it as a continuous practice similar to meditation, to sustain the therapeutic gains and prevent relapse.

6. Confront Trauma Directly

To effectively deal with trauma, one must confront it directly to the point where some relief is experienced, as there is no other real way to achieve resolution.

7. Psychedelic Session Setup

During psychedelic therapy, wear an eye mask to keep eyes shut and listen to music that evolves from spacious to atmospheric, intentionally designed to coax emotion, as this is a staple component of the therapeutic process.

8. Choose Psychedelic for Trauma

For trauma, consider MDMA therapy to revisit difficult experiences with greater safety and trust, or classic psychedelics for a deeper, potentially more challenging but comprehensive exploration of the psyche, including both difficult and profound aspects.

9. Question Microdosing Efficacy

Be cautious about the perceived benefits of microdosing, as current scientific evidence suggests it does not compellingly beat placebo, with much of the reported effect attributed to positive expectancy.

10. Psychedelic Efficacy Beyond Placebo

Understand that the efficacy of classic psychedelic therapy is not primarily driven by positive pre-trial expectancy, suggesting that its therapeutic benefits are due to direct drug action and experience rather than a “super placebo” response.

11. Anticipate Core Psychedelic Fears

Be prepared for common core fears during the initial phase of a psychedelic experience, such as losing one’s mind or dying, as these are palpable and reliable aspects of the basic drug action.

12. Sustained Brain Connectivity Post-Trip

Understand that the increased brain connectivity observed during psychedelic experiences can persist for at least three weeks afterward, which is hypothesized to contribute to long-term positive therapeutic outcomes.

13. Utilize Music in Psychedelic Therapy

Recognize music as a staple and potentially synergistic component of psychedelic therapy, as all published studies showing positive outcomes incorporate music, suggesting its critical role in the combination treatment.

14. Address Relapse in Chronic Depression

For individuals with chronic depression, be aware that psychedelic therapy may offer a window of wellness, but relapse is common, suggesting the need for ongoing or repeated treatments.

15. Understand Psychedelic Session Durations

Be aware of the typical duration of psychedelic experiences: Psilocybin and MDMA sessions last approximately 4-6 hours, while LSD sessions can extend to 8 hours or more, which is crucial for planning and post-dose monitoring.

16. Psilocybin Mushroom Conversion (Caution)

Understand that one gram of magic mushrooms broadly contains about 10 milligrams of psilocybin, but this is guesswork and should not be used to calibrate self-dosing due to variability and potential for error.

17. LSD Perceptible Threshold

Recognize that the threshold for perceptible psychedelic effects with LSD is around 10-12 micrograms, which helps differentiate between sub-perceptible microdoses and doses that may induce altered states, though individual sensitivity varies.

18. Psilocybin for Anorexia Nervosa

Consider psilocybin therapy as a potential treatment for anorexia nervosa, as preliminary results indicate alleviation of obsessive thoughts about food, increased willingness to consume healthy amounts, and improved weight.

19. Psilocybin for Fibromyalgia

Consider psilocybin therapy as a potential treatment for fibromyalgia syndrome, as preliminary observations from a study using a single 25mg dose of psilocybin are showing profound experiences and very promising results for generalized chronic pain.

20. Typical Psychedelic Session Frequency

Understand that psychedelic therapy typically involves 1-3 dosing sessions, spaced 1-3 weeks apart, which provides a general framework for the number and frequency of sessions used in clinical trials.