Translator: Hiroko Kawano Reviewer: Rhonda Jacobs
This is Kirk.
He suffered from depression for five years.
He tried antidepressants, talking therapy,
and nothing helped.
In May 2015, in Imperial College, he was given psilocybin,
also known as magic mushrooms.
And since that time he's been depression free.
This is Ben.
He suffered from depression for 30 years.
And in that time he tried everything: CBT, group therapy,
a list of medications prescribed to him by his doctor,
and nothing helped.
In June 2015, he was given psilocybin,
and since that time he has been depression free.
Not only had the symptoms of his depression gone,
but in the last year,
he has done an acting course, a printing course,
he's flown on a plane for the first time in a decade,
and his career and social life are flourishing.
I can't show you his face
because magic mushrooms are an illegal psychedelic drug,
and he's asked to remain anonymous.
Magic mushrooms -
you might think of the '60s, dropping out,
jumping out of windows thinking you can fly.
You might think of going crazy,
quite the opposite of what magic mushrooms did to Ben and to Kirk.
And despite its bad reputation, we need to ask the question:
What does this mushroom know that we don't?
What does it do that we can't?
I'm a clinical psychologist at the psychedelic research group
at Imperial.
It's a vibrant group of scientists and clinicians
asking these very unconventional questions in a most conventional way.
It is led by Robin Carhart-Harris - he's a pioneering neuroscientist,
and also overseen by David Nutt,
who is a world-renowned psychopharmacologist.
And together they cut through ribbons and ribbons of red tape
so that we could do the first psilocybin for depression study last year.
And in this study, 20 individuals with treatment-resistant depression,
were given a high dose of psilocybin in a therapeutic setting.
Now, the numbers of may seem small, but the results were remarkable.
We kept seeing these drops in their depression scores
after the psilocybin treatment over and over again.
Their symptoms of depression were going right down,
much bigger reductions in depression scores
than you would expect to see in trials of conventional treatments
like antidepressants and talking therapy.
The depression scores were going right down,
and they were staying down.
Six months after the dose,
six of them were still in remission, no symptoms of depression.
Three of them didn't really respond to the drug,
so there were small reductions in their depression
but only for about a week.
But for 11, their depression was greatly reduced for about two months,
and then the symptoms of depression started to creep back again.
Now, that might sound very disappointing,
but with antidepressants, you have to take them every day.
They have some unpleasant side effects; it takes weeks for them to work.
And they are a palliative treatment, not a cure.
But with psilocybin treatment,
we were seeing immediate reductions in depression symptoms,
immediate relief that last for months, without side effects,
and it seemed to be working on the root causes
rather than just suppressing symptoms.
Depression is a relentless, haunting affliction.
Winston Churchill called it the black dog.
Patients in our study called it a concrete coat, a sack over the head,
a locked box, a prison.
They had tried between three and 11 types of antidepressants
and six types of talking therapy,
but nothing had released them.
They were stuck in their individual prisons of depression.
And they're not the odd ones out.
We are entering an epidemic of depression.
It's the number one cause of disability globally,
and it will affect everyone in this room -
either someone you care about or you directly.
And we don't understand depression.
We don't really know what causes it.
And despite enormous scientific endeavor, we have not yet found a conclusive cure.
We don't really understand it.
It's a complex mixture of so many different factors.
And when it hits, it can be a wave of sadness shame and grief,
or it can be just a shroud that kills all feelings.
And it's not an illness that we can just test for and treat.
It's different for every person.
So how to unlock depression?
The key is never simple, and it will be different for each person.
So, in our study,
we were originally looking at the effect of psilocybin on the patients' brains.
So it makes the brain go from rigid to flexible,
hyper-connected.
You could say that it unlocks the brain.
So in our study, we did these brain scans,
and we could see this increased flexibility.
And we also included a symptom measure,
so we could see that depression symptoms were going right down.
But that doesn't tell the full story.
We wanted to know from patients in their own words.
What was happening?
What was the psilocybin doing?
So we interviewed them all six months after the dose,
and we analysed the interview transcripts and came up with two themes
about what psilocybin was doing.
But before I get onto those themes,
I think maybe I should clarify what a psychedelic experience is.
So psychedelics allow the unconscious mind to become conscious.
Important material that has been built up over the course of life
but that has been pushed out of sight where you can't see it,
emerges, like - it's kind of crumpled clothes
that you push to the back of your wardrobe,
and it emerges, it comes out;
you don't just see it, you embody it.
Memories, emotions, pain, love, grief -
whatever has been hidden emerges and demands you feel it.
It can be incredibly painful and incredibly beautiful.
Patients in our study described overall having three main types of experience.
So firstly, visiting past traumas;
secondly, having insights about your life -
negative patterns and how to change them;
and thirdly, these experiences of harmony and connection and unity.
And sometimes they would have all three experiences
in the course of one dosing session.
So here's our treatment room.
And you would have the two therapists either side of the patient.
They'd be given eye shades and asked to sit back and listen to the music,
and just surrender to whatever comes up.
And they would have had sessions with the therapists beforehand
so that they trusted them and they felt safe.
But the therapist doesn't structure the sessions at all
or direct the content in any way.
But there was a structure to sessions.
There was a beginning, a middle, and an end,
and a flow of ideas and symbols that built on each other
in the most sophisticated way,
as if it had been planned by a most excellent therapist.
Now, in my previous work as a non-psychedelic psychologist,
providing talking therapies in the NHS,
I would plan my sessions for my patients
and think, how can I help them talk about traumatic experiences
or how could I help them get a different perspective
or develop some self-compassion or some motivation for change.
And I'd try and instill all these things.
But it's all coming from the therapist;
the patient experiences it as somehow outside of themselves,
and it sometimes just misses the mark.
But with the psilocybin sessions,
I was witnessing patients go on their own journeys of healing,
the ideas all came from inside themselves,
and they were powerful and transformative.
Because the lessons were planned by the most accurate therapist there is:
themselves.
So, the themes:
What did the patients say the psilocybin did?
The clicker is broken.
Can I have another clicker?
(Laughter)
Okay.
The next slide isn't coming up, but I'll tell you what it says.
It says that the first theme was of an inner unlocking.
So patients described going from being emotionally locked up inside
to being emotionally liberated.
They described going from being avoidant of emotion
to accepting emotion.
So, they talked about how in depression,
when stressful or painful things happened,
emotions were distanced or suppressed.
They - our society doesn't really value suffering.
It's seen as a weakness.
So they'd learned to put their feelings in boxes.
Sam remembered growing up and being told 'Boys don't cry',
so he learnt to suffer in silence.
And many of the patients just - they couldn't deal with their feelings
because so much had happened in their lives,
they had so many years of hurt,
they just didn't have the resources to face it all.
And they had many different ways of avoiding their pain,
self-medicating through food, through television, through painkillers
and then often through antidepressants,
which didn't really work on the root causes of their suffering,
just numb the worst of the pain.
But they also numbed other emotions too.
And so many of the patients described feeling numb and unable to feel.
Many of them had described
experiencing trauma in their life, often in early childhood.
And they've never been able to process it or think about what had happened.
And in their psilocybin experiences, they were able to process these things.
John -
Where's John?
John here -
He had suffered from abuse in childhood,
and in his psilocybin dose, he saw a great big cask,
and he knew that in that cask with all of his pain and shame
that he'd never been able to think or talk about.
And he grappled with it. It was extremely painful.
But in the course of the session,
he was able to unlock that box and accept his past.
And it was so powerful.
Many of them cried for the first time in years.
This cathartic experience of accepting emotion
and just being able to live it.
We saw in six hours what you would often see in six years of therapy.
And now the second theme is of an outer unlocking.
So, they described going from disconnection to connection.
So, they talked about depression as a gradual turning inward,
slowly becoming disconnected from the people you love,
from your identity
and becoming just kind of trapped in their minds,
trapped in a small corner of their minds,
locked there with constant negative thinking attacking them all the time,
and the psilocybin started a process of reconnection.
So Ben described it this way.
He said, 'It was like when you defrag the hard drive on your computer.
I experienced things being rearranged in my mind,
I witnessed it as it was all put into order,
and I thought my brain is being defragged!
How brilliant is that?
And since that time my thoughts make sense, and I ruminate less.'
And other patients described the same process
but in a different way.
Some described it as the fog lifting or being able to see clearly.
John said it was like turning on the lights in a dark house.
And after that mental reboot,
they were able to connect to their senses,
they would connect to their self, their identity.
Kirk said he felt like he was gliding through life,
and they could connect to other people.
John went for dinner with his wife for the first time in seven years,
said that they were like teenagers again.
Many of them felt a connection to nature.
They didn't just see nature as a thing like a television or a picture,
but they felt part of it.
And they connected to a spiritual principle for the first time -
some of them.
Overall, they went from being trapped to being unlocked, expanded and free.
So, altered states of consciousness have been held in high esteem
for thousands of years around the world.
But the scientific research is in its infancy,
and we're excited to be doing a bigger study this year.
But we're still treading carefully.
We don't know so much about it yet.
And it won't be right for everyone.
So, we're treading carefully,
and we're going to learn so much over next five years
about how and when psilocybin can help us.
But I believe that it could revolutionize mental healthcare.
Patience in our study described all these superficial treatments,
short-term therapies, sticking plasters that didn't help.
Nothing had ever helped
because nothing had ever got to the heart of their pain.
And in this epidemic of depression, there are so many people in need,
so many people need help,
and the NHS can't afford to provide long-term treatments,
years and years of psychotherapy for everyone.
But I believe that if we incorporate psilocybin
into existing short-term therapies like the therapies I used to work in,
that we can make them so much more effective, so much more powerful.
It's supplementing therapy with a medicine
that lets you find a way out of your suffering
rather than just padding the cage.
So, can magic mushrooms unlock depression?
The answer is 'no'.
It's not the mushroom that unlocks depression,
it's the patient.
The mushroom just shows them the key.
Thank you.
(Applause)