Three years after Ian Roullier finally faced down the father who abused him and saw him sent to jail, he confronted him again, in the shape of a terrifying armoured horse.
This wasn’t a nightmare. Roullier was not only awake, he was high on magic mushrooms in a hospital room. He and eleven other patients with long-standing depression were treated with the illegal drug psilocybin (the active ingredient in magic mushrooms) at Imperial College London, part of a trial that saw psychedelic drugs used as medicines for the first time in the UK in nearly 50 years.
It’s a small study, with no control group, but the scientists running the study believe this could, eventually, become a treatment for depression. Today’s results have been called “promising but not compelling” by other scientists, who say more research is needed to determine whether the effect is real, and sticks over time.
Roullier has had depression for much of his adult life, but four years ago he began a downward spiral that he couldn’t pull out of. Both he and his sister were abused by their father as children, and in 2012 they at last faced him in court and saw him jailed. Though it was the end of one struggle for justice, the stress of the court case pushed Roullier over the edge.
I tried to carry on,” he said, “plough through everything and keep working as hard as I could, even though the longer I ignored it the more depressed, angry, and full of despair I became.
He kept reducing his workload in the hope that he could shake off his depression, but ended up having to quit work in 2014. Antidepressants made it worse; talking therapies didn’t help.
Then, while searching the internet for other treatments, he found a talk by scientist Robin Carhart-Harris about how psychedelic drugs might be useful to treat depression. Roullier got in touch and, just over a year later, joined the trial.
The data has just been published in the Lancet Psychiatry medical journal, and it shows that most of the patients felt significant relief from their depression for a number of weeks after the experience, and five of the 12 were still free from depression three months later (Roullier is not among them). It’s impossible to say at this point whether the effects can be distinguished from the placebo effect – where participants can get better when taking a dummy treatment and being told it’s the real thing – or whether the apparent relief from depression will last over the long term. But the results are intriguing.
What the raw data doesn’t show, though, are the intense and often terrifying journeys that many of the subjects went on in the sessions.
I think you could do as much harm as you could do good.
It is a treatment that even the researchers themselves admit can be extremely risky if not handled in the right way, as Carhart-Harris said: “It’s a very frightening thing to say perhaps – and it speaks to the power of psychedelics – but I think you could do as much harm as you could do good.”
The criteria for being accepted on to the Imperial trial was to have “treatment-resistant” depression, so these are, by definition, people who are in a vulnerable state, who haven’t been helped by antidepressants or talking therapies. Many of the participants have been living with depression for decades, and one of the conditions for the trial was that they would come off their medication, to avoid it contaminating the results.
This is the first trial using psychedelics to treat depression in the modern era, and part of a worldwide resurgence in psychedelic science. The first wave came to an end in the ’60s and ’70s as the drugs were made illegal. Until then psychedelics were a major research topic for psychotherapy, and were used as a treatment for everything from alcoholism to schizophrenia. Between 1950 and 1965, around 40,000 patients underwent some kind of psychedelic therapy, and it produced over a thousand scientific papers.
The number of scientific papers being produced during this “psychedelic renaissance” is a relative trickle, but already since the first paper was published in 2006 there have been promising results from small trials in the United States looking at psychedelic treatments for post-traumatic stress disorder, end-of-life anxiety, and alcoholism.
That 2006 paper was based on a landmark trial at the Johns Hopkins hospital in Baltimore. Since then the team behind it has run some of the most pioneering trials with psilocybin and LSD. Many of their studies talk about psychedelics producing a “mystical” or “spiritual” experience – the strength of which is closely linked to any healing process that comes from the drug, whether that is related to lessening anxiety for those with terminal cancer, or giving up drinking for alcoholics.
“It felt like I was stuck in a loop, and this broke the loop.”
For some on the Imperial depression study this seems to be true. One participant, who did not want to be named, also had depression for over 20 years, to the point where he says he simply couldn’t imagine going on. He said the experience of the psychedelic session was “transformative, like a fog lifted and my confidence came back”.
He is one of the five patients still in remission (depression-free) three months after the study: “There simply aren’t words to describe the experience. I can say that it felt like the usual self-narration we all have daily vanished completely. I used to ruminate and think, ‘What’s the point of anything?’ Now I’ve had an experience of being connected to everything, it felt like I was stuck in a loop and this broke the loop.”
Carhart-Harris said that “breaking the loop” is one of the effects psychedelics have on the brain, and it’s why he was so keen to test them on depression.
Three years ago, he ran an experiment giving psilocybin to healthy volunteers and scanning their brains to measure the effects. The scans showed a decrease in a key area called the default mode network. “It’s a region that’s overactive in depression,” he said. “It’s responsible for that heavy introspection and rumination you can get chewing over problems – chewing over how terrible you are and worthless, for example. And it’s about sort of quieting that heavy negative critical self-reflection and introspection.”
This explains why the drug might give relief from symptoms while people are under the influence, but Roullier and several others report feeling better, if not all entirely depression-free, several months after the drug session. While not ruling out a direct drug effect on the brain, all the subjects and researchers say that what seems to have the lasting impact is the meaning that subjects take from the experience itself and the deep inner journey that many of them describe.
The researchers emphasise how the trial was not just about giving people psychedelic drugs in the hope they felt better, but about supporting and guiding people carefully through the experience of a psychedelic trip.
Since the ’60s, the phrase “set and setting” has become part of psychedelic drug folklore, in other words that the setting – the environment that the drug is taken in – and the set, the state of mind of the participant, are crucial to the outcome of the psychedelic experience.
So the team at Imperial did their best to curate the “setting” for their participants, turning a bare hospital room into a comfortable and warm space with the use of careful lighting, drapes, and music. Three people were present with the subject to help support them in the experience, usually including Carhart-Harris and at least one trained psychologist.