Psychedelic Therapy for Depression

If you’re interested in exploring psychedelic therapy as a treatment for depression, you’re probably wondering:  “Does psychedelic therapy for depression work?” or, “Should I take psychedelics for depression?” and, “Where can I find psychedelic therapy for depression?” Psychedelic therapy is an increasingly popular option for individuals struggling with depression and treatment-resistant depression. Here’s everything you need to know before you start your journey.

Can you take psychedelics for depression?

Taking psychedelics for depression is most effective when paired with treatment, often referred to as psychedelic integration, from a qualified therapist or guide.  

Studies have shown the benefits of psychedelics like psilocybin and ketamine for treating depression. But in every study conducted so far, psychedelic treatment for depression was accompanied by talk therapy.

What is psychedelic therapy for depression?

Psychedelic therapy for depression typically follows a four-step framework:

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• Step 1: Education. The client and their therapist or guide explore treatment options, and consider the potential benefits and drawbacks of different forms of psychedelic therapy for depression.

• Step 2: Preparation (part of Integration). Once the client and therapist have agreed on a treatment plan, the client attends one or more therapy sessions to help them prepare for their psychedelic journey. This is the stage for setting goals and expectations, and learning how the experience will fit within the wider context of treatment.

• Step: 3: Facilitation, or the Journey. The client undergoes the psychedelic experience. In some cases, the client may take this step on their own, with a guide or “trip sitter” other than their therapist, then meet with their therapist for the fourth step.

• Step 4: Integration. Possibly the most important step in psychedelic therapy for depression, integration consists of one-on-one work with a therapist or healer to contextualize and interpret the psychedelic experience. The client’s experiences during a psychedelic journey may be confusing or distressing. It’s the therapist’s job to help the client fit these experiences into a larger framework, so difficult experiences become a source of new, actionable insights.

Psychedelics and depression don’t always mix well. Before undergoing psychedelic therapy for depression, consult with a qualified therapist and make sure it’s right for you.

How does psychedelic therapy treat depression?

The integration stage of psychedelic therapy helps clients draw insights from their experience, shift perspectives, and progress in their treatment.

But the physical mechanisms of psychedelics, and the changes they may cause in the brain of a client, are still being studied. To date, there is no conclusive model explaining how psychedelics treat depression on a physical level.

New studies are continuously underway. Here are some recent papers on depression and psychedelics:

• Psychedelic therapy for depressive symptoms: A systematic review and meta-analysis. Researchers review and summarize the findings of 14 studies on psychedelic treatment for depression. They find a clear correlation between therapy with psilocybin, LSD, and ayahuasca with short- and long-term improvements in symptoms.

• Psychedelic therapy in depression and substance use disorders. This overview looks at the history and current status of research into psychedelic therapy for depression and substance use disorders. It considers some of the physical mechanisms of psychedelic treatment.

• Long-term effects of psychedelic drugs: A systematic review. This paper covers treatments for many conditions, and not only depression. But it’s a fascinating look at the long-term effects psychedelic treatment may have on the brain.

What substances are used in psychedelic therapy for depression?

A variety of substances are used in psychedelic therapy for depression, but not all of them have been thoroughly studied.

Psilocybin for depression

Psilocybin, the active ingredient in psilocybin or “magic” mushrooms, has proven to have beneficial effects on symptoms of depression when combined with integration therapy.

The client may take psilocybin orally in the form of dried mushrooms (sometimes powdered and made into capsule pills), or as synthetic psilocybin pills.

Here are some recent studies on the effects of psilocybin therapy on depression:

• Psilocybin-Assisted Therapy for Depression: A Systematic Review and Meta-Analysis
• Psilocybin, an Effective Treatment for Major Depressive Disorder in Adults - A Systematic Review
• Efficacy and Safety of Psilocybin-Assisted Treatment for Major Depressive Disorder: Prospective 12-month Follow-up

Ketamine for depression

Ketamine is a general anaesthetic and analgesic used on both animals and humans. It may be prescribed for off-label use to treat depression. It comes in powdered or liquid form, and in clinical settings it’s typically administered intravenously.

Numerous studies have shown the effectiveness of ketamine, coupled with psychotherapy, in treating depression: 

• Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial
• Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder: A Randomized Clinical Trial
• Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression

MDMA for depression

MDMA (3-4 methylenedioxymethamphetamine) is a synthetic psychoactive drug originally developed in the 1920s. Starting in the 1970s, it was used in clinical settings to enhance psychotherapy.

The chemical structure of MDMA is similar to both methamphetamine (a stimulant) and mescaline (a psychedelic), but it also has features in common with serotonin, dopamine, and norepinephrine.

In a clinical setting, MDMA is usually administered orally in pill form.

One recent study shows MDMA therapy may have beneficial effects for clients suffering depression:

• Rapid and Prolonged Antidepressant and Antianxiety Effects of Psychedelics and 3,4-Methylenedioxy-methamphetamine—A Systematic Review and Meta-Analysis

LSD for depression

Lysergic acid diethylamide (LSD) is a synthetic psychoactive drug originally developed in 1938 by Albert Hofmann. In the 1950s and 1960s it was widely studied in clinical trials, and used experimentally in psychotherapy.

LSD is a serotonin receptor agonist, meaning it binds to serotonin receptors in the user’s brain. Its exact mechanisms are not widely understood.

In clinical settings, LSD is usually administered orally in liquid, blotter, or pill form.

Some recent studies suggest LSD therapy may be effective in treating depression:

• Classical Psychedelics for the Treatment of Depression and Anxiety: A Systematic Review
• LSD Acutely Impairs Fear Recognition and Enhances Emotional Empathy and Sociality

Microdosing for depression

“Microdosing” refers to the method of taking small amounts of psychedelics on an ongoing basis. 

The dosage is low enough that it doesn’t lead to a full-blown psychedelic experience—the client is able to go about their daily routine while microdosing. But anecdotal evidence (and some studies) support the idea that these small doses have an ongoing or cumulative effect treating symptoms of depression.

Some recent studies on microdosing and depression:

• The Therapeutic Potential of Microdosing Psychedelics in Depression
• Adults Who Microdose Psychedelics Report Health Related Motivations and Lower Levels of Anxiety and Depression Compared to Non-Microdosers
• Self-Rated Effectiveness of Microdosing With Psychedelics for Mental and Physical Health Problems Among Microdosers

What are the effects of psychedelic therapy for depression?

Psychedelic therapy for depression differs from one client to the next based on the substance being used, the dosage, the therapeutic techniques or frameworks applied, and the severity of the symptoms.

In some cases—ketamine therapy, for instance—treatment may result an immediate, effective relief of symptoms like suicidal ideation.

In other cases—like microdosing—it may take months of ongoing psychedelic therapy before the client notices any changes.

Psychedelic experiences are highly subjective. One client may undergo a sudden mental or spiritual epiphany under the influence of psychedelics. Another client, with similar symptoms and the same dosage, may find their journey a frightening ordeal. 

In either case—”good trip” or “bad trip”—integration therapy is key. Through integration, clients and therapists work together to make sense of the psychedelic experience and use it for healing.

Psychedelic therapy and depression: Anecdotal evidence

No single description can capture the experience of undergoing psychedelic therapy for depression. 

To get a better sense of what it feels like, and the effects psychedelic treatment for depression may have, it helps to turn to anecdotal evidence: 

• Can Magic Mushrooms Unlock Depression? (TedxOxford): Clinical psychologist Dr. Rosalind Watts conducted studies on psilocybin treatment for depression. In her TEDx talk, she discusses the outcomes for her clients and dives into how it feels to take the journey.
  

• The Healing Mushrooms: Following three clients in a clinical trial studying the effects of psilocybin on depression, this feature-length documentary offers a candid, behind-the-scenes look at psychedelic therapy. In this section of the film, one trial client undergoes psilocybin therapy for major depression and describes his experiences afterwards.

• DOSED: This feature-length documentary follows one woman’s journey using psychedelics to treat her depression, trauma, and opioid addiction.

• Dr. Andrew Huberman: Dr. Huberman is an advocate for the benefits of psychedelic therapy. In this section of a longer interview, he discusses the use of psilocybin to treat clients with treatment-resistant depression.

Psychedelics and antidepressants

There have been few studies done on the risks of combining psychedelics with antidepressants. 

Some therapists or guides recommend clients taper off psychopharmaceutical drugs before undergoing the psychedelic journey. There two good reasons for this:

• Serotonin syndrome. Certain psychedelics, such as MDMA or ayahuasca*, may react adversely with SSRIs and lead to serotonin syndrome, a serious and potentially fatal condition. 

• Dulled effects. Conversely, some SSRIs and other classes of antidepressants may dull the effects of psychedelics, leading to a less-than-optimal experience for the client undergoing psychedelic therapy.

* (Because they work differently from MDMA or ayahuasca (which contains MAOI inhibitors that may interact with antidepressants), psilocybin, LSD, and pure DMT do not typically increase the risk of serotonin syndrome when combined with antidepressants.)

Before you stop taking any drugs you’ve been prescribed to treat depression—whether by stopping all at once, or by tapering off your dosage—talk to your prescribing doctor. 

Quitting antidepressants may cause antidepressant discontinuation syndrome, which has wide ranging negative effects. It might also lead to an increase in depressive symptoms, including suicidal ideation.

Where to find psychedelic therapy for depression

Interested in trying psychedelic therapy for depression? Before you begin your search for a qualified therapist, healer, or guide, it’s important to understand both the risks and benefits of psychedelic therapy.

For a start, check out our guide to everything Canadians need to know about psychedelic therapy.

Then visit First Session to find psychedelic therapists in Canada: 

The personal video interviews on First Session can help you get a sense of what it would be like to work one-on-one with different therapists—so you can spend less time searching online and more time getting treatment.

Key takeaways:

• On their own, psychedelics aren’t an effective treatment for depression—they need to be combined with one-on-one treatment from a qualified therapist, healer, or guide

• The integration stage of psychedelic therapy is crucial for examining and contextualizing a psychedelic experience

• Psychedelic therapy for depression affects each client differently; it’s impacted by the dosage, substance, and type of treatment being given

• The most common (and most studied) psychedelics used to treat depression are psilocybin and ketamine

• Before embarking on psychedelic therapy for depression, take time to find a therapist who is right for you