Psilocybin for depression with Ashleigh Murphy-Beiner

My unofficial Vital Study Zine #11 with observations from Vital Psychedelic Training and recent happenings in the space

‘White Light’ from Paul Cocksedge Studio

“We have really explicit conversations about sex, about violence, about death and ego death…”

Plus of course, “Paranoia, wanting to go to the toilet, feeling like you're going to the toilet, and the physical bodily experiences,” says Ashley Murphy-Beiner, psychologist and guide at Imperial College’s landmark ‘PsiloDep 2’ trial, which sounds suitably like a Quatermass movie.

Ashleigh Murphy-Beiner is exactly the sort of impressive individual driving the psychedelic renaissance: a mediation coach and Peruvian ceremony facilitator alongside her studies at Imperial College London, she’s noted for her research on ayahuasca for treating depression too. She’s talking about preparing psychedelic novices for their first trip on synthetic psilocybin, the active ingredient in old-fashioned magic mushrooms. It’s used mostly due to stigma around LSD.

“We let them know we’re not going to judge them on anything weird… although they’re not going to do anything like that, because mainly they're worried it’ll really embarrass them or, or cause shame,” she continues, giving a window into life with depression.

Depression is a ‘global burden’. The main cause of disability and the number one reason for taking time off work affects a quarter of a billion people worldwide, and more in The West. One in six Brits are on anti-depressants, and US figures rose by up to 30% during the COVID-19 crisis. Doomongers will be pleased to know there are plenty more sad stats in this week’s ‘zine.

Imperial College psychologist, meditation coach and ayahuasca advocate Asheligh Murphy-Beiner

Can psychedelics cure long term depression where talk therapy and medications failed? Although arguably still spectacular in comparison to existing treatment, results are frankly not as good as those for psychedelic studies on treating trauma, addiction, and end-of-life crisis. That’s partly because depression mostly remains a mystery, with the widely-accepted ‘serotonin imbalance’ theory recently publicly debunked. Ashleigh calls the causes “biopsychosocial” meaning there are biological, psychological and social implications. Many patients have come crashing down to Earth when faced with the cruel reality of life in late capitalism. Preparation and integration are absolutely essential, say trial patient advocates Ian Roullier and Leone Schneider of advocacy group PsyPAN. Dr Rosalind Watts created a treatment model, Acceptance, Connection and Embodiment to cover the ground between secular dystopian life and the psychedelic experience. 

Results of psilocybin for depression trials so far though are certainly optimistic compared to market anti-depressants. A major advantage is that psychedelic treatment opens up the mind, rather than numbing out all feelings, like current anti-depressants are said to. Opportunity and relish can once more be a part of depressive’s mindset. Plus they can dump their daily regime of equally barely-understood serotonin pills with side-effects like a plummeting libido. 

This is one subject for which there is certainly no silver bullet. Here’s Ashleigh talking about ayahuasca, and the ACE therapy model used at the trials with Dr Ros, plus the ethics of the trials and therapy itself, and rounding up the trial results on the Chasing Consciousness podcast, all of which you can see on the New Psychonaut YouTube channel.

This week’s topics arranged along Vital’s core learning pillars are below.

Next issue: MAPS MDMA-AT program designers Michael and Annie Mithoefer.

Feed your head

Approach

Patients say psilocybin offers “experiencing everything” in contrast to the ennui of SSRIs

David Shrigley, ‘Magic’. Works from Lougher Contemporary

Depression is a problem. One is six Brits are prescribed drugs to counter it. But still nobody knows what it is, how it works, or how to cure it. 

This is in stark contrast to the popular narrative that ‘depression is caused by an imbalance of ‘“happiness chemical” serotonin in the brain’. The most popularly-prescribed anti-depressants ‘selective serotonin re-uptake inhibitors’ or SSRIs regulated it. Apparently. Like you might conclude by the name ‘selective’ and ‘serotonin’. Or by reading research in respected medical journal The Lancet, written by senior psychologists at Oxford and Yale; although the average depressive is more likely to get the mis-info off commercial content blogs from psychiatrists. 

SSRIs have some worrying side-effects. Like nasty poos, even worse sleep, plus most notoriously loss of libido – which is no good if your relationship is already on the rocks because of your depression. Or your redundancy, which is a major cause of depression but not taken into account by the medical sector. Plus, the ‘medical model’ actually makes patients feel more stigma around their depression than otherwise.

SSRI users report an ‘emotional numbness’ known medically as ‘SSRI-induced indifference’ with practical effects not dissimilar to depression itself. ‘Evidence indicates that a reduction in depressive symptoms may not be the single most important outcome to patients, but rather factors such as the ability to participate in everyday activities and return to work,’ says this British Medical Journal article from its 2020 Evidence Based Medicine special issue.

“It was like the light switch being turned on in a dark house… [my] concrete coat had come off”

But SSRIs do increase serotonin levels (like recreational ecstasy) although possibly reduce them long term (like recreational ecstasy). Plus – anecdotally – my close friends who are prescribed SSRIs do say “help take the edge off.” I wouldn’t want to go without my ADHD meds, which do make an enormous difference. But neither SSRIs nor my Amfexa go any way towards curing the conditions, only reducing symptoms.

A balls-out report from UCL published only this summer, made headlines by highlighting the gap between this narrative and reality. And we know what happens when anybody does that. (Like I’m fond of quoting, in the original version of The Emperor’s New Clothes the child who points out the emperor is naked is banished to the wilderness. Not made king instead by a grateful populace, which is a modern alteration). 

The status quo brought out its big guns. Rolling Stone, once the organ of the counter-culture, spread muck all over author Professor Joanna Moncrieff (of University College London, one of the most respected medical research centres in the world, while Rolling Stone is no longer respected as a pop music magazine, just saying) pointing out her membership of the Critical Psychiatry Network ‘Which aims to “[mount] a scientific challenge to claims about the nature and causes of mental disorder and the effects of psychiatric interventions.” Like RD Laing. Rolling Stone also drew attention to, and those of a sensitive disposition please stop reading now, her reticence for… vaccine mandates, as expressed in an open letter to the British Medical Journal from NHS workers that she signed. The real problem was that some of the shrill left’s enemies on the shrill right, like Fox News rabble-rouser Tucker Carlson, agreed with the paper. 

I’ll stop before I get depressed. The point is: psychedelic treatment for depression counters the ‘emotional numbness’ of the condition, on or off SSRIs.

In fact, the opposite happens. “It was like the light switch being turned on in a dark house, the concrete coat had come off,” said one PsiloDep Trial participant according to the vital presentation by Ashleigh Murphy-Beiner, a psychologist on the trials and facilitator of its dedicated ongoing integration circle. Another trial patient said: “I allow myself to experience everything, even if it's sadness. Now I know how to deal with my feelings rather than rather than repress them.”

Why? “Oceanic boundlessness” AKA increased connectivity, the mystical trip accompanied by profound meaning, “going beyond the self”, and resolution of emotions (it’s usually shame according to Murphy-Beiner) by mini-spiritual emergency-cum-challenging experience are the top signifiers. This is before we discuss the default mode network, neuroplasticity, or neurogenesis. The ‘inner healer’ or ‘homeostasis principle’ to use its new scientific name dispenses these as required.

If depression can be cured by restoring powerful human instincts like connection and meaning, is it caused by a lack of them? Former narrative cheerleader yet admittedly rather good writer Johann Hari made his comeback from exile with Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions (here’s the TED Talk). Therein he claimed, backed up by doctors and patients, that depression is mostly caused by our bureaucratic dystopia: “the depression of many of my friends, even those in fancy jobs – who spend most of their waking hours feeling controlled and unappreciated – started to look not like a problem with their brains, but a problem with their environments,” he writes. And well done him. Although depression is not my area, and I’m far from qualified  as a pro, it’s very tempting to agree.

But if the problem isn’t brain chemistry but civilisation itself, isn’t sending depressives back out after psychedelic treatment into the same desperate non-life that made them so desperate in the first place just going to make them depressed again? At this point one can only make a fart joke, and nobody can get away with that better than proper brain box Dr Chris Timmerman, who tweeted this new report Understanding the effects of serotonin in the brain through its role in the gastrointestinal tract because it describes psychedelics as ‘cognitive laxatives’.

Freud is dead

Therapy

‘ACE’ is a new therapeutic approach devised by Drs Ros and Richards, with inspo from Stan Grof

‘Icosahedron’ by Anthony James from Unit London

Freud is Dead. And we have killed him.

My loose understanding of the gossip in the ivory towers of psychology is that Freudian psychoanalysis maintains an iron grip on legitimacy. 

This seems to have crumbled almost overnight like empires do. Psychoanalysis’ spiritual home The Tavistock Clinic has been rocked by scandal. And Imperial College didn’t use psychoanalysis as such in PsiloDep 2. Because it’s only been an initial part of psychedelic therapy as documented by Stanislav Grof. 

Indeed Grof’s former colleague, TV’s Dr Bill Richards who’s still kicking it himself at John Hopkins (and on Netflix) advised on Acceptance, Connection and Embodiment (ACE) therapy, the model applied by Imperial College in its landmark trials testing psilocybin against a market SSRI anti-depressant.

“The trials followed a standard psychedelic psychedelic therapy format: preparation, the high dose, and then integration alongside an Acceptance and Commitment Therapy [ACT] adapted model,” relays Ashleigh. 

ACT is a kind-of proactive mindfulness to encourage ‘psychological flexibility’ an adaptive mindset resilient to stressful events. The psychological flexibility model or PFM is referred to in the title of Dr Ros’ stealth bomber of a paper, The use of the psychological flexibility model to support psychedelic assisted therapy which points out the approach is in use in trials at NYU and Yale, too.

And guess what? Everyone prefers it to being told stuff in the past they were doing their best to forget has ruined both their present and future, so it’s going to cost them £200 a week. Plus, ACT’s explanatory infographic is a freaking icosahedron, the sacred geometric form that’s like a 20-sided Dungeons & Dragons dice.

Acceptance and commitment therapy’s ‘hexaflex’ graph

ACT is empirically proven in all of these tests we’re beginning to think will be endless, and approved by EG the NHS.

“It's a very complex experience that people are going through. So we're using lots of different influences”

But because ACT’s not Freudian analysis, it gets crap from the old guard. Seems like nobody cares what they think any more, though, because their way hasn’t worked, except for them. And they gave kids gender reassignment.

That’s not all. “As clinicians, we were drawing on a lot of different psychological theories to support people because it's a very complex experience that people are going through. So we're using lots of different influences,” says Ashleigh.

ACE is Dr Rosalind ‘Ros’ Watts’ remix of ACT. It even has P-ACE (for preparation) and I-ACE (for integration). It includes aspects of polyvagal theory, lived experience and non-dual thinking to name but two.

And there’s even deferral to the inner healer or ‘homeostatic instinct’ to give it its new scientific name in ACE. Metaphors employed for the healing process include ‘diving for pearls’ illustrated by specially prepared visualisers. Plus, let’s not forget, a new ambient John Hopkins’ LP bespoke-made for the trials.

“We're asking people to open up to emotional pain at a pace they may never have experienced”

Stan Grof says psychoanalysis was useful for the earliest stages of treating in-patients, but soon gave way to even more fundamental realms of the psyche – and body – that required knowledge not only of cutting-edge thinkers.

“I wonder how possible it is to grasp”

He names William Reich for perinatal matrix III when the body spasms start (not seen many of those on the course yet) and Jung in his Red Book days, but the ‘transpersonal’ (IE weird), plus theology, literature and philosophy too.

“We invite them to tap into a sense that there may be wisdom and guidance to be learned from emotional pain, and difficult experiences in life,” says Ashleigh. There’s practical considerations that don’t come up in that room your therapist has in Finsbury Park with the knitted throws and knackered dreamcatcher on the ceiling.

“We're asking people to open up to emotional pain, to an extent, and at a pace they may never have experienced before,” says Ashleigh, “I wonder how possible it is to grasp. We wrangled over what we tell people beforehand, so they can make an ethical and informed decision about taking part in a treatment like this.”

‘Must we ourselves become gods simply to appear worthy of it?’ opined Nietzsche upon his most famous line, ‘God is dead.’ The firebrand philosopher meant a sense of shared, guiding ideology rather than the monotheistic biblical concept of God.

He was mostly right, because us stupid normies did come up with a new God – science. The bits of that which considered our relationships to each other, so the only ones that counted, originated from Sigmund Freud, and Richard Dawkins via Charles Darwin.

The new anti-religion preached a mirror image of historical spirituality: humans were essentially chimpanzees, except cleverer, so even more unpleasant to each other.

Arts, achievement, compassion, shared laughter… all just tactics in the game to get ahead. Beneath it all we were just throwing our turds at each other, and pretending not to enjoy getting screwed by the alpha male.

Who hasn’t been seduced by this perverse science at some point? Especially on cocaine, like Sigmund Freud was half the time. 

Eventually though it gets… depressing.

A Love Unconditional

Space

Wanted: open hearts to hold space over borderline personality disorder

From ‘Dappled Light’ by Rana Begum showing till September 2022 at Ptizhanger Manor and Gallery

If there’s a subject in mental health that’s lively as psychedelics, it’s borderline personality disorder or BPD. Things got even stormier when the two got together. 

Or rather, didn’t. Psychedelic hierophant, Imperial College’s Dr Robin Carharrt Harris ruled personality disorder sufferers out of psilocybin trials in the earliest stages of reporting. Interpersonal relationship issues might prevent these voyagers achieving a necessarily productive therapeutic relationship with their guides, hindering ‘letting go’ to the experience. 

Asked about respite for personality disorder sufferers in the Vital Q&A about her work at Imperial College with psilocybin, Ashleigh declares she certainly hopes so. She highlights a courageous academic appeal by Toronto’s Rick Zeifman, and Anne Wagner of the city’s Remedy clinic, on the subject.

The paper notes how clinically-proven effects of psychedelics, like increased mindfulness, a clearer sense of identity and behaviour, healing addictions and a reduction in suicidal tendencies line up neatly with BPD’s issues. The impressive doc proposes possible treatment angles including dialectal behaviour therapy (DBT) a socratic method invented for BPD, plus transference-based therapy (big up the space holders there). It also cites a bunch of examples where BPD symptoms were markedly improved by psychedelic treatment: MDMA looks like the front-runner for medical modality, but Swiss researchers say many came to them seeking LSD treatment for narcissistic personality disorder (NPD) in the late 80s and 90s with no major reported issues. Say what you like about them, but anyone turning up for LSD therapy saying “I’m a massive abusive narcissist, please help me” has done their shadow work. Moreover, just recently doctors in Basel claimed success when treating a complex personality disorder with LSD and MDMA. “This decision was not taken lightly,” reads the abstract.

There’s currently no medication for BPD but sufferers can be prescribed for co-morbidities. Savage psychological wounds, acute trauma, prompt intense abandonment fear in BPD sufferers, possibly leading to volatile and self-sabotaging behaviour. In a thoughtful article on BPD from multiple award-winning UK Cosmopolitan mag, expert Dr Dawn Starley levels it all out by reminding smartphone shrinks that by no means all personality disorder sufferers are disruptive. Moreover, any perceived cruelty, mind games or violence come from a place of terror rather than sadism. Words like ‘guilty’ and ‘innocent’ are perhaps not nuanced enough (sync!) to describe a BPD court defendant (certainly a diagnosed one). And neither is, for example, ‘manipulation’, says BPD specialist Dr Susan Heitler.

Equally, "[Partners, friends and family members] can experience feeling abused or gaslighted themselves. The negative experience for some is substantial,” she says. It’s natural to want to help a loved one in trouble. Selfishly wishing your lover would just get better is forgivable too. But the two of you are often better served by staying apart. This is non-dual acceptance at its starkest.

Results Based

Medical

Does psilocybin therapy work, or not?

Kirsten Liu Wong, ‘How Fast the Shadows Fall’

Does psilocybin therapy soothe depression? The short answer is yes.

But don’t go getting all ‘salvation fantasy’ on me now.

Kick ass John Hopkins studies out earlier in 2022 claimed more than half of test subjects suffering from major depressive disorder were in remission (statistically cured) after treatment and a year later, after eight hours of prep (with Bill Richards, mind) and two doses, with five follow-up appointments. Which is… mind-blowing.

Imperial’s comparison to SSRI escitalopram ‘PsiloDep 2’ ran into some IRL type stuff when the scale it used turned out to give mediocre – well, equal – results. Other scales fared far better. But symptoms returned within three to six months. Is it fair to say that “the miracle cure thing ain’t gonna stick” as Rick ‘The Strass’ Strassman laid down in his own Vital lecture? 

“Some will want longer term therapy, to understand or change things in a way that others may not”

Several patients went back to SSRIs. “For some people, psilocybin was very powerful,” says Vital lecturer Ashleigh Murphy-Beiner, who acted as a guide on the trials, “They’re quite okay with saying ‘that's enough for now’. Others lived with the symptoms of depression in a new way, probably the majority, actually, did. The psilocybin brought relief.”

NYU trial subject Court Wing defended PsiloDep 2 on Psychedelics Today, saying he “received incredible benefits – my depression of five years went completely into remission and has remained there.”

Depression is one of humanity’s worst problems, barely understood. It’s a bit consumerist of us to think somebody’s suddenly sorted it, in such a romantic fashion. For now we can only defer to the inner healer, wish godspeed to the guides, researchers, and patients, then get our Forest Passage on.

“The longer term option will be costly”

From the sharp end, Ashleigh says: “I hope all options are available to people, to work very differently with the experiences that they've had in life. Some will want longer term therapy and really get to the roots, understand or change things in a way that others people may not.

A shorter treatment or less intensive psilocybin therapy might be sufficient for them. I'm worried that the longer term option will only be available privately [not via the UK National Health Service], because it will be costly of treatment. And I'd really like the longer term treatment to be available at an affordable cost.”

Thought leaders like Dr Ros evoke 12-step-esque community circles. But, Ashleigh observes, “There’ll be a push to making shorter term treatments like we have in traditional talking therapies already now, because of budgets, and funding. The people that want to resolve aspects of their mental health experiences are disadvantaged by that.”

IRL is a bummer

Integration

Returning to everyday existence brings depression patients right back down

Nick Cave ‘Soundsuit’ at In the Black Fantastic Hayward Gallery till September 18

Psychedelic integration isn’t the ideal topic for water cooler chat with your line manager on a Monday morning.

Meditation, vegetarian diets, forest bathing and volunteering, all inspired by the cosmic visions on a magic mushroom trip. It all sounds suspiciously like hippy stuff, guaranteed to create even more disconnect between you, your news cycle-bedevilled colleagues, wine-guzzling borderline alcoholic partner, and rigid family. 

“Most of the people I’ve worked with have had a disappointing crash. Integration is partly about managing that disappointment. You can’t separate the drug from the therapy – and the community you go back to after a session,” said Dr Ros, AKA PsiloDep 2 clinical lead Dr Rosalind Watts at Psych Symposium’s integration panel earlier this year also featuring Ian Roullier, co-founder of trial subject support and campaigning group PsyPAN. 

“My colleagues think it’s extreme… whacky”

PsiloDep 2 trial subjects were given 35 to 40 hours of therapy, which is more than I’ve had in my life. But costs, for a start, kept post-experience integration services light. The trial subjects’ woe prompted Dr Ros to manifest ACER, her integration platform that “involves getting into nature and a closely bonded support group, that’s saved all of us during the pandemic,” says Roullier. 

Former international-level professional sportsman and Iboga advocate Rory Lamont was on the panel too. played rugby, a traditional contact sport that’s notorious for its conservative values. He only had the informal WhatsApp group set up by the folks on his retreat for succour. 

“I went through some difficult challenges post experience,” he told the panel, “The connection with the medicine is just the start: we want to embody the insights but if we’re not being met by our family and friends it’s isolating and can bring back the loneliness, and the depression.”

The new approaches his insights compelled him to take were nightmarishly distant from his existing lifestyle. “These medicines get to the root of our suffering, the trauma and disconnection from family, friends, society,” he says, “Instead we get a connection to mother nature and community, that brings about the profound healing.” After the experience is over though it’s straight back to ‘real life’, such as it is. Most of my colleagues think it’s extreme, whacky,” says Lamont.

“The worst part is when you feel the effect fading, and you can’t access it any more”

PsyPAN co-founder Leonie Schneider says psilocybin was “the start of a long healing process which I’m very grateful for, but it’s quite a thing to be involved in. I didn’t get the ego death, the mystical experience, and came out slightly disappointed. But I got some other, incredible things that we wren’t what I expected.” Schneider may not have been able to get those benefits without experienced integration support. 

Ian Roulllier also took part in Compass’ psilocybin trials, where “my depression came back as soon as the drug wore off. But there was a strong focus on integration with a group centred on Maudsley Hospital [where Compass and the UK NHS public healthcare provider are building a dedicated centre in woodlands of New Bethlehem AKA ‘Bedlam’ asylum].” 

The drugs are catalysts and require the integration to have long-term tangible effects, says Roullier. Trial subjects can’t breeze into Imperial for another heroic dose top-up, “The worst part is when you feel the effect fading, and you can’t access it any more.” 

Although there were moments of oceanic boundlessness. 

“The best is every now and then I check in, and just go out on the grass, and feel it under my feet,” muses Roullier, movingly and sincerely, “But I did get attacked by a swarm of wasps once. I thought, am I still tripping?”