Demystifying Psychedelic-Assisted Therapies With Andrew Penn, MS, PMHNP

Amid promising study results, psychedelics are currently a popular topic of discussion within the field of mental healthcare, with many speculating about its therapeutic potential and implications for psychiatric practice.

On Monday, September 19, at the 35th Annual Psych Congress in New Orleans, meeting Co-Chair Andrew D. Penn, MS, PMHNP, associate clinical professor, psychiatric clinical nurse specialist, University of California, San Francisco, presented his session entitled, “Psychedelic-assisted Psychotherapy: How is it Different From What We Already Do?” before an audience of mental healthcare professionals, including doctors, nurse practitioners, care advocates, and non-profit representatives.

Ahead of his presentation, Penn spoke with Psych Congress Network about what exactly psychedelic-assisted psychotherapy is, how its potential differs from traditional approaches to mental healthcare, and his musings on how psychedelics may change the field in the near future.

Stay tuned for Part 2 of this exciting expert Q&A! For more insights direct from the session rooms, check out the Psych Congress newsroom here.

Brionna Mendoza, Associate Digital Editor, Psych Congress Network: What aspects are different in psychedelic-assisted psychotherapy from a traditional approach that clinicians need to be aware of? 

Andrew Penn, MS, PMHNP: Psychedelic assisted therapies (PAT) utilize a medication to catalyze a therapeutic relationship. They are not stand-alone or take-home therapies, so they’re different than existing treatments like SSRI’s. PAT tends to be more time-limited and intensive than traditional psychopharmacology or psychotherapy. Psychedelics tend to discourage experiential avoidance, which is different than antidepressants that our patients sometimes describe as “numbing” or “flattening” of emotions. As such, emotions can be more intensified under the drug, giving the patient and therapist an opportunity to address important psychological issues in integration psychotherapy. 

Mendoza, PCN:  What can psychedelic-assisted psychotherapy accomplish that a more traditional approach cannot? 

Penn: PAT appears to be a novel approach to addressing PTSD, addiction, depression, and existential distress at end of life.

With regards to palliative care, psychopharmacology has little to offer, as the short duration between diagnosis and death may be too brief for antidepressants to offer much help, and the kind of distress experienced by the dying may be qualitatively different than those suffering with major depression. Additionally, PTSD has only two FDA approved medications - paroxetine and sertraline, with only low to moderate effect sizes. Given the potential mortality of PTSD (especially in our veteran population), there is a significant need for new approaches. A similar problem exists with addiction medicine. While there are several treatments that offer promise (buprenorphine, naltrexone, and acamprosate are all FDA approved), there remain significant gaps, with several substance use disorders (e.g. methamphetamine, cannabis) left without any approved pharmacotherapeutic treatments. PAT may offer an alternative route to combined psychopharmacology/psychotherapy that extant treatments do not address.

Finally, while we have far more treatments for depression, many patients remain refractory to these treatments, and/or dislike the side effects of chronic antidepressant treatment. The episodic nature of PAT allows for medication-free periods following treatment, and may be at least equivalent, if not superior, to existing treatments. 

Mendoza, PCN: How do you think the psychedelic-assisted psychotherapy will affect the mental health field over the next 10 years? 

Penn: I think psychedelic therapies will be part of an increasing trend towards episodic treatments in mental health, especially for mood and anxiety disorders. Rather than using a treatment chronically, as we have done with SSRI’s, treatments will be used for a shorter duration and then stopped. Some of these treatments will be psychedelics, others will use other mechanisms of action. The challenge will be to learn how to maintain the benefits for as long as possible, and when to re-deploy another round of treatments when the patient begins to relapse. 
 

Mendoza, PCN: If clinicians are interested in learning how to apply this therapy in their own practices, where should they begin? 

Penn: I’d encourage them to check out SANA Symposium, a virtual conference focusing on PAT (full disclosure, I’m the co-chair). Additionally, numerous other conferences are appearing each year, dedicated to the topic of PAT. 

Andrew Penn, MS, PMHNP, was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. He has completed extensive training in Psychedelic Assisted Psychotherapy at the California Institute for Integral Studies and has published in the American Journal of Nursing, Bipolar Disorders, and Frontiers in Psychiatry. He was a study therapist on the MAPS-sponsored Phase 3 study of MDMA assisted psychotherapy for PTSD and is currently a co-investigator on the Usona-sponsored phase 2 study of psilocybin facilitated therapy or major depression.

Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing where he teaches psychopharmacology and is an Attending Nurse Practitioner at the San Francisco Veterans Administration with the joint UCSF/SFVA NP residency program. He has expertise in psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He has published on the risks and benefits of cannabinoids in psychiatric treatment.

As a steering committee member for Psych Congress, he has been invited to present internationally on improving medication adherence, cannabis pharmacology, psychedelic assisted psychotherapy, grief psychotherapy, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice. In 2021, he was awarded the Distinction in Teaching Award by the UCSF Academic Senate.