Psychedelics: A Unique Psychiatric Paradigm
In his Psych Congress Elevate 2023 session "Expanding Treatment Options Through Psychedelics—What You Need to Know," David S. Mathai, MD, postdoctoral research fellow, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, took a deep dive into how clinicians can educate their patients about psychedelics and help them make informed decisions about their use.
In this Q&A, Dr Mathai gave Psych Congress Network a behind-the-scenes look into his session, the history of psychedelics, and why psychedelics represent a "unique psychiatric paradigm."
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Evi Arthur, Associate Digital Editor, Psych Congress Network: What were the main takeaways from your session “Expanding Treatment Options through Psychedelics - What You Need to Know”?
David S. Mathai, MD: There is a great deal of promising research emerging on psychedelic therapies. We are in a way catching up on lost time, because of decades of stigma and poorly informed legislation. As exciting as these therapies are for mental health, we still have much to learn in terms of their risks, optimal uses, and challenges for existing healthcare infrastructures.
Arthur, PCN: What are the primary challenges for clinicians working with patients through psychedelic-assisted therapy?
Dr Mathai: Clinicians will need to learn a whole new set of psychological competencies for working with psychedelic-assisted therapies. Medical training fails to equip providers to adequately support the challenging mental and emotional experiences that individuals can have with psychedelics. However, this kind of support is critical. It starts from the very beginning, preparing individuals for a psychedelic intervention, and extends well past drug administration into appropriate integration and follow-up.
Arthur, PCN: Why did you feel it was important to examine the history of psychedelics?
Dr Mathai: A valuable part of medical education is understanding where we come from in our respective fields, and understanding how this knowledge is still relevant today. Looking at the history of psychedelics, we can better understand the origins of stigma around these interventions and the way it persists in both clinical and non-clinical communities. Addressing this stigma is essential for us to be able to move forward with widespread access to psychedelic therapies.
Arthur, PCN: What are the practical implications for clinicians discussed in your session?
Dr Mathai: This session is just a starting point, but I hope it leaves clinicians with an understanding of how much these therapies diverge from existing pharmacotherapies and how additional training will be necessary to learn the various competencies that are required for this work. Psychedelics are not yet broadly approved, but there may be new opportunities to get involved in this work within the next several years.
Arthur, PCN: In your session, you mention that psychedelics represent “a unique psychiatric paradigm.” Can you elaborate on what you mean by that?
Dr Mathai: Psychedelic-assisted therapy represents a profound and deliberate synergy of pharmacotherapy and psychotherapy. By various measures, it tracks with the best of what we have to offer in psychiatric care. We have compelling evidence thus far that the benefits of this approach extend beyond symptom reduction—our usual benchmark—and get at much deeper aspects of personal identity and wellbeing. Time will tell if this is the psychiatric equivalent of the "disease-modifying therapies" we have seen in other branches of medicine. In any case, this kind of intervention can be tremendously meaningful for patients who are suffering and for clinicians who are involved with their care.
Arthur, PCN: What misconceptions on this topic would you like to clear up?
Dr Mathai: Even though these drugs have risks, it is worth noting that the harms of psychedelics have often been grossly exaggerated for various reasons over time. Based on actual scientific data, psychedelics have a much larger margin for safety than many commonly abused substances, including alcohol and tobacco, which are of course legal and widely available. The use of psychedelics in carefully supported research settings further protects patients against risks that might be seen with use in more recreational contexts.
David Mathai, MD, completed his medical training and psychiatry residency at Baylor College of Medicine in Houston, Texas, before joining the department of psychiatry and behavioral sciences at The Johns Hopkins University School of Medicine. He is a clinician-investigator with a background in studying behavioral models of addiction and cognitive impairment, the neuropsychiatric effects of cannabis, and the antidepressant properties of ketamine. His current postdoctoral fellowship consists of roles as a scientific collaborator, study physician, and session therapist for psilocybin-assisted interventions. His work emphasizes applications of psychedelic medicine within safe, humanistic, and psychologically-oriented frameworks. He is also interested in contextual factors shaping drug response, the judicious use of medication, and serving as a liaison between existing clinical and academic communities.
