How Psychedelics Can Aid Therapy, with Dr. Will Siu
Several key psychedelics—MDMA, psilocybin, and ketamine—are being actively studied as therapeutic aids in conditions like depression and PTSD. Others, like marijuana and ayahuasca, also show promise. In this episode, Dr. Will Siu and I discuss psychedelics as healing agents. We cover their effects, the latest research, important points to be aware of, and their potential future in mental health care and beyond.
Dr. Michael Ruscio, DC: Hi, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today I’m here with Dr. Will Siu, and we’re going to be talking about psychedelics and how psychedelics might actually be able to help with healing. And how, more specifically, they may be able to help with gut healing. Will, welcome to the show. Very excited to expand upon this topic.
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Dr. R’s Fast Facts Summary
*The following statements are not medical recommendations. Psychedelics are powerful agents and should be taken under the guidance of an experienced practitioner.
- Nonspecific amplifiers of the unconscious
- MDMA (active ingredient in ecstasy)
- In touch with memories and emotions related to trauma
- Stays on the plane of reality
- Psilocybin (mushrooms)
- Not on the plane of reality
- Depending on the dose can be used as a psychedelic agent
- Intense visions
- Not on the plane of reality
- Stays on the plane of reality
- MDMA for PTSD
- Ketamine for depression
- Psilocybin for treatment resistant depressive disorder
- Preparation and Integration work before and after are very important
- 90% of the long-term benefit of psychedelic therapy is in the sober weeks after, when patients do the integration work
- Results are usually achieved in a short term application with no real need to continue the therapy
- Soltara – trusted Ayahuasca center
- If you feel called to it, go with your gut
Who should be extra cautious with using psychedelics
- Psychosis (schizophrenia)
- Personality disorders
Where to learn more:
- Get help using this information to become healthier.
- Get your personalized plan for optimizing your gut health with my new book.
- Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.
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Dr. Will Siu: Yeah, thanks for having me. It’s an honor. I’m excited to just talk about psychedelics. And not only what’s been going on, but yes, I like that you mentioned gut health because I think the potential for psychedelics is much, much bigger. We’re just beginning to understand what that’s going to be.
DrMR: Great. I want to get into your background in just a second. But before we do, in case anyone’s heard the term psychedelics and they have a vague, fuzzy understanding of what that is, can you give us a general definition?
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What Are Psychedelics?
DrWS: Yeah. It’s a great question, honestly. There are a lot of terms that get thrown out there… psychedelic, entheogen. Within the community, there are people that feel very strongly about what the term actually means. I like to keep things simple, generally.
So there’s a doctor who’s kind of the grandfather of psychedelic medicine named Stanislav Grof. He’s still alive, but is in his 80s. His definition is my favorite. He calls psychedelics nonspecific amplifiers of the unconscious process. I like that term, because it’s really something that honors that we don’t really know what’s going on. It’s not something specific to the medicine. We take these different medicines, some of them being natural, some of them being synthetic (meaning, made in the lab). And they unfold something that’s already within us, that’s already available to us. That’s what I like to think of these as.
Stan is also well-known because he developed something, holotropic breathwork, which is a way of essentially working in a sober state, or a relatively sober state, without any compounds. He’s found, really, over the decades of work with this, that people can reach the exact same places—have intense visions and access to the unconscious memories that they haven’t had—through a process of breathing. So that’s the way I like to think of psychedelics. It’s just ways of accessing our unconscious.
DrMR: There does seem to be a tie-in with psychedelics to facilitating what may otherwise take someone quite a while to get to—how we define “quite a while,” varies, I think—through something like meditation or breathwork or therapy. And that’s what excites me the most about this, that we might be able to get someone to a healed state (using a vague term) more quickly than using other methods. I think someone (this is a rough paraphrase here) said something along the lines of, “You can do five years of psychotherapy in one ayahuasca ceremony.” I don’t know if that’s literally true, but it seems plausible. That’s what I’m excited to expand upon.
Before we jump into some of those details, tell us a little bit about your background and how you got here, because obviously there’s no specialization. You don’t specialize into psychedelics! So I’m curious about the road that got you here, and tell us a little bit about your training background also.
DrWS: Sure, absolutely. I grew up in Southern California. I went to college out there at UC Irvine, studied neurobiology. At that time, I wanted to be a medical researcher working in a laboratory. I initially went to medical school at UCLA. Midway through, I wanted to do more research, so I went to the NIH for a year, which is in Bethesda, Maryland. It’s kind of the government research labs. Spent a year there, doing research in inflammation of the eye. And then found that it was really something that I loved to learn about.
So then I decided to do a PhD, took a further break from medical school. I went to Oxford in England and then did a PhD in pathology. Essentially, it’s the British department out there at Oxford for immunology also. So I ended up completing a PhD in immunology, then returned to finish medical school at UCLA.
At that time, I still wanted to become a surgeon, actually. To make a long story short, I was in my second to last rotation, which was psychiatry, having never taken a psychology course. I did all this prep work to become an ophthalmologist, do the right research, get to know the right people, and get the right letters of rec. And then ended up, within two weeks, loving psychiatry and people talking about the unconscious. I remember seeing this young woman, a little girl who was really struggling. The professor I was working with was telling me about how, “Oh, it’s the unconscious process, and she’s working on all of these things between her and traumas of childhood.” And I was just fascinated. And so, within two weeks, it was a tough process, but I’m like, forget surgery. I’m going to become a psychiatrist.
Then I ended up going to Harvard in Boston to do my psychiatry residency. While I was there, I was in this thing called the research track. They funneled me into becoming a researcher. Then within a year and a half of being at Harvard, I was realizing that there wasn’t really anything I was interested in, that the science behind really understanding human behavior—even though there’s tons of publications and money being thrown into it—was not that well-developed to where it was actually making a difference for people, in terms of actual, do people get better from anxiety, depression, etc? One day, I remember distinctly, we had a lecture on the treatment of depression, and it was told to us at the start: “This is the best evidence we have for treating a mental illness.” And I got really excited.
The lecturer that morning was telling us about SSRIs for depression. This multistage, double-blind placebo-controlled trial showed about 30% of people don’t have depression anymore after. And that’s compared to placebo, which is about 19%. I remember my heart really sunk because I was like, I’ve spent 13 years of school after high school preparing to do this whole medical career and become a psychiatrist for 10% better than placebo? I went into a deep depression, almost dropped out really. So actually I then dove into therapy and tried medications, and nothing worked for me.
I had actually been raised a Jehovah’s witness, even though I had left the church in my late teens. But I’d never thought about taking drugs. I was like 33, 34 years old. Never tried drugs, really. I had smoked pot a handful of times. I was just at a loss of what to do. I won’t tell the full story, but essentially, at the same time, I had someone who introduced me to psychedelics, and told me about research that had been done in the fifties and sixties, which was very promising. And then found out that research was being done again on it, and that it linked very well with psychotherapy, which I had been getting benefit from. It was just very, very slow, as you had mentioned.
So that was my entry into it. Then I met Rick Doblin who runs MAPS, who’s really been heading this for 30 years. He happened to live two blocks from the hospital I was working in. Then the rest is history. I got involved in the training and now here we are.
Use of Psychedelics in Mental Health
DrMR: Wow, the way you tell that story is pretty compelling, especially when you consider that the medical system puts so much emphasis on the drug therapies. And I’m assuming there are other things that are emphasized like certain facets of talk therapy. But when it comes to another treatment outside of your different iterations of talk therapy, the drugs are definitely lackluster. I would strongly agree with you there.
I think part of that challenge is, so much is focusing on what is probably a non-curative model. And I look at how many patients we have with various gut maladies that manifest as depression, brain fog, anxiety. We’re seeing the published literature starting to show this now. There have been two meta-analyses published showing that probiotics can lead to an appreciable improvement in mood, either in depression or anxiety, depending on the studies that you’re looking at. That’s just one example of how powerful the gut can be to the brain.
It’s something I suffered through myself, when I had an intestinal infection and I went from being super happy-go-lucky to all of a sudden feeling depressed. That little guy in your head who monitors your thoughts is saying, “What the heck is this? Why are you feeling depressed?” I didn’t know it, but it’s because there was all this inflammation in my gut that was eventually leading to depressive thoughts in the brain. So I’m right there with you. I see so much more room for improvement.
I came across a study, I believe, with ecstasy, showing fairly remarkable results in post-traumatic stress disorder. That was the first study I saw that opened my eyes to, “Wow, for these people who are having a hard time with drug therapy, with talk therapy, and not able to get back to a normal life, this thing that I was formerly thinking was reserved for going to a rave or something like that was actually able to get them out of the lurch there.” I’m assuming you’ve seen that study?
DrMR: Now, I just want to get your thoughts on what the psychedelics are bringing to that community. As you alluded to a moment ago, the currently available therapies are kind of lackluster.
DrWS: Sure, I’m glad you pointed out MDMA. That was really the second wave of research led by Rick Doblin. I think it was the early eighties when he founded MAPS, which is the big nonprofit that has been funding and administering the MDMA research. On the numbers for MDMA, I think the cumulative data from the phase one and two trials are something like 53% of people no longer have PTSD after three months. And these actually are not just PTSD patients, they’re treatment-resistant PTSDs, which means they’ve had a severe form of PTSD that has been really resistant to treatment with the standard protocols. So to have over half who, after only a four-month treatment, do not require ongoing medications was really remarkable.
That actually led to the FDA designating MDMA a breakthrough therapy for PTSD in 2017. And breakthrough therapy status by the FDA means it’s given a fast track through the process of the phase three trials and becoming a prescribable pharmaceutical. That’s significant, because it’s the first time in history a drug has been given the breakthrough therapy status for a primary psychiatric illness. It has never happened before that. So, this substance that the DEA and the FDA would call a schedule one, meaning it’s highly addictive and it shows no medical benefit—as you were saying, most of it’s been associated with raves and abuse—was actually shown to be better than anything that we’ve ever had for a psychiatric illness.
And then about a year later… Last year, psilocybin, which is magic mushrooms, was given the same breakthrough therapy designation for treating depression. So there’s a lot of excitement around it. And it’s very much going to change the paradigm of how we even think of mental illness.
Caveats & Barriers in Use of Psychedelics
I think academia is very slow to embrace psychedelics, in many ways, because it’s a threat to how we’ve been doing business. Old psychiatrists, like back in the early 20th century (Freud in the 1900s), or late 1800s and early 1900s, were doing psychotherapy. That’s not really a part of the majority of psychiatric residencies at this point. Really, psychiatrists are put in a position of prescribing drugs and psychologists are doing the therapy.
So that’s a major shift. It’s also not just a medication therapy. It’s medication plus psychotherapy. And that’s incredibly important to emphasize. Earlier you caught my ear when you said, five years of therapy from one ayahuasca experience. The statement in and of itself I would say is inaccurate. Only because it doesn’t honor the preparation and what we call integration, so the therapy work before a psychedelic experience and the therapy after. There are no statistics, but I’d like to throw out a number like 90% of the long-term benefit of psychedelic therapy is in the sober weeks and months after, where one does the integration work.
Can someone feel like they’ve done five years of therapy after an ayahuasca experience? Absolutely. I would actually say even more. It could be more like 10 or 20 or 30. But those that maintain it are much, much less. So that’s one of the things that we’re grappling with within the psychedelic therapy community right now: how do we emphasize to people that this is important to keep working on?
DrMR: I think that makes complete sense, that this should not be looked at as something that would be a stand-alone therapy, but it would be part of a larger overall process. I think that’s just incredibly well said, and definitely worth underscoring. This shouldn’t be something that one finds from some sort of sketchy website—ayahuasca or psilocybin—and decided just to do it on their own. Of course this should be used as part of a greater clinical process. But it’s just so exciting that we have these tools, and they’re starting to make some inroads. And they’re probably uphill inroads.
I can understand some of the social taboos surrounding them, and why medicine would be even more circumspect than they normally are. But the evidence that you’ve cited (and I definitely want to come back to more of the evidence in a moment) makes it so blaringly obvious that it’s doing something therapeutically beneficial, and we can no longer really turn a blind eye to it.
DrWS: Yeah, absolutely. It’s interesting because we actually had a meeting, a gathering, this week of some publicists, researchers, thought leaders, and lawyers on psychedelics. And one thing it’s also important for me to say—and that I often say when I’m speaking at a podcast or a conference or something—is that I actually don’t think psychedelics need to remain within medicine. That’s not a message I want to send.
I do think there’s such a thing as responsible, safe use of psychedelics with people on their own. I just think it’s important to do that in a safe, supported environment, and to do some sort of integration to make sure that one can maintain the benefit in some people’s lives. That happens to be popping up in our culture right now as psychedelics through psychotherapy, within the Western medicine construct. But I don’t think long-term that it needs to be limited just to that.
As a field we’re still developing. And I think most therapists, whether psychologists or psychiatrists, don’t have the understanding of how to work with psychedelics. This is new. For a lot of us in the mental health profession, just taking psychedelics in and of themselves is new, right? These are illegal. So how can practitioners go out and talk about it or train each other to work with psychedelics, when if we admit to any kind of stuff publicly… there are always things like, is a medical board listening? Would they take away our licenses?
That’s something that I’m very careful about. I haven’t said anything about taking psychedelics myself in an illegal context. And it’s something that the field is grappling with. Again, a lot of these are plant-based like marijuana. We’re talking about things like San Pedro cactus, peyote cactus, ayahuasca. These have been safely used in an indigenous setting for thousands of years. So I think it’s just going to be important to see how we unfold this in a safe manner.
Rick Doblin from MAPS always says, medicalization leads to legalization, and that’s definitely true for marijuana. We’re at a very early time right now. But that was really just to emphasize that long-term, I think that people should be able to explore their consciousness safely with these medicines.
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And that’s what seems to be happening in some of these. One area that I know is popping up would be these ayahuasca clinics, if you will, that are not located in the US, where one will work with an actual shaman. They do have medical staff there, but they seem to do this as part of a larger overarching process. I believe you go away for about a week in most cases. Just like you alluded to, the traditional shamanistic doctor who has a lot of experience using ayahuasca is the one administering and overseeing. So certainly, I think not everything needs to be confined to the medical system.
And yes, it’s insightful that you say medicalization leads to legalization. I certainly could see some of these following that same trajectory.
Top 5 Psychedelics to Watch in Medicine
Speaking of these different agents, what are the most common ones that you think people should be aware of? People hear ecstasy or they hear ayahuasca. Is there a top five that you think are the best viable candidates?
DrWS: I think that’s a great question. The thing that that also shows is a lot of people are talking about psychedelics and therapy, but really we’re talking about a group of medicines that are very, very different. So that’s another thing that I think is going to be unfolding over the next five to 10 years: “Okay, now that we’re getting more traction and support behind these, what should be the go-tos?” Or are some of these going to be better for certain illnesses?
The things that are in late-stage clinical trials right now would be MDMA, which is the active ingredient in ecstasy (but it’s not the same thing as ecstasy) and psilocybin, which is the active psychedelic within mushrooms. Those are probably the top two for people to know about.
I would say third is definitely ketamine. So ketamine, interestingly, is already an available prescribable medicine. It has been for decades, through anesthesia and pain medicine. Interestingly, what most people don’t know is ketamine has also been used by mental health professionals—meaning psychiatrists and therapists—for probably close to 20 years in psychotherapy. There just hasn’t been much news around it. So that’s actually a legitimate psychedelic therapy that’s very effective, that’s available right now.
So those are the three I would say that top my list. Obviously ayahuasca would be a close fourth because it’s so available right now. It’s so in the news. Actually, marijuana would be another one that I would consider, maybe, if you’re making me do a top five. All of them are different.
One thing that I think about is how the psychedelic experiences themselves within those all differ. I think for bread and butter, for people who are just getting interested in this stuff because they read Michael Pollan’s book—or they’re watching the news channel and they see this on TV, but they haven’t really tried them—I don’t think going down to the Amazon for one or four or five weeks to do ayahuasca is necessarily the best first choice.
Different Effects of Psychedelics
I like to make the distinction on which of these provide experiences that stay on what I would say is the plane of this reality, meaning the narrative of this life, from birth up until now. MDMA, for instance. The vast majority of the time, the people that take MDMA in a clinical setting, at the doses that we use it at, are going to have mostly memories and emotions that come up related to childhood traumas, neglect, break-ups, difficult situations.
On the other end of the spectrum, you have something like ayahuasca, where you have intense visions. You can connect with dead loved ones, you can see spirits or animals in the room that aren’t necessarily there. The reason why I make that big distinction is because if someone’s just trying to feel better, meaning just less depressed or less anxious on an everyday basis, I would say, stick on the end of something that, as I said, stays on the plane of this reality like MDMA. Low-dose ketamine I think also fits that.
I think psychedelics essentially provide new content that we can use to heal ourselves. If we’re just trying to heal content of this life, it’s helpful to have something that sticks with that. Because if we’re just trying to make sense of childhood abuse or parental divorce, and all of a sudden ayahuasca’s shooting us into a past life or connection with dead relatives, that’s not necessarily going to help us feel better. It can actually be providing new content or new experiences that can be more traumatic. I have a few patients that I see right now that have gone to either psilocybin or ayahuasca retreats and have been feeling much, much worse after the experience. Those are the stories that you don’t hear so often on the news or people talk about on social media. But there is a significant amount of people now that are having these experiences and feeling much, much worse after having them.
DrMR: That’s very interesting. Certainly, I think it’s very important to make sure that we have an objective look at the outcomes with these therapies. You’re absolutely right, we don’t want to just get excited.
I will admit the consumer in me got excited about ayahuasca when I first heard about it. Then I went and watched a few videos. You can’t help but think, “Wow, are there these imbalances in my memory, my limbic system, what have you, that could improve from using this ayahuasca?” And these people who you see in these testimonial videos always had these glowing—and rightfully so, it seems like they did have a great experience—reviews.
But just like you said, we want to see if for every five of those, might there be one person who’s not having a good experience and maybe even had a bad experience? So we want to be a little bit bridled with how quickly we jump to any of these.
Important Psychedelics Studies
Which leads to another question I wanted to ask you, to expand upon some of the research here. You mentioned the MDMA study with PTSD. Are there a few really keynote studies with some of these different psychedelics that you feel are worth elaboration on?
DrWS: Yeah, MDMA for PTSD is the major one, which I’ve mentioned. The other large one is psilocybin for treatment-resistant depression. So that’s the one that was also given this breakthrough therapy status and also is in the process… Imminently, they’re starting phase three clinical trials. Those are the major ones that have a lot of science backing behind them.
The other one that’s worth mentioning is ketamine for depression. That one has had a significant amount of work in the published literature. Also ketamine for the ability to treat depression with acute suicidality. That one’s important because we don’t really have anything within the psychiatric pharmacology box to actually treat suicide. It’s only becoming more and more prevalent, sadly. And we haven’t really had anything to be that effective. Ketamine seems to be something that could fit into the medical system’s toolbox to be able to potentially impact suicide. So I think those are the three major studies in big mental health issues that are important to be aware of.
Options for Psychedelics Therapy?
DrMR: And I’m assuming for someone to do any of these in the States, they’d either have to leave the States, or if they didn’t, they’d have to do it not through a doctor’s office? Is that where the status is, like fecal microbiome transplant therapy? If you want to do it in the States, you have to do it in this emerging underground ring, unless you fit the narrow criteria of having treatment-resistant Clostridium difficile? Is that the path someone is confronted with it if they’re looking into psychedelics?
DrWS: Yeah. For all of the phase three trials for MDMA for PTSD, for instance, I think MAPS is looking at doing 200 or 300 patients across the nation in a few years. So the legal research using MDMA and psilocybin is incredibly limited. Ketamine is available, again, for the treatment of depression and off-label. That’s a whole thing we could probably talk about in a separate conversation. But there are now more clinics and mental health professionals exploring ketamine, and that tends to be legal. There are just not that many people out there trained to do it right now.
So yeah, most people are not necessarily leaving the country. Most people are staying within, trying to essentially find underground therapists. There are underground therapists that are doing really, really wonderful work. There are some underground therapists that have really not stopped doing therapy with psychedelics since the 60s. And it’s been wonderful because a lot of them have written about it and we’ve benefited a lot from their work.
Again, I don’t think that these things necessarily need to stay within medicine long-term, I just think, really, safe use. I also will say, I know a lot of the people that have been trained by MAPS and other training programs to provide legal MDMA and psilocybin therapy. And I would say, combining my network of above-ground legal therapists and underground therapists, there’s only a handful that I would fully trust with myself or a loved one, because I think the knowledge of working with these medicines really comes with years of experience.
So the legal route of taking these is very, very limited. And it’s going to be limited for the foreseeable future until it’s widely available. There’s a lot of talk in the psychedelic community around these issues of accessibility of these treatments. Because there’s a lot of excitement post-Michael Pollan, I don’t know how many emails or calls I get every single week from people sharing their really powerful stories, and sad stories of them or a loved one struggling and looking for help. I have to tell them, there really isn’t anything available legally and I can’t really help them in terms of referring them. It’s a pretty painful process that I’m reminded of, essentially, on a daily basis.
DrMR: Yeah, I can imagine that would be frustrating. And for the people who are in that situation, obviously you don’t want to make any official recommendation here. But hypothetically, you would recommend, I’m assuming, that someone try to find someone in the States who’s experienced with and can assist them with MDMA, psilocybin, or ketamine, as opposed to doing a week at some type of ayahuasca clinic. It sounds like maybe that’s too big of a jump for people to go right into. It sounds like the ayahuasca is an aggressive therapy and that might be too long of a reach for most people. Would you agree with that?
DrWS: I would say in general, yes. But I think it’s really what people are called to. There is one center that I really respect that’s doing good work in Costa Rica named Soltara. I have no formal affiliation with them. I’m not on their payroll or their board of directors. But there’s very few of these out there. And there are some people who go there who have never done a psychedelic, who have a wonderful experience and they come back and they work with their therapist or other healers to facilitate the process. So I’m just giving general advice.
But I usually tell people, go with their gut feeling. The problem is sometimes people will look and look and look. Even the underground therapists that I know have like a three-month waiting list because there’s so much demand right now.
People often, I will see, will go to the first person they even find that will take them, regardless of how they feel about it. It might be that the first person they meet in the underground world will provide an amazing experience for them. Really, I think it’s about just trusting your own gut. And I realized I’m talking to someone who knows a lot about the gut! But I think that’s something that’s very real. Trust yourself, and if something doesn’t feel right for whatever reason, don’t go for it. It’s probably just best to wait.
Psychedelics & Healing Catharsis
DrMR: And just to make sure we don’t gloss over this, it seems that one of the things that is so attractive about psychedelics is not only their ability to help where other therapies have not helped, but it seems that many of these—if I’m understanding this correctly—after a term of use can have a long-term impact, without needing ongoing use. So let’s say someone’s using MDMA, ecstasy… it’s not a super-attractive proposition, in my opinion, if they have to be doing that constantly to maintain the results. But that doesn’t seem to be the case. The short-term therapeutic phase will then lead to a long-term resolution, without needing repeat use of the compound. Is that a correct assumption?
DrWS: Yeah, that’s the goal, really. It’s really about the healing needs and underlying processes that have been ailing us mentally and then vis-a-vis physically. So if we can get the catharsis, the movement of this—what I actually consider more of a physical energy than a psychological mental energy—and move it through, we can see healing in a very, very rapid way. But it’s really that catharsis that I’m talking about (which I can probably, again, talk for an hour or two about alone) that’s really important to have in a supported environment during the experience and in the weeks after. And that’s what’s rarer to be able to find and to maintain.
But yeah, we also see, especially in the ayahuasca realm, a lot of physical healing that can happen in a very rapid state for things that people have thought in the medical world to be untreatable or to even be terminal in some cases. So just to throw a little bit out there about the larger potential for psychedelics.
DrMR: Sure. Now, with marijuana, that’s something that I’m sure people perk up when they hear the prospect of potentially being able to function as a psychedelic, because of its availability. I remember hearing Joe Rogan discuss how he feels that edible marijuana, because it forms a different compound when it’s metabolized through the GI, in his view, can actually function as a psychedelic if the dose is high. So I’m curious as to your thoughts on that and then also if I can maybe ask a bit of a personal question.
There was one time when I was experimenting with CBD in edible form, and then I foolishly decided to try an equivalent amount of THC as I was formerly doing with CBD. I think did close to 50 milligrams, which is a huge dose. And I wanted to jump out of my skin. It was not a pleasant experience. Now, perhaps if I had known that going in and I was wanting to utilize all that energy in a therapeutic way, I could have harnessed all that. But it did not go well. So I’m curious about your thoughts there, caveats. Because that’s probably the lowest-hanging fruit for people. So I’d like to try to give them whatever guidance we could so that A, they can see the benefit but B, also prevent any unintentional harm.
DrWS: Yeah. It’s interesting, thanks for sharing that. People throw around the term “bad trips” a lot. I don’t really believe in bad trips. There can be difficult trips, there can be unsupported trips, or even unresolved trips that happen. But another big difference between the way we’ve looked at mental health treatment and psychedelic therapy is this. Even if you look at the categories of the medications that we use right now within psychiatry—we have antidepressants, antianxiety antipsychotics—we’re basically saying to people, if you’re feeling anything, let’s suppress it. Let’s get rid of it. We don’t even want it. We don’t know how to deal with it.
Then, societally, we do the same thing. We have a heroin epidemic. We have a lot of alcoholism. And what do alcohol and heroin do? They suppress painful emotions in the short-term. Obviously they have long-term negative consequences, but people are addicted to them because they work. You don’t feel good and you take alcohol, you will feel better… for a little bit.
The reason why I mention that is because psychedelics are the opposite, right? If we use Stan Grof’s definition, nonspecific amplifiers of the unconscious, what we want to do is to bring difficult emotions or difficult memories to the surface, so that we can actually work through them and express them. In that situation where we first experienced those traumas or painful experiences, they weren’t resolved, so we actually want to bring them to the surface. I love that you said this “coming out of your skin,” because it’s literally, either mentally or physically, these difficult experiences will come up.
And if you can do that in a supported environment, it can be a physical, mental catharsis where that will be out of our mind and our body in a pretty permanent way. But when it’s unsupported, it’s scary. Then it comes up and we don’t know what to do with it. And then it comes down and we’re just stuck with this, like, “Oh my God, I hope I never experience that again.” It can bring that unconscious material to the surface, and then it just stays there and we feel worse on a day-to-day basis. So that’s what I think about when you mention your experience. And marijuana is a perfect example of that. Marijuana is an incredibly powerful plant, especially now that THC content is getting higher and higher and higher, we’re going to see more of these problems. But I think it has very high potential for therapy. MAPS is actually doing a marijuana for PTSD clinical trial, I think, somewhere in the Southwest, Arizona or New Mexico, that’s ongoing already.
DrMR: I don’t want to hold you too close to a specific recommendation. But first, I should ask, is there a form that you feel is better for trying to use marijuana in this application? And is there a dose range? I’m sure there’s some variance here, but is there a dose range where you would say, most people need to get to a threshold dose of at least X to start getting into that therapeutic window?
DrWS: The clinical work in this area is very limited right now. And I, personally, don’t have a ton of experience with marijuana. So I will say that I’ve smoked marijuana. I do on occasion, when I am in a state where it’s legal like California and Massachusetts, where I’ve spent most of my life. So I’ll leave that little disclaimer.
But I got into marijuana after I got interested in psychedelics. So when I had my marijuana experiences, it was mainly at home at night. I would light candles and put on calming music. What I would tell people—the MAPS clinical trial, I believe is in smoked marijuana—is to take a puff of marijuana and then just wait. There’s no rush. I think people, when they get a little anxious or want a certain experience, will just take too much. And the nice thing, I think, about smoking is that you can just take a little bit, wait and see what happens.
So I wouldn’t be the one to ask about specific doses for marijuana. It’s not my area of expertise. But I would just say, start low and go slow.
Reactions to Marijuana: What’s Happening?
DrMR: Gotcha. And you make another remark that I think is interesting. I am far from an expert when it comes to medicinal marijuana use or even recreational, but I do talk with people about this in various clinical and nonclinical circles. And the sense that I’ve gotten is that some people are a little bit sensitive to marijuana. Let’s say they’ve taken out a blitz, 10 milligrams of THC. Some people would feel great. They’d want to go out, they’d want to talk with people, they’d want to do stuff, they’d want to play music. And other people might get the classical paranoid reaction. And I guess what I’m trying to distinguish between, in your view, are some people just more biochemically sensitive to THC or do you feel that those people are getting a bubbling up of some psychological or similar issue that needs to be dealt with?
DrWS: I love that question. My view is that the vast majority of these difficult experiences with marijuana come from the unconscious material that’s coming up. Because I imagine you or myself or a lot of people that I know have had a negative experience with marijuana, but they’ve also had very positive experiences, depending on “the set and setting,” which is a term that gets thrown around a lot with psychedelics. So I think it just happens to be what’s closest right under the surface.
But I think, say, for people who consistently say they have very positive experiences, it’s kind of a numbers game or a dose game, or the time of their life. So I think anyone’s capable of having these difficult experiences. Are there people out there, because of some receptor mutation or something, that will have it every time? It’s possible. I haven’t heard of that, but I would say it’s rarer than the psychological explanation.
DrMR: Interesting. Okay. And do you know a researcher here… and sorry to belabor marijuana, but again, it’s the one compound that’s so available. Is there a researcher here we might want to ping, who could elaborate on taming what could be the reactionary beast of THC into some sort of therapeutic gain?
DrWS: Probably. Sue Sisley is a researcher, I think she’s the one doing the clinical trial with MAPS down in the Southwest. She was in the news in the last couple of weeks, because I think she’s actually filed a lawsuit against the US government for holding back research in marijuana (which is a whole topic, very interesting in and of itself). But she would probably be a great person to start with.
Do Psychedelics Rewire the Brain?
DrMR: Gotcha. Okay. Now I want to come to a point that I’ve been wanting to tie in here for a while. I’ve mentioned this in brief on the podcast before. One of the things that we’ve talked about with both Annie Hopper, who developed the DNRS program, and also Ashok Gupta who developed the Gupta Program, is forms of limbic retraining. They seem to be very helpful for people who have either had traumatic events in their past or they’ve had quite a healing crisis. They need to rewire their limbic system to not focus so much on being sick, or not have so much facilitation of some of these unfavorable pathways in the brain, because of their prior trauma.
To give it a very vague description, it’s almost like a very robust meditation and support program that helps to retrain some of these pathways in the brain. And I’ve heard some very good things about it, both anecdotally and with patients who I’ve referred to it.
The analogy I saw in some of the ayahuasca literature was, because there’s so much neurological activity going through, I believe, the amygdala and the hippocampus—I’m not saying this is limited to ayahuasca, but this is just what I’ve seen— what happens is, the pathways that are unfavorable, that have to do with, “Oh, I’m not feeling well,” “Oh, I was abused in my past,” can’t support the connection. And you have to actually override that pathway and you start budding other pathways because there’s so much juice going to the circuit. And that may be what helps you to come out of a short-term ayahuasca experience and feel healthier in the longer term, because they’ve now rewired some of that circuitry in the brain.
I think this is what both DNRS and the Gupta Program are doing, and it seems to be what ayahuasca can do. So I’m wondering if you feel the psychedelics are working on that mechanism, where it’s actually helping to facilitate plastic changes in the brain, to wire around these hotspots that have been formed during trauma?
DrWS: Yeah, it very well could be. This is kind of where I went from being a dedicated laboratory researcher to being much more on the psychology, just, “Well, just show me how this makes a difference for someone in an everyday life.” It’s interesting. In the imaging work that’s being done, there’s stuff on LSD that’s been published in some of the top journals in the last couple of years, showing these differences of lighting up in the amygdala and all these other things. Also some imaging stuff has been done with MDMA. To me it’s a little bit of chicken and egg, because we don’t know the psychological processes happening at the same time. So does the psychological process lead to the change in the neurochemistry or the other way around?
From the experience that I’ve had and the people I’ve talked to, I actually think it’s more on the end of the mental process that’s causing any physical change in the brain. This can lead to a whole other area of spirituality, and energy work, which also we don’t have time to get into. Because one can even ask, is consciousness, our memories, actually all in the brain? And that actually hasn’t been shown in any definitive way. There’s a whole area of body work that’s done, often with psychedelics. Ayahuasca tends to be a very physical experience. There tends to be a lot of purging, whether it’s vomiting, sweating, a lot of movement, stomping, and I think that kind of stuff is an important part of the healing process. So I think there’s a lot more to be researched and to be looked at with how psychedelics actually do the healing process.
I just want to mention that, I think, that’s another cool thing about psychedelics, is that it’s helping reintroduce spirituality into Western culture. I think part of what’s getting us to the point where we’re suffering so bad is that spirituality has really not been a part of Western culture as it has in other countries.
DrMR: Yeah, I’m in agreement with you there. I think a higher form of purpose or meaning is something that we need to have, whether it’s religious or secular. It does appear, at least in my tangential understanding, that that’s a pretty darn important part of existence.
And I like the fact that these are being integrated together, at least hopefully, to help give someone that higher sense of purpose and meaning, and something to worry about outside themselves and their health. I’ve certainly seen patients who are overly focused on their health. They just fall into this black hole, every time they feel a little flicker of bloating. They freak out, and that starts this whole cascade and that can be destructive in and of itself.
Anything in particular you want to mention on the gut? I think we’ve discussed how, by using psychedelics, you can have a global impact on one’s psychology, psyche, neurology. And then that has obvious trickle-overs to many systems, including the gut. But is there anything in particular for the gut that might be interesting to talk about?
DrWS: In terms of specifics with psychedelics, nothing in terms of published stuff. I do think that, right now, in psychedelics, the focus is on mental health. Everything so far has been within mental health. MDMA for PTSD, psilocybin for treatment-resistant depression. I think a burgeoning area for future research is going to be psychedelics for general physical health.
I really think we shouldn’t even be talking about the difference between physical and mental health. They’re so closely tied together. And I remember back to my training, even before I became involved in psychedelics. The connection between mental health and gut health was very, very clear. And that’s always stood out to me.
So I think there’s going to be a tremendous amount of research that’s going to show how these can be helpful for gut health. You know better than I, but things like irritable bowel syndrome and all sorts of other issues have this mental health component to them. I think it’s an incredibly important area that deserves research and it’s going to happen. But it’s really not anything anyone’s looked at so far.
DrMR: That makes sense. And I agree. I think with time, they’ll see that there’s pretty encouraging evidence looking at the positive impact patients have had, in my experience, with either the DNRS or the Gupta Program thus far. And then also there’s work showing meditation helps reduce the use of the medical system in general. I’m assuming some of that use of the medical system involves people going in for IBS and IBD type complaints. So I think that’s something that hasn’t been “proven” yet, but I’m fairly confident that it will be.
Who Should Avoid Psychedelics?
What about people who might want to be cautious with psychedelics? I’ve heard varying recommendations. I believe the biggest were if one has a diagnosis of being bipolar. But are there a couple of tick marks where if you have X, Y, or Z in your history that you might want to be extra cautious or just avoid psychedelics completely?
DrWS: Yeah, I think the major ones that people say in the clinical studies are often bipolar with mania and psychosis. Those definitely tend to be the big exclusion criteria, people that are not allowed into the studies. Often active addiction and personality disorders are also thrown in there. This is a whole topic in and of itself. I would say the major one to definitely avoid is psychotic illness, schizophrenia. But that’s not to say that I think long-term we’re not going to be able to have psychedelics treat or help some people with psychosis long-term. At least, we’re probably five to 10 years away on doing anything there.
Also I never like to throw people in a bucket of, this is untreatable or they should never have this kind of treatment. I’ve seen people with bipolar illness and personality disorders and addiction get a lot better with psychedelic therapies. The thing is that the practitioners need to be comfortable with the treatment for these illnesses. And the reality is that, again, psychedelic therapy is very new, and we don’t have enough research and practitioners available right now for that. And again, that’s not to say that people cannot get some help from doing this through ayahuasca, etc. I’ve seen people get help. But I just think there needs to be significant caution and even more attention to making sure that people have support before, during, and after a psychedelic experience if they have some of these diagnoses.
DrMR: Gotcha. Seems reasonable.
And is there anywhere that you’d want to point people to on the internet, a website? You mentioned MAPS. I’m assuming you have a website. Anywhere you want to point people if they were curious to learn more?
DrWS: Yeah, MAPS, I think, is a great place to start. The KRIYA Institute is a really good nonprofit information place for ketamine. Chacruna.net is a really good website for plant medicines that does a lot of really great publications. My website has a little bit, I’m building that up in the next month or so, willsiumd.com. And I have an Instagram account where I post links to articles, or write articles or links to podcasts that I do. So it’s just @will.siu.md on Instagram. I’d say, anywhere there.
DrMR: Awesome. Well, thanks so much for the conversation. Sorry I kept you a little bit longer here than anticipated, but there were so many interesting threads to explore. And I’m sure our audience will find it fascinating. If anything really interesting comes your way and you want to come back on the show to share, you have an open invitation whenever you want to come back on.
DrWS: Awesome, thanks. Yeah, this was a lot of fun. And yeah, will certainly be in touch. It was great talking to you.
DrMR: Cool. Thanks again.
What do you think? I would like to hear your thoughts or experience with this.
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