There is immense potential with Ketamine for patients who are depressed, anxious and suffering from PTSD.  MDMA and psilocybin assisted therapy is promising because these medicines have other potentials that Ketamine may not offer. Legal restrictions in the United States exist outside of the narrow availability of use in Phase 3 FDA trials. Illegal underground use is not recommended not only because there are potential criminal and legal consequences, but additionally most “guides” offering these options are not psychologically trained to pre-screen inappropriate candidates, support people if trauma comes up while under the influence of these substances, nor able to help clients integrate what occurred during the journey.

Ketamine soothes the brain stem and amygdala, and works on the kappa -opioid receptor system. Ketamine is a dissociative drug and tends to soothe the nervous system rather drive insight and spiritual awakenings. Psilocybin works on the 5HT2A receptor sites and the “default mode network”. MDMA also works in the 5HT2A receptor sites, but also involves other neurotransmitters such as oxytocin and serotonin. Both of these substances create opportunities for deep insights and curiosity. The mystical and visionary experience with high doses highly correlates to patients gaining a greater meaning to their suffering. With appropriate assistance from a mental health provider specifically trained in psychedelic assisted psychotherapy, the client may gain significant relief from trauma.

In the lecture, “How Do Psychedelics Work in the Brain?” from the Breaking Convention Convention in 2013, research using fMRI presented by Robin Carhart-Harris and others asserts the classical psychedelics, such as psilocybin, down regulate the default mode network and creates new, expansive ways of self reflection. The posterior cingulate cortex is the central controller of the brain for global brain function and relates to sense of self. The higher the client reports disintegration of ego, the more down regulated the default mode network and posterior cingulate cortex. In the study by Roland Griffiths et al, Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial according to one of the researchers, William Richards, mystical experiences correlated to higher dose, i.e; “Becoming the Divine”, rather than the lower dose, visionary experience,“Being at the foot of the Divine in awe”. This tends to induce a sense of meaning to the suffering that accompanies cancer. I suspect the same would apply to any kind of suffering, including that which accompanies complex and single episode PTSD.

In addition to psilocybin, in the study, MDMA-assisted psychotherapy for treatment of PTSD; study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials, and additionally by the live trainings at MAPS Part B by Annie and Michael Mithoefer details the reduction of distress from PTSD in MDMA assisted therapy sessions. A fascinating lecture offered by Dr. Ben Sessa from the Psychedelic Science 2017 conference titled, MDMA Therapy- A Child Psychiatrist’s Perspective spoke about how childhood trauma creates a heightened fear response. Dr. Sessa asserts that MDMA is the

antithesis of trauma, soothing the amygdala and creating insight. He is currently studying the use of MDMA in the treatment of addiction through the lens of treating the underlying childhood trauma which drove the addiction in the first place. Studies are published almost daily about the positive impact psychedelics have on mental health.