September 20, 2021 • 2hr 49min

Dr. Matthew Johnson: Psychedelics for Treating Mental Disorders

Huberman Lab

In this episode, Dr. Andrew Huberman interviews Dr. Matthew Johnson, Professor of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine and a leading researcher on psychedelic compounds. They discuss the biology, psychology, and therapeutic potential of psychedelics like psilocybin, LSD, MDMA, and ketamine. Dr. Johnson explains how these compounds work in the brain, what the psychedelic experience is like, and how they are being studied as treatments for conditions like depression, addiction, and PTSD. He also addresses common misconceptions, potential risks, and the evolving legal status of psychedelics.

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Key Takeaways

Psychedelics are compounds that can profoundly alter one's sense of reality and self. They include classic psychedelics like LSD and psilocybin, as well as other classes like MDMA and ketamine.
Psychedelic experiences can lead to lasting changes in self-representation and perspective, which may underlie their therapeutic potential for conditions like depression and addiction.
Clinical trials are showing promising results for using psychedelics like psilocybin and MDMA to treat depression, PTSD, addiction and other mental health conditions when administered in controlled therapeutic settings.
The psychedelic experience is highly dependent on "set and setting" - the mindset and environment in which the drug is taken. Clinical protocols emphasize preparation, support during the experience, and integration afterwards.
Potential risks of psychedelics include exacerbating psychotic disorders in susceptible individuals and the possibility of challenging "bad trip" experiences, especially in uncontrolled settings.
There is little evidence so far supporting benefits of microdosing psychedelics, though more research is needed on various dosing protocols.
The legal and regulatory landscape around psychedelics is rapidly evolving, with some compounds likely to be approved for medical use in the coming years, though recreational use remains illegal.
Psychedelic research faces unique funding and regulatory challenges, but is gaining momentum and credibility within mainstream medical and academic institutions.

Introduction

In this episode, Dr. Andrew Huberman interviews Dr. Matthew Johnson, Professor of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine and a leading researcher on psychedelic compounds. They discuss the biology, psychology, and therapeutic potential of psychedelics like psilocybin, LSD, MDMA, and ketamine.

Dr. Johnson explains how these compounds work in the brain, what the psychedelic experience is like, and how they are being studied as treatments for conditions like depression, addiction, and PTSD. He also addresses common misconceptions, potential risks, and the evolving legal status of psychedelics.

Topics Discussed

Defining Psychedelics (6:40)

Psychedelics are compounds that can profoundly alter one's sense of reality and self
Include classic psychedelics (LSD, psilocybin, DMT, mescaline) as well as other classes like MDMA and ketamine
Classic psychedelics act as agonists at the serotonin 2A receptor
"All of the so called psychedelics across these distinct classes...had the ability to profoundly alter one's sense of reality and that can mean many things. Part of that is profoundly altering the sense of self acutely." - Dr. Matthew Johnson

The Psychedelic Experience (14:09)

Can involve hallucinations, synesthesia, altered perception of space and time
Challenges existing mental models and sense of self
Intensity depends on dose, compound, individual, and setting
Not typically full hallucinations of non-existent things, more like perceptual distortions

Neurobiology of Psychedelics (19:56)

Classic psychedelics like psilocybin act on serotonin system
MDMA increases release of serotonin, dopamine, and norepinephrine
Ketamine affects glutamate system
Exact mechanisms of psychedelic effects still not fully understood

Clinical Research Protocols (28:00)

Dr. Johnson describes a typical psychedelic experiment in his lab:

Extensive screening and preparation beforehand
Controlled setting with trained guides present
High doses (e.g. 20-30 mg psilocybin) to induce strong psychedelic effects
Participants encouraged to focus inward, often wearing eyeshades
Integration sessions afterwards to process the experience

"Letting Go" in the Psychedelic Experience (37:30)

Participants encouraged to surrender control and fully experience altered state
Can lead to profound insights and emotional breakthroughs
Challenging experiences ("bad trips") can occur but may still be therapeutic if processed well
"You could be crying like a baby hysterically. Like that's what you should be doing if that's what you feel like." - Dr. Matthew Johnson

Redefining Sense of Self (48:00)

Psychedelics can lead to lasting changes in self-representation
May help people break out of rigid thought patterns and behaviors
Could explain therapeutic effects for depression, addiction, etc.
"I think the common denominator are persisting changes in self representation...the way one holds the sense of self, the fundamental relationship of a person in the world." - Dr. Matthew Johnson

Exporting Insights to Daily Life (58:56)

Integration process helps apply psychedelic insights to everyday life
Can lead to lasting behavioral changes and improved mental health
Contrasts with dismissive attitudes toward drug experiences in recreational settings

Flashbacks and Persisting Effects (1:04:36)

True flashbacks (spontaneous recurrence of psychedelic effects) are rare
Hallucinogen Persisting Perception Disorder (HPPD) affects a small percentage of users
More common are memories or insights from the experience resurfacing
No evidence for urban legends about LSD staying in spinal fluid, etc.

MDMA, DMT and Other Compounds (1:15:54)

MDMA increases empathy and emotional openness, being studied for PTSD
DMT produces very intense but short-lasting psychedelic effects
Ketamine has dissociative effects, approved for treatment-resistant depression

Risks and Potential Negative Effects (1:26:00)

Psychotic disorders: Can exacerbate or trigger symptoms in susceptible individuals
Challenging experiences: "Bad trips" can be psychologically difficult
Behavioral risks: Impaired judgment can lead to accidents/injuries
Heart effects: Increased heart rate and blood pressure
Risks greatly reduced in controlled clinical settings

Microdosing (1:38:15)

Taking very small doses of psychedelics, often on a regular schedule
Anecdotal reports of benefits for mood, creativity, focus
Little scientific evidence so far supporting benefits
Potential risks of frequent dosing not well understood
"None of the peer reviewed studies that have much credibility, none of them have shown a benefit and they've tried." - Dr. Matthew Johnson

Risks for Kids, Adolescents & Teenagers (1:56:45)

No clinical research yet on psychedelics in minors
Developing brains may be more vulnerable to risks
But also potentially more plastic/adaptable
Future studies likely to explore carefully in treatment-resistant cases

Legal Status and Regulation (2:03:40)

Psychedelics remain illegal at the federal level in the US
Some local/state decriminalization efforts underway
MDMA and psilocybin likely to be approved for medical use in next few years
Debate over models of regulation - medical only vs. broader access
"I like the word regulation better than legalization." - Dr. Matthew Johnson

Psychedelics for Treating Brain Injury (2:18:35)

Emerging research interest in psychedelics for concussion/TBI
Animal studies show neuroplasticity effects
Anecdotal reports of cognitive benefits
Dr. Johnson planning studies with retired MMA athletes

The Changing Landscape of Psychedelic Research (2:27:45)

Growing acceptance in mainstream medical/academic institutions
Increased funding from philanthropy and industry
FDA designating some psychedelics as "breakthrough therapies"
Challenges of doing rigorous clinical research with controlled substances

Participating in Research (2:44:23)

Clinical trials listed at clinicaltrials.gov and institutional websites
Specific inclusion criteria for each study
Cannot provide one-off treatments outside of research protocols
Some online survey studies also available

Conclusion

Psychedelic research is a rapidly evolving field with great potential to revolutionize mental health treatment. While challenges remain, compounds like psilocybin and MDMA are likely to be approved for medical use in the coming years. Ongoing research aims to better understand the mechanisms, optimize therapeutic protocols, and explore new applications.

However, psychedelics also carry risks, especially when used outside of controlled settings. More research is needed on long-term effects, optimal dosing, and potential applications for different conditions. The legal and regulatory landscape continues to evolve alongside the science.

Overall, psychedelics offer a novel paradigm for mental health treatment - potentially allowing profound shifts in perspective and self-representation through just a few dosing sessions. While not a panacea, they represent an exciting frontier in psychiatry and neuroscience.