Dr. Julie Holland, author of the new book, Good Chemistry, says that when patients on antidepressants no longer experience relief, psychedelic medications can be used in conjunction with talk therapy to work through some past trauma.
People who have been taking antidepressants for several years sometimes hit a wall, a point where treatment no longer seems to relieve their symptoms. Psychiatrist Julie Holland says psychedelic drugs can help with that.
Holland was in charge of the emergency psychiatric unit at Bellevue Hospital on weekends from 1996 to 2005 and currently runs a private psychotherapy practice in Manhattan. She is a medical monitor of the MAPS studies, which include developing psychedelics into prescription drugs. Her new book, Good Chemistry, explores how she thinks psychedelic drugs, including LSD, psilocybin, MDMA and marijuana, could be used more widely in psychiatry to make treatment more efficient and effective.
“There are certain herbal medicines in particular – things like psilocybin or ayahuasca – that really help people explore not only their personal trauma,” she says, but also “this sense of oneness and connection. People really come out of these experiences with a new perspective.”
Holland acknowledges that the use of psychedelic drugs in psychiatry is controversial - but she says that applying them in practice is slowly gaining acceptance.
“Good psychotherapy takes years and there are many fits and starts,” she says, “and people run away when it gets too hard. But it keeps changing. … The data is so compelling that in my opinion people in my profession have no excuse for not knowing what's going on. “
Highlights of the interview
Beyond the limits of antidepressants
We haven't had much innovation in antidepressants in a long time.
People got these drugs and then they never came out. And many people have been taking antidepressants for decades, and they are not designed to be used that way. So that's kind of a number 1 problem. But things are definitely changing where people better understand that it's not as simple as just altered chemistry or altered genetics. That your childhood has experiences and trauma and things like income inequality - there are all kinds of things that have an impact on what your mental health will be. And a big part of it is dealing with trauma. So the daily doses of antidepressants, anti-anxiety drugs, sleeping pills, antipsychotics, they're really not there to help the primary problem. They are there to seal the cracks and act as plasters, while psychedelic psychotherapy really tries to find the cause of the symptoms rather than just putting some sort of paper on the symptoms. ...
I don't mean to say that everyone should throw their pills away completely. But I do think that for people who have been taking antidepressants on their own for decades, it's worth researching if there are other ways to maybe treat some of the symptoms and maybe figure out some of the underlying causes of the symptoms.
About the treatment of post-traumatic stress disorder (PSTSS) with cannabis
This is kind of a new paradigm, a revolutionary way to treat trauma. When people are traumatized, they become very anxious. They get a little hyper excited. They can't sleep well. They cannot eat well. You can give meds to reduce anxiety or… to help you sleep. But you don't really get to the root cause: namely that they are traumatized and that they need to process the trauma further and work through the trauma. … And what CBD does and cannabis does and some psychedelics do and MDMA does is it takes you to the other side of the nervous system, the parasympathetic nervous system, which isn't about fight or flight – it's about staying and being open.
About the treatment of PTSD with MDMA or ecstasy
MDMA is simply an exquisitely perfect chemical to enhance the psychotherapy process, so that's basically why it was chosen. MDMA helps people feel more relaxed and more open and more familiar and more confident in the therapist, which is important. … It helps people to be awake, alert, verbal, to want to talk, to want to explore. But because it increases serotonin, there is very little anxiety and also a feeling of satiety - like you don't really need anything, like you have everything you need. So this state of high dopamine, high serotonin and also high oxytocin makes it really great to be open, have confidence, explore trauma comfortably, and trust your therapist that they will help you explore these trauma safely. And this sense of security is actually very important. MDMA, because it increases oxytocin, calms the amygdala - the fear response. Investigating trauma is scary, and often when people get scared they close and don't want to talk and don't want to explore.
About the effectiveness of MDMA-supported psychotherapy
Pretty much everyone I've spoken to who has had an MDMA-assisted psychotherapy session has gotten away from it as if they've worked through a great deal of their trauma - maybe not their entire trauma, but they definitely have a better kind of land on how it looks . … For example, I have a patient who, her husband, has committed suicide. And she had a really hard time forgiving him or processing that, and with MDMA she was able to do that in one session and leave some of that weight and heaviness there in the therapy room.
I've had patients who have stopped harming or killing themselves. I've had patients who no longer feel compulsively suicidal. Many patients who have changed their behavior around alcohol or compulsive eating or drug use.
Why MDMA doesn't work if a patient is on antidepressants
Eighty percent of these antidepressants are prescribed by people who are not psychiatrists and they are simply renewed over and over again. Antidepressants that work on serotonin are called the SSRIs - where they are is exactly where MDMA needs to go to do the job. So they absolutely block the operation. So if you're on an SSRI, you don't actually feel MDMA when you're on it. And then you have something like ayahuasca, which is very popular - a psychedelic tea - and there are a lot of drugs you can't take if you're planning on having an ayahuasca experience.
Sometimes there has to be some kind of medical check-up in these situations because I don't want people to do things that are potentially deadly if they could have a positive growth experience if they didn't take certain medications.
About how these psychoactive drugs can facilitate brain rewiring
Many of these drugs that we are talking about, like ayahuasca and psilocybin, MDMA, cannabis - all facilitate what is called neuroplasticity, the kind of brain that grows and changes and rebuilds. And there are things called synaptogenesis, which is like forming new synapses. And then there is neurogenesis, which forms new brain cells.
Anyone who grew up in the '80s has the idea that these drugs kill brain cells, but it's actually the exact opposite - that many of these plant-based drugs and psychedelic drugs cause brain cell growth and what is called neuroplasticity, which is a variant for forming new connections and potentially rewiring the brain slightly as a result, which really helps.
That's what promotes growth and behavioral change. And you don't necessarily see a lot of growth and behavioral change when people are on antidepressants or maybe even going to therapy for years. With really good therapy that you have been going to for years, you often have behavioral changes. But to see them after one session is really remarkable. And it's hard to just go back to the daily dose after seeing this kind of massive change in behavior.
About how the corona pandemic has made many people more anxious
Even before the pandemic and the kind of political turmoil I had patients who were extremely concerned because of the current political situation or some people who are upset about the environment and what is happening. So our anxiety levels were already pretty high before this corona pandemic all happened in the spring. Since the 90s, the numbers have only increased with the use of prescription anti-anxiety medications. And we saw a big peak around 9/11, and we're going to see a big peak now too. So it is ubiquitous. It's an ongoing problem. Anxiety has overtaken a kind of depression as the number 1 complaint, not only among psychiatrists, but also among general practitioners. ...
At the start of the pandemic, there were concerns about contracting the virus. But what has happened in recent months, in addition to the kind of pervasive sense of fear and doom, is that the people who are isolated, the people who live alone, my patients have not had human touch for three months. And because you are so isolated and disconnected, you become more anxious. It will make sleeping more difficult ... So it feeds on itself. That's what I'm really worried about right now is that the isolation and disconnection affect physiology, make people more anxious and then they don't sleep well, they don't eat well. They try to calm themselves down with unhealthy behavior and it all goes from bad to worse.