Dr. Grammer: “…this gets back to that default mode network that we were talking about several episodes ago, where we have these different networks in the brain that do inward focus, outward focus, and then navigating the two. And so if we think about this being too much inward focus, the psilocybin seems to enhance those networks associated with outward attention, and that sense of belongingness that then creates a buffer and resiliency against some of those internal thoughts. And what’s cool about all this is the duration of that impact, or that effect seems to be relatively long lasting months, if not indefinitely.”

[Life to Live by Grace Mesa (Instrumental Version) begins]

Beyond Depressed is a mental health podcast for people who want to know the science behind emerging treatments and if those treatments are right for them or a loved one. New therapies using psilocybin, magnetic stimulation, ketamine and medical marijuana are bringing people much needed relief. Together, we’ll take a deep dive into depression and how therapy, medications and drugs can help you feel better.

Beyond Depressed is hosted by Dr Geoffrey Grammer. Dr. Grammer is a decorated retired Colonel with the United States Army and is currently serving as the Chief Medical Officer for Greenbrook TMS. He has experience in psychiatry, internal medicine, and behavior neurology.

Disclaimer: The following podcast is for information and educational purposes only and should not be considered official medical advice.

[Life to Live by Grace Mesa (Instrumental Version) ends]

Dr. Grammer 

Welcome back to the podcast. I am Dr. Geoffrey Grammer. Today, the question is, if you had to change your life for the better but had to experience ego death to do it, would you take that risk? We’re going to talk about that and psilocybin today. I’m joined again by Joe, and new to the podcast, we have Brianna, who works in the mental health field and will be representing the Gen-Z group in today’s topic.

Brianna 

Hi, Dr. Grammer.

Dr. Grammer 

Hi, thank you guys, both for joining. So psilocybin or magic mushrooms, believe it or not, is being investigated as a treatment for depression, as well as other conditions. And this will be the first of several episodes discussing kind of the psychedelic class of medications. What have you guys heard about psilocybin? So a lot, psilocybin and other psychedelics, I think, have gotten very popular again, in the last five or six years, because of podcasts, a lot of the big podcast and YouTube personalities, interview people who are experts on it, talk about doing it. It’s seems to become a thing in intellectual and celebrity world again, to discuss their Ayahuasca trips in Peru, and they’re using mushrooms and things like that. But I think a big part of its generational, I think what’s interesting about the table now is I’m a millennial, you’re probably an (Gen) Xer, Brianna, your Gen Z.

Brianna 

Technically a millennial, but like

Dr. Grammer 

Borderline.

Brianna 

Yeah.

Joe Clements 

Yeah, younger, younger millennial. Junior millennial. So I’m curious – my introduction to this has come from very high minded intellectual podcasts about it. What do you know, Brianna, about mushrooms about psilocybin?

Brianna 

Yeah, often when I hear about it, it’s from people actually, from their personal experiences and what they’ve done, the trips that they’ve had, or just their experience overall. So I feel like I hear more so from the horse’s mouth.

Joe Clements 

What do you hear?

Brianna 

Just about how crazy it is how they’re like, like an indifferent universe, in the sense, just their feelings, their out of body experience, I know a lot of people have had bad experiences as well, because again, like they’re not really in control a lot of times, so they just don’t really know what’s going on. So I’m… from what I’ve heard, I really, it seems like a scary moreso drug, but it seems also very intense as well.

Dr. Grammer 

Okay. And that’s been my hesitation as well as people have been like, yeah, you just got to be in the right state of mind when you’re doing it or watch out. So I think for me, it is the the loss of control the surrender to it, which is really what you’re doing. If you’re going to go on a on a ride like that. It has been intimidating for me in terms of trying it. So kicking it back over to you Dr. Grammer as the expert. How, how did we get to a point where you a medical professional, are now talking about psilocybin as a… and I keep saying this as a legitimate clinical use to treat depression and other mental health disorders. What has that path been like? Yeah, so research into psilocybin started even back in the 60s. And there were some institutions like Harvard being one of them that started a program. And people felt like this was a compound that could facilitate a form of, of psychotherapy. But the 60s was an interesting era where there was a dichotomy in our culture of sort of a more traditional base, and then a social, almost revolutionary upheaval, leading to many of the changes that we now value and cherish. But drugs got caught up in that, right. And so, psilocybin, LSD, kind of got demonized and and then taken out of the clinical and scientific world, because it was felt that it was contributing to this idea of an anti authoritarian Gestalt within the younger generation. And then it sat quiet for a while, but fortunately, some brave researchers again at Harvard, and Johns Hopkins and I believe Sinai, all started new programs, and began to see some pretty dramatic results. And so if you look at the original literature on this, and een the literature now, the the impact of this treatment was so profound, that it was impossible to ignore. And I think we’re beginning to see like, hey, these substances alter the mind, okay? We know that the mind in certain psychiatric illnesses is not functioning correctly. Therefore, can we use these substances to facilitate changing things back to a state of health? And when we can take away this kind of almost fervent disbelief or denigration of the substances and say, Hey, let’s look at this scientifically look, let’s look at this in a medically controlled environment can we use these well, then we say, hey, wow, this might be a powerful modality for us that have previously been unavailable. So the neat thing about psilocybin, and what a lot of people hear about is just how mystical the experience can be, I think we’ll talk a bit more about maybe the mechanism of action, right, so we talk about psychedelics, including psilocybin. That class is usually affiliated with binding to a certain receptor in the brain called 5HT2A, okay. And it’s an agonist for that receptor.

Joe Clements 

What is an agonist?

Dr. Grammer 

It stimulates it, okay. So with psilocybin, with psilocybin, what happens is people will experience a pretty substantial change in your awareness of the world around you and takes a lot of people on a journey, that some feel can be very therapeutic. So I guess with that in mind, I mean, what, what have you heard about the actual trip that people have when they use psilocybin?

Joe Clements 

So the most detailed description I’ve read is, and the book is famous, How to change your mind.

Dr. Grammer 

Yep.

Joe Clements 

Do you recall the author’s name? I can’t.

Dr. Grammer 

Pollen?

Joe Clements 

Okay. Yeah. Michael Pollan. Yeah. So read, read that that’s the most detailed description that I’ve ever read. It seems like what is experienced there is some sort of highly symbolic, archetypal dream state, or at least that’s what he experienced was a reconciliation with relatives that had passed away that he didn’t feel like he had fully grieved up until that point. And so what I’ve heard most about it is there seems to be something going on that would almost be reflective of like, what Carl Jung would describe as the mind of human archetypes, these like shared ideas, shared consciousness, things like that. But that is the most detailed explanation I’ve read of it. And then I’ve heard all the way up to people being like, oh, you know, I just felt like I was the king of everything for a few hours. So like this euphoric, almost highly egocentric experience I’ve heard people describe. Yeah, absolutely. And Brianna, let me ask you a question. Do you feel like the world now promotes a sense of mysticism, let’s say compared to like, 100 years ago?

Dr. Grammer 

I feel like nowadays, we are very open to more things. So when people have come to me speaking about what they experienced when doing magic mushrooms, or I feel like it’s like you said, a mystical experience. I know, I’ve heard often that people just see different animals or just feel like something coming about them in a sense. So I feel like nowadays, compared to 100 years ago, it’s very much more common, I guess, it just seems like it’s more familiar nowadays. Yeah, I mean, I think it’s interesting, because no one can really tell you how the psychedelics work, we know they bind to that receptor, for example. And we know there are certainly people who get treated with psilocybin that come out reporting a very profound experience that changes their life for a substantial period of time. What idea is that with psychedelics, it used to be thought that it was instilled by some as thought as sort of a third eye, seeing the world differently than we see now. And I think, in some ways, our culture has moved away from this idea of mysticism and uncertainty into a kind of concrete science based world.

Joe Clements 

Materialism.

Dr. Grammer 

Yeah, exactly. Where there’s just nothing left to discover, and spirituality has faded. Well, in the end, while there are a lot of things that we used to think were magical, like solar eclipses, and so forth, we still are far away from being able to understand why we exist, why reality is what it is, for something like happen that created all of this, what is the purpose of the universe? And what happens to us when we leave our bodies? Right? So these are kind of universal questions. And some people have found that psychedelics can actually enhance an understanding of this and a lot of spiritual experiences that cultures have had over the past have used things like Ayahuasca to promote that sense of mysticism. And I think in modern society, we’ve kind of given some of that up. So what I think some of the enthusiasm for psilocybin is is a kind of restores that sense of wonder and appreciation for all that does make up the universe and not necessarily that material kind of immediately in front of me world. So let… you’d mentioned before we were talking about ego death, and, and so what is that right, let’s talk a little bit about what happens when someone is dosed with psilocybin and then we’ll kind of get into and this, the idea is, it’s not just a little bit, right? It’s a lotta bit. Exactly. So with psilocybin, there’s a couple of ways that people have historically taken that, one is what’s called micro dosing. And where you take a little bit every few days, if you take it everyday you develop a tolerance, it stops working, so you have to take it every few days. And then some people feel like that creates a calming sense of euphoria that can persist over time. But it doesn’t bring about that fundamental and relatively long standing change. Macro dosing is where you use doses greater than typically three grams. In one trial, for example, they’re using six or 12 grams, depending on the arm that you’re in, of medical grade psilocybin, right? That that’s a huge amount. And so what happens when people get dosed with that kind of amount is they will go on a trip where they begin to feel themselves leave their body. And you’re absolutely right, like if you watch – whether it’s YouTube videos, or read about this, within that book, the narratives on this truly sound like just phenomenal. But the thing that’s cool about it is, it’s not just an occasional person who has that. This sense of mysticism, happens to people. And it seems to be independent of their preconceived notions of spirituality, it seems to be somewhat independent of their prior experiences. And so people will feel themselves beginning to leave their body and it can actually feel like you’re, some people describe it as almost feeling like you’re dying, where you have to sort of forcibly breathe, and you begin to feel like your limbs kind of departing. And eventually, your awareness separates completely from your body, and you enter into this sort of etheral world. And in that world, people have all kinds of discoveries, some people will see themselves and from a perspective, they’ve never had almost as if they were looking at themselves from the outside, including all the good and bad. Some people will re-experience past events, but see it from a different perspective than from behind their own eyes. Some people will have completely novel experiences where they have symbolic meaning whether they’re being punished or rewarded. And the trips, quote, unquote, can be frightening, exhilarating, and everywhere in between. In that space, some people actually describe being even unaware that they took the drug, and anything that was passed, and anything that was present dissipates, and all they are is a now in this place. So much so that some people feel like the warmth of a greater being, connection with people who had left the earth, a sense of connectivity with that common consciousness, which is a big one, where people suddenly realize that they as an individual aren’t quite as individual, but they’re actually connected to everything around them, or a sense of connectivity to nature. And they’ll stay in that place for quite some time. And then they begin to come back into the body and the re-entry can actually be somewhat uncomfortable, like the departing where you’re slowly kind of reintegrating back into your body. Now, while all this is happening, if you do it in a medical setting, you have specially trained therapists who are there to help guide you through that to keep you safe, the environment and the room have to be very specifically configured to be warm and inviting and safe. And you have all sorts of safety mechanisms in place so that if things do get dangerously uncomfortable, you can make a safe intervention to bring people back pretty quickly.

Joe Clements 

How?

Dr. Grammer 

With essentially, if it’s not just the redirection and guiding people to a better memory, because there’s some idea that whatever your connectivity, thoughts is going into that trip is what you’re going to follow. So if you come in with sort of negative thoughts, unfamiliar place, unfamiliar people, you’re more likely to have a bad trip. If you come in feeling safe, comfortable, you know, the people around you, you’re more likely to have good trips. So you try verbal redirection, but worst case scenarios, you may actually have to give another medication or a trip killer, if you will, to pull people back to reality. You can use things like a benzodiazepine, to decrease anxiety like Ativan or something. And then some people will use an atypical antipsychotic because it actually blocks that 5HT2 receptor. And that can bring people back as well.

Brianna 

And how long do these trips usually last?

Dr. Grammer 

About six to eight hours?

Brianna 

Wow.

Dr. Grammer 

Yeah, so a long, long time.

Joe Clements 

It’s a big commit.

Dr. Grammer 

It’s a big commit. So yeah, when you get this treatment, you’re you’re gone for the day and potentially the night. And that’s why like, you need to be careful. And this is a theme in this like, don’t try this at home, folks. That’s the biggest advice I can give.

Joe Clements 

Are people who are depressed, more likely to have a bad trip just based on the fact that they’re coming in already in a negative state of mind.

Dr. Grammer 

That’s where I think the protocol becomes so important because what the therapist and the environment is supposed to do is help the person’s frame of mind going into the trip. And so not necessarily you can actually go in despite being depressed and have a good trip, if you have the right kind of setup for it. I think. Now, when people come back from this, the changes are fairly profound. And 80% of people will report that this trip was one of the most meaningful things that has ever happened in their life. 80%. And when they were asked, months later, if that was still the case, the same percent was like, Yeah, about the same percent was like, Yeah, that was the most meaningful thing that ever happened to me. And what people will describe when they come back is a couple of things. Number one, an increased awareness of things that have happened in their life and of who they are. There can be an increased sort of sense of empathy and understanding to people that they previously had complicated relationships with, a sense of forgiveness knowing that people that have hurt them the past, maybe we’re doing the best that they could with what they had. And yeah, they made mistakes, but they’re human beings. And we need to have some forgiveness for that. They see parts of themselves, like if you’re using alcohol, for example, and you see, you suddenly realize I’m not just hurting me, but I’m hurting everyone around me that loves me. Right. And that gives a new perspective. So I think that that’s one thing that occurs that helps people kind of reframe, who do I want to be right, who what am I going to hang on to is sort of resentment, what habits are… am I going to continue to pick that that keeps me from my idealized self, of who I want to be. And then the other thing that happens is this enhanced sense of connectivity to the world around you. And this goes back to that mysticism that I was talking about, because I think people come back often say, Well, I suddenly feel a sense of belongingness, to my community, to my family, to nature, to spirituality to the universe. And if you think about that, you know, one of the models for depression is this idea that we become overly consumed with our internal thoughts, this gets back to that default mode network that we were talking about several episodes ago, where we have these different networks in the brain that do inward focus, outward focus, and then navigating the two. And so if we think about this being too much inward focus, the psilocybin seems to enhance those networks associated with outward attention, and that sense of belongingness that then creates a buffer and resiliency against some of those internal thoughts. And what’s cool about all this is the duration of that impact, or that effect seems to be relatively long lasting months, if not indefinitely.

Joe Clements 

So what is interesting about that would be that it’s almost like root case psychotherapy, right? Like, so instead of the therapist, you’re kind of working your way verbally, from the outside in, this would seem like a realization that happens from the inside outwards, right? And so what I’ve heard is a lot of descriptions of things that sound very, like, you know, Freudian, or Jungian, like these highly symbolic things that almost… like actual narratives, almost like a dream state. Is there a thinking that something like that’s going on, and that’s why the results are long lasting, because it is producing these conscious, lived realizations about both things good and bad, similar to what you can get with talk therapy, often after months or years of working through it, but because it’s plowed over your defense mechanisms and your barriers, you’re just straight at the core of what the issues are.

Dr. Grammer 

Yeah, I actually think that’s well said, because this will also be a theme when we talk about MDMA or ecstasy being used for PTSD is that you’re accelerating the psychotherapeutic process. And you need these therapists to not only help guide you in and guide you out, but to help you interpret kind of the experiences that you’ve had. And so you can, at least it seems, increase sort of someone’s self awareness in a very short period of time by changing the perspective by which they look at different things in their life and their understanding of the universe. So yeah, definitely seems to help facilitate that.

Joe Clements 

So for depression, you can see how that work for maybe like things born of trauma, you can see how that work, maybe PTSD, for things like personality disorders, does it work? Or because of the nature of personality disorders? Are people with personalities, not actually able to experience the full benefit? Because there’s some issue with how strong their identity is? Maybe they have multiple identities? How does that work?

Dr. Grammer 

Yeah, I think with personality disorders its going to be a lot more complicated. So right now, the the clinical trials are fairly circumscribed. So all these things are still kind of in their, on their path to trying to get FDA approval. There are a couple of vendors or sorry, excuse me, there are a couple of manufacturers out there who are getting ready to start phase three trials, which is sort of the last step into kind of proving efficacy. And in those trials, they’re being very specific about hey, we’re going to treat just depression. And I think you bring up a good point, because whether it’s eating disorders, substance use depression, all those if you change your perspective might change how you approach the symptoms of those illnesses. But there’s another part of this too, that people have used and this is what spawned some of the recreational use, and this is this idea of sort of self improvement. So who do I want to be as a person? Am I empathic enough? Am I broad enough in my thinking? Or have I become almost mechanistic in the way that I approach the world every day. And I do think that there’s an intriguing opportunity to look at this. So what I’m most interested in is a lot of people I see with depression have very real existential crises, right. There are some people who feel like there’s no meaning to life, they exist, but like, why they don’t really have any sense of fulfillment from that. And if you think about that, part of our whole humanity struggle is to kind of figure out our own self awareness, and arts and literature and self discovery, and all these things to kind of promote our journey through that. But it may be things like psilocybin, I’m gonna sound a little mystical here, but bear with me, it may be things like psilocybin – really do improve awareness of the greater universe and help with that existential negotiation. And to that point, some of the work being done at Hopkins is actually in end of life anxiety in cancer patients. And they actually there, there’s a fair amount of initial evidence suggesting that people become at peace with the idea of dying after undergoing treatment with psilocybin because they began to see themselves as more than just the individual that they are, and instead, you know, part of a greater whole.

Joe Clements 

So the idea would be that, so it’s not, it’s not being studied. So you’re not putting like a sociopath or a narcissist or a psychopath in the mega dosing of psilocybin to see if they come back, and they’re like, oh, no, I shouldn’t have been so cruel when I was younger, you’re, you’re specifically testing it on people who are depressed. And the idea is that when they don’t feel as isolated or atomized or alienated, through that experience, that that alleviates a significant amount of the depression.

Dr. Grammer 

Yeah, absolutely. That’s the idea. And I think there are some researchers who feel like, just like with ketamine, the trip is sort of a side effect and not necessarily a therapeutic effect. But from my reading, and in talking to some of the researcher who know the…

Joe Clements 

That would be a very materialist viewpoint on it.

Dr. Grammer 

Exactly, exactly. But I’ve talked to some of the people doing the primary research, and many of them would disagree and believe that in this case, the self discovery from the trip is a major part of the therapeutic effect. I think it’s going to take some time to ferret out if that’s really the case, but at least the current trial designs are building in the systems in place to make sure that they maximize the potential from this.

Joe Clements 

Oh, well, I mean, I think there’s an easy way to know if that matters, right? Are the observations people are coming back with true about themselves or about others? If it’s true, then that level of integration, if you look at the talk therapy perspective, would actually be part at least part of the value proposition. If what they’re coming back with is not true at all, but they just have this feeling that is true, then it’s probably not a valid piece of it. So is the common experience that what people realize is, is actually a true thing, or that most people would look into that? Yeah, that was, that was a pretty bad thing you did or like you really did miss that person and not deal with it.

Dr. Grammer 

Yeah, I think it’s a good question, because one could also argue again, in that materialistic atomized world, well, the reason their perspective has changed is because their mood has improved. Therefore, the perspective isn’t from the actual trip, it’s just because we’ve improved their underlying, depressed construct that was kind of filtering information that they were processing. I personally don’t believe that, because you’re absolutely right. If you look at the narratives that people have for this, they find utility in the self awareness that they felt they experienced during the trip. And again, the thing that’s interesting to me is, some of those trips have common themes to them, that seems to bridge cultural bias. And so that says to me that there may truly be something to this altered state that helps people reset, and some people even describe being reborn. Reset the way that they approach the world. Yeah, I think and, and, Briana, I’m curious if this has happened, I mean, I think some people the older we get, the more we kind of become contained within a box when we’re younger, we’re much more likely to answer the unanswerable questions with filling in gaps with fantasy and so forth, we’re more likely to try new things to see what we like and we don’t like. But as we get older, those novel experiences decrease in frequency. And I think it does cut people off from the greater universe. Have you or any of your friends kind of describe that kind of phenomenon?

Brianna 

Yeah, for sure. Especially being younger and really wanting to experience different things, in a sense, definitely feel very open to trying these new, new things. Especially I feel like being a recent college graduate, like college is a really great time to experience a new thing. So I feel like that has happened often as well. I know oftentimes, if people are staying out drinking for the night or something like that. And they want to say like, maybe we should try this tonight, like, how was that? How would that play about? And I know, it probably isn’t the best thing to do. But what would you say about that?

Dr. Grammer 

Yeah, I mean, again, I think recreational use of these substances is definitely not advised. And while I’m not aware of anyone dying from the actual compound of psilocybin itself, no one stopped breathing or had a sudden arrhythmia, what has happened is the trip can become anxiety provoking enough, that it can lead people to run into traffic jump off a window, or some people feel so anxious and feel like they’re dying, they actually will attempt suicide, to ease that, that sense of annihilation. We know that with, you know, particularly with alcohol, it can mess up all kinds of stuff. One, and very few studies are done, where they’re like, okay, we’re gonna get a bunch of people drunk and then we’re going to give them a drug to see whether or not they get sick, right. So if we look at something like cocaine, which a lot of people will drink, and they do cocaine to counteract the sedative effects of alcohol, so they want the inhibition of the alcohol, but they want the stimulation of the cocaine, those two compounds will form a molecule called cocaethylene, which is cardiotoxic. And that increases the risk of sudden cardiac death as an example, right. So it wouldn’t necessarily be something to think about, but it does happen. So particularly with any of these drugs, whether it’s marijuana, psilocybin, LSD, DMT, MDMA, I cannot stress enough, like people are looking at it. And this stuff is happening now. And it’s going to be coming out with where we can use it. Within years, not decades, don’t try to jump the gun and do something that could potentially put you at tremendous risk, and unfortunately, make things worse, rather than better.

Joe Clements 

What is I mean, it obviously they’re different, different drugs, but what is the difference in effect between LSD and psilocybin?

Dr. Grammer 

So LSD is a little bit more of a hallucinogen, the half lives are going to be a little bit different and the dosing is going to be a little bit different. And DMT, for example, which is essentially part of like what ayahuasca is, has an even shorter half life and a stronger trip so it has to do with the affinity of that whether or not they’re interchangeable, has not been shown yet. So a lot of these manufacturers are looking at all of those compounds to figure out where they can best be used. And I think until we have better clarity on that data, other than the trips being a little bit different, we need to still think of them as experimental compounds.

Joe Clements 

What is the difference between a hallucinogen and a psychedelic?

Dr. Grammer 

Some things can have hallucinogenic properties, but a psychedelic is by definition classified as something that binds to that 5HT2A receptor.

Joe Clements 

Okay. And that 5HT2A receptors responsible for what in the brain?

Dr. Grammer 

Well, again, nobody really knows right? So if you have an SSRI on board, you’re going to be stimulating the 5HT2 receptor with directly with serotonin. The psychedelics bind to the receptor stronger than serotonin. So that’s why it seems to create this this kind of overwhelming effect, is it overrides serotonin and basically, it almost what do you call it, amplifies whatever that receptor does, right? So what secondary messenger changes actually lead to all these things? What happens within the brain that results with this improvement? We actually don’t know yet.

Joe Clements 

 So psilocybin would not be considered a hallucinogen?

Dr. Grammer 

It is.

Joe Clements 

Oh, okay yeah.

Dr. Grammer 

Yeah yeah so so it’s a hallucinogen and a psychedelic, but like ketamine, for example, can have some mild hallucinogenic properties. And a lot of people will actually describe it as a psychedelic but can’t… but specifically, it’s actually not.

Joe Clements 

Are there anything? Okay, so that would be the… yeah, I was gonna say is there anything that’s a hallucinogen but not? So hallucinogen just means you’re going to experience things that aren’t present in the environment.

Dr. Grammer 

Yeah.

Joe Clements 

Psychedelic just very specifically, is a molecule that binds to that specific receptor and enhances this experience in the brain.

Dr. Grammer 

Yeah, I mean, if somebody wants to look at something, it’s kind of funny. The gentleman who discovered LSD did so by accident, and he was looking at different molecules and accidentally contaminated himself and went home and started tripping, and was like, holy cow, I’m onto something. And then he he did another experiment on himself where he intentionally dosed himself and was like, Oh, I have something here. And so his hallucinogenic effect was pretty profound. But through that it kind of brought in this whole era of like, oh, we have something here that’s truly different, the psychedelic compound and then through years, they figured, okay, it’s this 5HT2A agonist. And so we’ll see other compounds kind of do that same thing. And, like marijuana, for example, doesn’t necessarily bind to that it binds to the cannabinoid receptor, but it can create hallucinations, particularly closed eyes hallucinations, for example, until it could be a mild hallucinogen, but it’s not a psychedelic.

Joe Clements 

So what going forward is likely to happen in terms of the clinical use of… In 10 years are you going to go to the medical marijuana dispensary and then there’s also going to be psilocybin products aisle? Is it going to be something like TMS therapy where you’ll go to very specific clinics, get your psilocybin dose, and spend your eight hours there every few years? How do you see that playing out?

Dr. Grammer 

It’s a good question, because that’s something that I think the manufacturers are trying to wrestle with now, because the amount of training that goes into certifying the therapists and the provider to prescribe it, and the amount of criteria needed for the treatment room is pretty substantial. So when they go to roll this out, the question is, how do you scale that? Right? And even if the treatments are like once every six months, or once every few years, or maybe once in a lifetime, whatever it’s going to be, we just don’t know yet. Because again, the population has been steady, it’s been fairly narrow in its scope, I think what’s going to happen is, it’s going to be a lot like Spravato, where you have to go to a center that becomes certified to deliver that treatment, you’ll be there for the entire day, if not through the night, you may get one or two treatments. Okay. And then a long term follow up.

Joe Clements 

So this sounds bizarrely, to me, like a modern version of shamanism.

Dr. Grammer 

I think, no, actually…

Joe Clements 

You go to the Oracles, you know, office, go on your journey, be guided through it, and then leave a changed person after your journey?

Dr. Grammer 

Absolutely. So so they call it what is it called a trip guide, is what a shaman is. And in some ways, your therapist is a bit of a trip guide. The difference is, and again, don’t go down to South America to find a retreat to do this, because if you start having a bad trip, they rub your back, tell you to be okay. But in a medical setting, we actually do things to kind of bring you back pretty quick and keep you safe. So, but you’re right, it is very similar to that.

Joe Clements 

Which is just an interesting parallel to how it’s probably been done before and even very primitive human cultures.

Dr. Grammer 

Well, what I like about it, and Brianna, I would be interested in your thoughts on this as kind of we close out here. The neat thing about this, and I think one of the reasons why people are so drawn to it is our society has gotten more materialistic, it has gotten away from this idea of mystery of mysticism. But when we actually look at big questions of the universe, truly the universe, like space time, the continuum, you know, and all that we really don’t know as much as maybe we think we do. And I think we’ve been wired as a as a species to have some connectivity to something greater than ourselves. And if this can help restore that, in a modern era, I think that can have value across a variety of conditions, as long as it can be done safely. So I really think that there’s going to be some sort of role for psychedelics in enhancing the human condition to offset some of the stresses of modern day life. I don’t know if that kind of resonates with you at all, or

Brianna 

No, I definitely agree with that. I feel like people nowadays often, of course, think there is greater to what we are. People being able to experience that as well and get that firsthand like experience to be able to say like, I did this, or I saw this, and this is how I feel about it. I think that will be amazing for people to be able experience. So I think going forward, that that will be something people will definitely look forward to and really, honestly want to experience not even because they may be depressed or have some type of mental illness, but honestly, just because it sounds like something exciting that they will want to enjoy in life at least once or something.

Dr. Grammer 

Yeah. And I think there’s real value in helping derive meaning we all want meaning, right? We all want to know why we exist and what our purpose is. And if this third eye helps people get there, I think we need to move away from demonizing it and figure out how we can administer that to people safely.

Joe Clements 

What patients, and right now this is experimental, so if you’re a patient and you have the opportunity to be in one of these studies, what type of patient is well suited for it right now?

Dr. Grammer 

Well, it depends on the study criteria. So I want to be really clear for folks don’t go harvest mushrooms that’s like super dangerous because what will kill you and what you’re trying to look for look very similar. And even experts can get it wrong, so don’t go the woods. Also don’t buy you know, the foul smelling moldy stuff out of a plastic bag from somebody because potencies totally different and all this stuff and you can end up really having an experience that you weren’t looking for. Let’s wait for the science to develop. The easy way to find out if there’s a study in your area is almost all trials now have to be in a in a data bank that’s at the website clinicaltrials.gov exactly like it sounds, okay, clinicaltrials.gov. If you go there, you can type in psilocybin, and then whatever condition you’re looking for depression, it’ll tell you all the studies that are ongoing in the world that kind of do that. And in there, it’ll show you the criteria, both the inclusion and the exclusion criteria. I’m aware of one study near where I work, that, unfortunately, they’re very specific in their age range, I think it’s like 18 to 54, and very specific with their kind of criteria. And so that’s a bit more narrow, but treatment resistant depression is what that particular study is looking at. So I know that we’re about out of time. Any final comments or thoughts before we close out?

Brianna 

I think I have a quick question. I don’t know if you explained this earlier. But what are the different ways to intake this drug?

Dr. Grammer 

Yeah, so most people right now are using some sort of oral substance. Now, the street users will often just chew it straight out of the bag. I’m, I’m told that tastes really bad. I have not personally tried that.

Joe Clements 

Teas, too.

Dr. Grammer 

Yeah. And that’s the other thing is you infuse it into something. Now the manufacturers are either isolating the compound from organic growth, or they’re they’re synthesizing the compound directly. And in those cases, it’s either a pill, or some other method of oral delivery, like a dissolvable tab or something like that. So yeah. Well, we’re about out of time. So we’ll close it here. But again, very exciting stuff. And the point of this is, a lot of folks out there struggle with treatment resistant disease, whether it’s depression or substance use or what have you. And psychiatry right now is undergoing sort of a revolution in expanding the tools that it has available to help people feel better. And psilocybin is one of those things that we’re looking to see where it’s best used for, how we safely administer it. And these are things that are going to… we’re going to see if they do hit the marketplace, kind of hit the marketplace within the next few years, not years and years down the road or decades down the road. So wait for the science to finish, wait for it to be approved, and then find centers that are certified to evaluate you and determine if this is right for you. Don’t do this recreationally on your own. So we’re gonna also talk in the future about medical marijuana, as well as PTSD, including the use of MDMA for that. So more kind of, we’ll call them psychedelic esque compounds out there. I want to thank Brianna and Joe for joining me today. Thank you and we’ll see you next time.

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