麻豆果冻传媒影音

Rachel Yehuda, PhD, has a patent for a post-traumatic stress disorder (PTSD) blood test and a lab , and was among "the first to articulate the neurobiology of PTSD," according to .

"I've spent [three] decades trying to figure out how to solve trauma and PTSD," she said in an interview with MedPage Today. "After a while you start to see patients not getting better as they should."

In 2018, Yehuda met Rick Doblin, PhD, who founded a nonprofit in the late 1980s to study psychedelics and similar substances as potential mental health treatments, and attended a 6-day psychedelics therapist training.

"It was a life-changing experience," she said.

Yehuda subsequently studied up on the psychedelic psilocybin and the psychoactive compound MDMA. She even tested MDMA on herself, via a guided "trip" while following an FDA-approved protocol, she said.

Yehuda was the driving force behind the at Mount Sinai's Icahn School of Medicine in New York, which launched earlier this year. It's one of several academic centers recently emerging in the U.S., following a model established at Johns Hopkins University in 2019.

After a half-century of dwindling research funding amid political backlash, research on psychedelics such as psilocybin, LSD, Ayahuasca, mescaline, and similar substances is experiencing something of a revival -- to the extent that several prestigious academic institutions now house dedicated psychedelic research centers. That includes:

• Johns Hopkins:
• University of California: (both and have dedicated programs, but not full centers)
• NYU Grossman School of Medicine:
• Mount Sinai Icahn School of Medicine:
• Massachusetts General Hospital:
• University of Wisconsin:

While each center has unique goals and programs, they all study potential health applications of psychedelics, and aim to train the future workforce and promote public education.

The recent wave of interest is attributed by sources and reports to several factors:

• Promising research, especially with MDMA and psilocybin
• Buy-in from academic institutions
• Increased funding, especially from wealthy donors and biopharmaceutical companies
• Ineffective mental health treatment for too may patients using existing therapies
• Renewed public interest in and experience with psychedelics

Psychiatry has long been a conservative field within academia, said David Nichols, PhD, founder of the , which launched in 1993 and has supported psychedelic research initiatives, though Nichols has been examining these substances since 1969.

All of a sudden, psychedelics "appear to be a magic bullet," he said. "You have this exciting discovery that these drugs might be really powerful tools."

But not all experts are sold on the idea that these compounds will become effective mental health interventions. Jeffrey Lieberman, MD, chair of psychiatry at Columbia University, expressed concern that there's a lot of "true believers" leading the work.

"It's moving at kind of a reckless speed," Lieberman warned. "The process is being driven by a wave of enthusiasm."

'You're Not Sticking Your Neck Out'

Psychedelics were extensively studied in the U.S. during the 1950s and 1960s, but controversial experiments by the CIA, alongside other politics, effectively brought research to a halt. The Drug Enforcement Administration (DEA) still lists most psychedelics as Schedule 1 substances.

Despite the backlash, Doblin launched the Multidisciplinary Association for Psychedelic Studies () in 1986 to examine the therapeutic potential of psychedelics. MAPS moved slowly with limited funds and academic acceptance, but around the turn of the 21st century, new researchers accelerated interest in the compounds.

Matthew Johnson, PhD, associate director of the Hopkins center, remembers how he was advised not to study these substances when he started his career at that time. University leaders expressed concern that such research would reflect poorly on their institution.

"People couldn't believe real scientists would stake their career on a fantasy," Nichols told MedPage Today.

But Johnson said that has "really evolved over the years in part because of our [study] results and our funding."

"It's top-level universities doing this research," he said. "There is protection there. You're not sticking your neck out as much as you would 10 years ago."

Psilocybin and MDMA, for instance, have recently shown benefit in clinical trials for depression and PTSD, respectively.

Overall, "the published data are remarkable," said Paul Hutson, PharmD, who leads Wisconsin's psychedelic research center.

William Stoops, PhD, an addiction specialist at the University of Kentucky College of Medicine, said positive early results from studies "convinced people it's worth investing in." (See this sidebar on psychedelic center funding.)

In addition, rising mental health crises -- PTSD and substance use , in the general population -- paired with inconsistent results for current therapies increased interest in new strategies.

Medical cannabis has also provided a roadmap for changing overall public perception and encouraged many patients to think about psychedelics, sources said. And the FDA has recently granted breakthrough therapy designation to at least two psilocybin products for major depressive disorder, and okayed an for an MDMA product for PTSD.

"There really is this signal this might be a major new frontier in mental health research," Johnson said. "That's why it's finally taken off."

As of October, "well over 100" people had expressed intrest in participating in out of the Massachusetts General Hospital center, examining how psilocybin interacts with the brain to counter depression, said Sharmin Ghaznavi, MD, PhD, associate director of the institute.

"It no longer seemed like this very 'out there' thing to open a research center," said Kevin Balktick, a New York-based entrepreneur who has organized a popular for more than a decade.

Structure and Research Focus

The structure of each center and how closely they are tied to their host academic institutions varies widely.

One is housed in a neuroscience institute, others in schools of medicine or pharmacy. Another exists within a research hospital.

Directors are experts in trauma, addiction, and substance use disorders, among other subjects. Their institutional leaders are supportive and give them space, they said.

Centers are primarily studying psychotherapy paired with compounds ranging from psilocybin and MDMA to Ayahuasca -- even LSD -- to treat depression, PTSD, and substance use disorders. Effects on anxiety disorders, opioid use disorder, and smoking cessation are also under investigation.

Some of the centers work with advisors -- including MAPS, Nichols, and journalist Michael Pollan, who published the best-selling book in 2018. "We are new to this space; there's a lot we don't know," Ghaznavi said, citing the Mass General board. "This is a way for us to learn from the work that people have been doing for a long time."

While most have embraced the term "psychedelics" in their center names, the Wisconsin center opted for "Psychoactive Substances."

"We thought 'Psychedelics' might raise eyebrows," said Hutson.

Yehuda described the overall field as a collaborative one. "In the field it feels like we are aligned, it doesn't have that 'Lets get there first' feeling," she said. "It has a vibe of togetherness. It feels good when I see another center pop up."

Impending Boom?

Despite the recent surge in psychedelic research centers coming online, sources in the field don't expect every major academic research institution to develop one.

"You don't need centers to do clinical trials," Yehuda said. "You need an idea." Hence at Yale and Stanford as another solution, sources noted.

Notably, many institutions "want to wait for more evidence because what happens if you start a research center and it doesn't work out?" said Collin Reiff, MD, an addiction psychiatrist at NYU Langone who works with the university's psychedelics center but is funded separately.

Nichols has a different take: "If they want to be a state-of-the-art psychiatry department, they are going to need to pick this up. It will be a mainstay of psychiatry in the future."

Nevertheless, he predicted, "I think [that's] going to spread slowly."

Johnson acknowledged that the field still needs "more rigorous larger-scale studies," and Stoops agreed there's a need for more randomized controlled trials.

Hutson warned: "I'm concerned people will think this is a panacea. There's a lot of passion about psychedelics. But I don't think everybody should be taking them. There's going to be some people that are disappointed."

Others expressed even deeper skepticism.

"You have all these centers popping up led by people receptive to the idea without doing rigorous research," Lieberman said. "We don't really have a critical mass of experienced researchers."

Too many studies are simple, "not sufficiently broad or focused on the right kinds of questions," he added.

"Research has to get out in front of this broad rush to utilize these substances," he said. "It may be slower, but in the long run it's going to be much more valuable."

'I Hope It's As Good As We Think It Is'

Yehuda's center is now examining how MDMA-assisted therapy sessions affect PTSD symptoms. It was green-lighted after Yehuda explained her rationale over two meetings with Icahn leaders, she said. Her track record likely helped her cause.

Still, it bothers her that despite all her work, trauma and PTSD continue to pose major mental health challenges.

"There's a little bit of frustration at the disconnect between how superbly we can describe things on a molecular level and the fact that this hasn't really changed outcomes for patients," she said of current treatments.

While psychedelics can put one "into a state of openness that is conducive to trauma processing," she said, "it's not a magic pill that makes trauma go away."

"We know psychotherapy can change the way the brain functions and now the question is, How might the use of psychedelics catalyze that process?" Yehuda said. "This is a hard thing, but getting it right seems to have as its reward so much potential social good that it was hard to resist the chance to make this meaningful contribution for people who have suffered. ... I actually care about this."

Yehuda plans to dedicate the rest of her career to this field, she said. "I've been accused of medicalization and I'm guilty," she said. "We have to figure out the science before there is a movement that this is OK."

When it comes to these substances, however, the one-time skeptic called herself an idealist -- like many in the field. "We will be honest brokers, but I hope it succeeds," she said. "I hope it's as good as we think it is."

Comment