WSJ Health Forum 2022: Psychedelics Set to Take Center Stage in Mental Wellness

MDMAs, ketamines, magic mushrooms have gained immense popularity in the last decade for their ability to help with mood disorders. There is extensive research to show the potential therapeutic benefits of psychedelics beyond recreational use. Much work has been done on reducing the hallucinogenic effects of these molecules by altering their chemistry to reduce undesirable side effects. 

At the virtual session of Wall Street Journal Health Forum 2022, titled ‘Taking Psychedelics Mainstream’, Matthew Johnson, Professor at the John Hopkins University School of Medicine and Jacqueline von Salm, Co-Founder and Chief Scientific Officer of Psilera spoke to Katherine Finnerty, Deputy editor at the Wall Street Journal about how psychedelics are making a profound impact on mental wellness. They discussed how psychedelics have evolved into a new branch of psychiatric care, right from the chemical synthesis of compounds to a new dosage regimen to redefining regulatory processes. 

Defining psychedelic drugs and their impact on the human brain, Dr. Johnson said that any compound that has a profound impact on a person’s perception of reality and their sense of self can be categorised as psychedelic. There are different classes of psychedelics that work in different pathways in the brain and provide a radically altered state of consciousness. 

These are now being developed as novel therapeutics for mental health, with proven success to treat addiction, depression and anxiety disorders. 

Related article: From Forbidden Drugs to Psychotropic Cures: A “Psychedelic Boom” Breaks New Ground in Treating Mental Illnesses

New Class of Psychiatric Drugs

Addressing how psychedelics contribute to mental health recovery differently from other drugs, such as Prozac, Dr. Johnson mentioned that they need to be administered under the monitoring of a therapist who can guide the patient through their altered mental state. It is restricted to limited dosages and hence very different from psychiatric drugs. Research has shown the basic mechanisms of brain activity, the specific parts of the brain that are activated by psychedelics and a downstream change in brain network communication, often correlated with the patient’s experience and clinical improvements. However, we need more research to understand what specific changes in the brain during therapy improves clinical outcomes. 

Professor Matthew Johnson, John Hopkins University School of Medicine

Dr. von Salm reviewed the range of new molecules that companies are working on. She said at Psilera, the focus is on DMTs (N, N-dimethyltryptamine) or psilocybin-like molecules with low potential for abuse/tolerance. They employ a combination of synthetic chemistry and computational drug design to target the serotonin pathways, similar to antidepressants. Another key feature is reducing hallucinogenic effects with de novo synthesis while keeping attributes of mood elevation, learning and memory. Startups should also consider accessibility and affordability for patients.

A Promising Future for Psychedelics 

While Dr.von Salm argued that psychedelics may not be suitable for OTC prescriptions, we may see topical patches for specific indications such as social anxiety disorders in the near future. She said that DMT/psilocybin patches are currently under development.

Dr. Johnson mentioned FDA-approved drugs such as Spravato, a ketamine therapy for depression and MDMA-assisted therapy for post-traumatic stress disorder (PTSD) are paving the way for more breakthroughs in the regulatory approval process for psychedelics. With more candidates in clinical trials following promising results in rodents, he expects that many more drugs will be approved in the coming 2-3 years. He also spoke of the need for innovation in clinical trial design since outcomes are very subjective. They could be accounting for placebo controls and double-blinds in the trials or including a stimulant for active comparison against a non-psychedelic to substantiate the claims. 

Jacqueline von Salm, Co-Founder and Chief Scientific Officer, Psilera

Dr. von Salm noted how big pharma and small companies are collaborating to standardize and popularize psychedelics. Startups focus on innovation, discovery and chemistry to build candidate libraries and leverage GMP and regulatory experience from big pharma. Psychedelics are very similar to standard chemical drug formulations which need standardization and consistency once the chemistry is settled.

Speaking of the potential of psychedelics to treat neurodegenerative diseases, Dr. von Salm mentioned that there are some candidates that work on stimulating neuroplasticity and neurogenesis. She agreed with Dr.Johnson that DMTs at sub-hallucinogenic doses have demonstrated positive outcomes in learning and memory in animal models. Dr.Johnson argued that it is an exciting area of exploratory research, wherein we may look at optimising dosage in humans or developing non psychedelic analogs for promising results to stop memory loss and learning disabilities. 

Author

Sahana Shankar