Psychedelics may help treat PTSD—and the VA is intrigued

Last month the U.S. Department of Veterans Affairs announced it will begin studying psychedelic medicines in veterans, requesting research proposals on methylenedioxy-methamphetamine (MDMA), psilocybin (derived from certain mushrooms), and other psychedelic compounds to stem the high rates of depression, post-traumatic stress disorder, and suicide in veterans.

More than a quarter of Iraq and Afghanistan war vets have developed PTSD since their deployment and some 8,000 service members are discharged from the military each year due to the disease. That anxiety condition and depression are largely responsible for the 17 veterans who die by suicide every day.

Advocacy groups have pressed the VA for years to take a serious look at psychedelic-assisted therapy for veterans after studies of MDMA in the general population showed it can be especially beneficial, with more than two-thirds of study participants no longer having PTSD symptoms after three sessions along with accompanying psychotherapy.

Such research in veterans as well as active-duty service members is important because their PTSD often differs from that of the general public’s, says U.S. Army Major Aaron Wolfgang, a psychiatrist at Walter Reed Army Medical Center and the Yale School of Medicine.

Rather than resulting from a single incident like a car crash or sexual assault, PTSD in service members often springs from “longitudinal traumas where they are in unsafe environments over a long period of time,” Wolfgang says. Veterans may also have compounding issues including poverty or homelessness that can further complicate their condition.

For these reasons, even “gold standard” trauma-based psychotherapies such as prolonged exposure and cognitive processing therapy may be less effective in veterans.

“Our best treatments right now still leave a lot of service members and veterans suffering,” Wolfgang says.

How much money the VA will ultimately commit to psychedelic research and how quickly the studies might begin are not clear. (The VA declined National Geographic’s request for an interview.) The agency’s research will build on a small body of science in veterans who have improved their mental health after receiving psychedelic therapy in other countries where the drugs are legal.

One veteran who made such a trip was Jesse Gould, a former Army Ranger. During a week-long retreat in Peru in 2017 he had four experiences with ayahuasca, a brew made from several plants and shrubs containing psychedelic compounds used in some indigenous South American cultures.

By the end of the retreat, “I felt noticeably changed,” says Gould, who went on to create the nonprofit Heroic Hearts Project to facilitate similar experiences for other veterans.

“The VA should be an advocate for veterans, so it makes sense for them to conduct research,” Gould says. Even if the U.S. Food and Drug Administration were to approve psychedelic medicines, the VA will want to evaluate effectiveness and risk among its own population, he says. The first new drug application, for pharmaceutical-grade MDMA—a drug known on the street as Ecstasy—was submitted by Lykos Therapeutics late last year, and the FDA recently indicated it will decide by August whether to approve it.

(When psychedelics will be legal?)

Myriad psychedelics are being tried

Heroic Hearts has facilitated psychedelic therapy for a thousand veterans since its founding seven years ago. The group has organized and financially subsidized retreats to Peru, Mexico, Costa Rica, and Jamaica, primarily for ayahuasca but also psilocybin and ibogaine, a compound derived from the roots of the iboga plant native to central Africa. Last year the program also brought eight veterans to Oregon after that state legalized psilocybin therapy in 2020. Treatments include weeks of group therapy preparation, one or more sessions with the drug, and months of individual and group follow-up therapy.

Independent scientists have sought to assess the program’s effectiveness, although their research is observational and considered less rigorous than comparing a treatment against a placebo. A report of eight participants published in the journal Psychological Trauma concluded that after an ayahuasca retreat five of the veterans had meaningful reductions in PTSD symptoms at the three-month follow-up. An ongoing study by Imperial College London has so far documented marked symptom improvements in 40 veterans with PTSD, although results are unpublished.

Like many veterans, Gould developed his symptoms after he ended his six-year enlistment that included three tours in Afghanistan. When he returned to his former career in finance, he found himself experiencing panic attacks, brain fog, and bouts of depression. Gould functioned sufficiently at work but drank excessively on nights and weekends.

Alarmed by his behavior, Gould went to a Veterans Affairs clinic and was diagnosed with PTSD. He recalls being told at a VA hospital that antidepressant medications might blunt his symptoms but that he’d mostly have to live with the disease. (Gould subsequently additionally diagnosed himself with traumatic brain injury from the explosive weapons he discharged.)

You May Also Like

SCIENCE

When will psychedelics be legal?

SCIENCE

Ketamine effectively treats depression. Do the benefits outweigh the risks?

SCIENCE

Many people wean off antidepressants too quickly. That can be dangerous.

Treatment in Peru

Gould learned about ayahuasca from a podcast and booked a retreat in Peru in 2017. He didn’t know anyone who had done this and felt it was a drastic but necessary step. “I was treading water in my life…. If I stayed on this trajectory, I knew things would get worse for me,” he says.

Unlike psychedelics like psilocybin that often yield pleasant thoughts and imagery while consuming the drug, ayahuasca generally facilitates a physical and emotional purging. Some believe this response serves to eliminate traumas from the body.

During the first two sessions one day apart, Gould vomited, sweated, and felt filled with fear and anxiety. But after the third one he experienced a profound sense of peace. By the end of the retreat, PTSD symptoms including hypervigilance and social anxiety had disappeared and he no longer felt compelled to drink excessively. This has lasted to this day.

Preliminary research on a range of psychedelics is intriguing 

Small studies in veterans raise the possibility other psychedelics might also prove helpful. One involved 86 veterans from special operations forces who visited a clinic in Mexico to take ibogaine and 5-MeO-DMT, a psychedelic compound obtained from gland secretions of certain toads. A month later, most had significantly improved their PTSD and depression and felt more satisfaction with life.

Lykos Therapeutics (formerly MAPS Public Benefit Corporation), which submitted the FDA application, is currently enrolling veterans in the Bronx to study its MDMA therapy in this group.

While all the research in veterans is preliminary, the results are encouraging, says Alan Davis, director of the Center for Psychedelic Drug Research and Education at Ohio State University who coauthored the Mexico study.

But the challenge the field faces is that the studies are small, observational, and they haven’t followed veterans for the years needed to determine if the benefits are long-lasting, Davis says. This is especially a concern with those who take the drugs during a foreign retreat.

“People are down there for a couple of days to a week and then they have to go home and be back in their same environment that they were struggling in,” they say. And while some clinics and programs, including Heroic Hearts, provide what Davis says is crucial ongoing psychological support in the months following treatment, not all do.

More research is also needed to better understand the dangers. With Ibogaine, for example, there are concerns it may harm the hearts of some users.

Urging the VA to plan for approval of psychedelic therapy

Juliana Mercer, director of the nonprofit Healing Breakthrough that has advocated for veteran access to MDMA, believes that if the FDA were to approve psychedelic therapy, demand among veterans will skyrocket.

When 21 active-duty service members and veterans with traumatic brain injuries were surveyed about their thoughts concerning this treatment, most initially expressed only moderate interest, with some believing it might trigger undesirable personality changes. But once they learned about the results of the research, many were eager to try it.

Healing Breakthrough wants the VA to begin planning for how they might administer psychedelic therapy and to whom.

“If they don’t start now to work out the logistics and start training clinicians, MDMA is going to be approved and they’re not going to be ready to implement this life-saving treatment,” says Mercer, a Marine Corp veteran who experienced MDMA therapy under a limited compassionate-use program.

(Psychedelic medicine is coming—but who’s going to guide your trip?)

Such logistics will be formidable, says Wolfgang, who has written about the challenges the VA and U.S. Department of Defense will face. For one, roughly 80 hours of professional therapy time is required for a single person to receive MDMA-assisted therapy, including the two therapists in the room for three multi-hour sessions plus introductory and follow-up psychotherapy.

Wolfgang worries that should a long waiting list eventually emerge at the VA, some veterans might turn to illegal sources of the drugs, which are often adulterated with other substances and are taken without medical oversight.

Veterans might falsely think, “I can go and improve my PTSD or depression if I take some illicit compound I get from my friend,” he says. Then, rather than possibly receiving benefits from the drug, they’d be “subjecting themselves to potential harm.”