Exploring inner depths

Patients with treatment-resistant depression who received ketamine or psilocybin often had intense, overwhelming experiences that could cause temporary anxiety. Those who felt unprepared or unsupported struggled to surrender to the experience, increasing discomfort. Trust in therapists, realistic expectations, and emotional support made surrender easier and reduced anxiety. Ketamine produced effects like openness, detachment from negative thoughts, and mystical experiences. Recommendations include offering multiple psilocybin sessions, longer-term therapeutic support, and better staff training to improve patient comfort and possibly treatment outcomes.

Study at a glance

Abstract

Psychedelics are remarkable, versatile substances that produce a wide range of effects and can cause both harm and healing. Clinical research into psychedelic treatments is booming. In spite of this renewed interest, relatively little is known about how patients experience these treatments. In this dissertation, patients who received a psychedelic (either ketamine or psilocybin) to a treat treatment-resistant depression were interviewed about their experiences. The aim was to better understand how these treatments might work therapeutically, and, at least as importantly, how to improve how these treatments are offered in the future. Many patients reported intense and overwhelming experiences that sometimes made them feel (quite) anxious, although this was often temporary. While anxiety is often reported as an adverse reaction, in psychedelic treatments it is thought that it can also be therapeutically meaningful. Patients who felt ill prepared or insufficiently supported often struggled to let go of control and surrender to the experience, which increased discomfort. Trust in therapists, realistic expectations, and feeling emotionally supported, on the other hand, made it easier to surrender to the experience and reduce anxiety. On ketamine, patients had experiences that hint at a (psycho)therapeutic potential, such as feeling more open, more detached from negative thoughts and ruminations, and even mystical (religious) experiences. Taking patients’ experiences seriously yielded concrete, relatively easy-to-implement recommendations – like offering multiple psilocybin sessions, providing longer-term therapeutic support, more thorough training of clinical staff – which may have a positive impact on the experience and comfort of participants, and possibly help improve treatment outcomes.