Inside the UK’s new psychedelic drug trial clinic trying to treat depression and anxiety – iNews

Ali has suffered from depression since she was 12 years old. Now a trained paediatric nurse living in Bristol, she has taken antidepressants and other medication for most of her adult life. In her late twenties, following the death of a close friend, Alis depression spiralled and she was unable to continue working. Trapped at home, the drugs she was being prescribed were causing her to gain weight, have recurring nightmares and sleep paralysis.

I was in a desperate place, Ali recalls. I had tried all sorts of therapies and medications. I was on really high doses. I think my mental health team didnt know what else to do with me. In 2019, Ali joined a trial being run by David Nutt, professor of neuropsychopharmacology at Imperial College, and Robin Carhart-Harris, head of Imperials Centre for Psychedelic Research, testing the impact of psilocybin the main active ingredient in magic mushrooms alongside psychotherapy, in 59 people with moderate to severe depression.

During her first psilocybin trip Ali experienced euphoria and a kind of spaciousness that was very different from the insular, crushing feelings of depression. She recalls wandering outside her own body through a cathedral-like building. In her second dosing session she travelled through different landscapes and memories. During one stage she was reunited with her deceased friend. I floated as a river with her for what felt like hours. It was a way of saying goodbye because I didnt get to do that, she recalls.

Not only were these psychedelic experiences life-affirming for Ali, but they also liberated her from myopic ways of thinking: I felt like myself for the first time in a long time. I wasnt completely free from my depression, but I was able to start seeing the good in life again and enjoy things, she explains. I promised myself that I was going to try to live, and to enjoy life.

During the trial, Prof Nutt and his colleagues found the psilocybin, when used in conjunction with therapy, produced rapid antidepressant effects. It was as effective as escitalopram (used to treat depression) and scored better in two key areas: participants reported a better sense of wellbeing and 58 per cent were considered in remission six weeks after treatment, compared with 28 per cent in the escitalopram group.

Prof Nutt has been researching psilocybin for around 20 years, but interest in psychedelic treatments is growing. Research from Kings College, London, published in January 2022, evaluated the safety of psilocybin as part of therapy in the largest randomised controlled trial of psilocybin in the UK to date; documentaries like Michael Pollans How to Change Your Mind are reaching new audiences on Netflix; and this month Europes first commercial facility for psychedelic drug trials is opening in central London.

Situated in an Edwardian townhouse off Harley Street, the clinic is a bland place with revolutionary aims. Apart from its calming dcor and opaque curtains there are few indications that it is a site where participants will experience mind-bending drug trips. But while the new era of psychedelic research might have its roots in the hippie communes of the 60s, and the turn on, tune in, drop out mantras of US psychologist Timothy Leary and his LSD acolytes, todays practitioners are rigorous, data-driven scientists.

Later this month, a team of around a dozen scientists, psychotherapists and clinicians will step into this newly renovated facility to launch Clerkenwell Health, a commercial contract research organisation (CRO) founded to facilitate clinical trials to test psychedelics for drug developers.

If you listen to the psychedelic purists of the 60s, the only setting is a hut in the middle of the Amazonian jungle, but thats been a challenge to reproduce in Central London, Emilio Arbe, Clerkenwells chief medical officer, tells i.

Since the ultimate aim is to bring these treatments to mainstream psychiatry, weve moved away from anything too exotic.

The first trials here, scheduled to begin in October, will test the effects of psilocybin, along with psychotherapy, on around 60 cancer patients struggling with terminal diagnoses. After three sessions of psychotherapy, half will receive the drug and half a placebo. The trial is being conducted for the Toronto-based biotech company, Psyence.

Using these drugs for psychiatric therapy isnt new. English psychiatrist Humphrey Osmond famous for trying to cure alcoholism with LSD coined the term psychedelic in 1956 in a letter to writer and mescaline user Aldous Huxley. The same year British psychiatrist Ronald Sandison was working in the worlds first purpose-built LSD unit at Powick psychiatric hospital near Malvern in Worcestershire, using the substance to help treat depression and schizophrenia.

In the late 60s and early 70s countries including the US and UK moved to make the use of LSD and psilocybin illegal. In the UK, the Misuse of Drugs Act (1973) also restricted medicinal use. Both remain Class A, schedule 1 listed drugs, meaning they are illegal and officially classified as having no medical use. The ruling has severely restricted, but not prohibited, clinical research into the ways psychedelics can influence the mind.

Clerkenwell is not the first organisation in the UK to experiment with mind-altering substances, but it is the first commercially funded venture to conduct clinical trials on its premises.

Having a specialist facility for psychedelic drug trials is essential to help bring new treatments to market, says co-founder and chief scientific officer Henry Fisher. A drug development company wants to run a clinical trial as quickly, efficiently, and safely as possible, he says. Its not just about giving someone a drug. The therapy is a vital and fundamental component to the intervention, as is the setting in which its delivered.

Like Ali, Ian Roullier, 45, has also taken psilocybin as part of a previous clinical pilot run by Imperial College London in 2015. After suffering for years from anxiety and depression, Roullier hit rock bottom in 2014. As a journalist he had worked himself to the point of exhaustion and was feeling burnt out. He took various types of antidepressants to try to find some respite from his low moods but they only made him feel numb and lifeless. After hearing about the trial at Imperial he enlisted, desperate to see if psilocybin-assisted therapy could help.

Roullier describes the ordeal as a visceral and challenging exercise. During his hallucinatory trip he engaged with feelings and emotions he had been avoiding for years. It was a Wizard of Oz moment, Roullier recalls. That doesnt mean that everything was rosy and beautiful, but my anxiety and depression had lifted. I approached situations openly, the self doubt, and self recrimination in my head had faded away.

Psilocybins potential to be a therapeutic enabler seems to stem from its ability to break down the rigidity of depressive thinking. Brain scans show that it increases connectedness between different parts of the brain. In particular, the compound stimulates a serotonin receptor in the cortex linked to neuroplasticity. Nutt hopes that it can induce fresh states of consciousness and not only unearth repressed memories, but when aligned with therapy help people re-evaluate them, and thus think differently about their future.

The first major insight we found was that psilocybin dampens down a part of the brain that is one of the driver hubs for depression, Nutt explains. We knew that antidepressants and psychotherapy did that, but usually it takes weeks or months to happen. With psilocybin, it happened within minutes.

The other conclusion Nutt and his colleagues drew was that psilocybin disrupted a part of the brain that contains our sense of self, a faculty that commandeers more brain activity in depressed people.

Sarah Bateup, therapy lead at the Clerkenwell clinic, believes that psychedelics like psilocybin could yield significant breakthroughs in mental healthcare. If youve had depression for 20 years, youve had therapy 10 times, youve tried every drug, youve had electroconvulsive therapy, and you dont get better, youre already thinking: Im not curable.

A psychedelic like psilocybin creates this window of opportunity, where the person is very open and more receptive to therapy, she adds. But she stresses that psychedelic-assisted therapy is a novel and highly challenging form of psychiatric care, and one that carries significant risks. After all, these substances are powerful and unpredictable.

Were being very robust, scientific and evidence based, Bateup says. We also think that its very important to strip out the symbolism that comes with psychedelics. If this is a medicine of the future, then it needs to be fit for world health systems its our responsibility to do high quality research, and show people that were boring scientists and clinicians, not people that have done too many drugs.

There is a growing interest in using other drugs, such as MDMA and ketamine in mental health treatments. Awakn, a life sciences firm with clinics in Bristol and London, is researching the potential for ketamine and MDMA to treat alcoholism, gambling addiction, binge eating, and sex addiction. In the US, treatments that include MDMA are likely to be approved soon for patients with post-traumatic stress disorder (PTSD), though regulator approval in the UK is likely to take longer.

Meanwhile, Compass Pathways, a mental health care company and developer of a synthesised psilocybin, has this year announced a collaboration with Kings College Hospital and South London and Maudsley NHS trust to accelerate research into emerging psychedelic therapies.

To ensure that Clerkenwell delivers safe and beneficial treatments, Bateup has devised a training programme to help therapists work across multiple conditions with a range of psychedelic compounds. The screening process has been extremely rigorous.

We dont just take people that have the right qualifications, Bateup says. Were looking for scientists and practitioners who can reflect on their work, take feedback, and always want to be learning.

It is this thorough approach that Roullier has also sought to champion. In 2021 he set up The Psychedelic Participant Advocacy Network (PsyPAN) with Leonie Schneider, another participant in the second Imperial trial. The non-profit aims to connect a global network of participants in psychedelic trials. By pooling together these lived experiences, they hope to help clinicians create more effective treatment models, and improve participant safety and wellbeing.

Although trials do indicate some successes, they are still limited and operating on a small-scale number of patients. These treatments may be very effective tools but its very important to push back a bit, Roullier advises. Weve gone from these drugs drive you mad to these drugs could cure this condition for ever. Even when psychedelics do work, Roullier stresses that they are not a quick fix. Roullier still suffers with depression, but he has not taken antidepressants since taking part in a second psilocybin trial in 2019, and regularly attends counselling sessions.

Im living proof that one trial doesnt fix you for ever. Psychedelics have huge potential, but it would be simplistic to say that they are the answer to the mental health crisis, Roullier cautions. We need to deliver these treatments as ethically and safely as possible, so they have the best chance of making it to market.

For Bateup, while psychedelic-assisted therapy is a challenging and nascent field, the biggest gamble would be to keep things as they are. Our mental health care system is pitiful and its getting worse. Treatment outcomes have stagnated. Nobodys invented anything new, she says. Theres a big group of people who are really suffering, and this could be something that makes a huge difference to them. Thats what I want. Thats what its all about.

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Inside the UK's new psychedelic drug trial clinic trying to treat depression and anxiety - iNews