[@hubermanlab] Essentials: Psychedelics for Treating Mental Disorders | Dr. Matthew Johnson

Link: https://youtu.be/OvHbhzArbfE

Short Summary

Number One Takeaway:

Psychedelics can profoundly alter one's sense of self and reality, potentially leading to therapeutic breakthroughs by disrupting established cognitive models, particularly the model of "self."

Executive Summary:

Dr. Matthew Johnson explains that psychedelics, while spanning various pharmacological classes, are unified by their ability to profoundly alter one's sense of reality and self. Research suggests these substances hold promise for treating depression, addiction, and potentially even neurological injuries by inducing significant neuroplasticity and reshaping the way individuals perceive themselves and their experiences. While potential dangers like "bad trips" and contraindications for individuals with severe psychiatric illness exist, Johnson expresses optimism about the future of psychedelic research.

Key Quotes

Here are five direct quotes extracted from the transcript that I found particularly insightful or interesting:

1. "I think of these as is psychedelics as profoundly altering models. you know, you know, we're all, you know, we're prediction machines and that's large. So much of that is is top down and uh and and psychedelics have a good way of you know, loosely speaking dissolving those models..." - This highlights the idea of psychedelics disrupting our ingrained cognitive frameworks.

2. "Given the huge variety of experiences that people have on psychedelics, given the huge variety of humans that are out there, but what are now very clear therapeutic effects in the realm of depression, what do you think is the value of going into this fairly restricted perceptual bubble, what we are calling letting go or giving up control? Because if the experiences are many but the value of what one exports from that experience is kind of similar across individuals that raises all sorts of interesting questions and this is not a a philosophy discussion. We're talking about biology and psychology here." - This captures the fundamental question about why diverse psychedelic experiences can lead to similar therapeutic outcomes.

3. "My god, it's like I can really just decide like flicking off a bike.” I can decide not to smoke." - This anecdote encapsulates the powerful shift in self-perception that some individuals experience, leading to a sense of agency and control over previously intractable habits.

4. "Wait, I want to make sure I understand. So you're saying the bad trip can be related to the transcendential experience, right? I think those are both speculating but you you have to pass through this sort of like you know reality shattering including your sense of self and one can handle that in one of two ways you can either completely surrender to it or you can try to hang on and if you try to hang on it's going to be more like a a bad trip..." - This explores the intriguing link between challenging or negative experiences during psychedelic trips and the potential for profound personal growth and transformation.

5. "I'm microcynical, if you will, about this term micro dose." - Huberman uses wordplay to start a section of the podcast where Matthew Johnson discusses current clinical data regarding microdosing and the mixed findings or lack of evidence supporting many popular claims of its benefits.

Detailed Summary

Here's a detailed summary of the YouTube video transcript, focusing on key topics, arguments, and information, excluding sponsor announcements and introductory remarks:

• Definition of Psychedelics:

  • The term "psychedelic" is culturally driven and spans different pharmacological classes.
  • Psychedelics profoundly alter one's sense of reality and self, acutely.

• Classes of Psychedelics:

  • Classic Psychedelics (Hallucinogens): LSD, psilocybin (magic mushrooms), DMT, mescaline.
    • Two structural classes: Tryptamine-based (psilocybin, DMT) and Phenethylamine-based (mescaline).
    • Act as agonists or partial agonists at the serotonin 2A receptor.
  • NMDA Antagonists: Ketamine, PCP, Dextromethorphan.
  • MDMA: Called an entactogen (touching within) and empathogen (affords empathy), standing in a class by itself.

• Psychedelics and "Models" of Reality:

  • Psychedelics profoundly alter internal models. We are all prediction machines and psychedelics dissolve those models.
  • Examples of violated predictions: believing one can fly or dive through a painting.

• Serotonin System:

  • LSD and psilocybin primarily target the serotonin system.
  • Serotonin, broadly, tends to lead to contentment in the immediate experience.
  • Dopamine places us into an external view of what's out there in the world and what's possible.

• Psychedelic Clinical Trials (Hopkins):

  • Trials involve screening (psychiatric interviews, cardiovascular health) and preparation.
  • Preparation includes building therapeutic rapport and explaining potential psychedelic experiences.
  • Participants receive pure psilocybin (20-30 mg range).
  • Session day minimizes tasks, focusing on the therapeutic response.
  • Emotional responses (crying, etc.) are welcomed; patients are encouraged to let go of control.

• Letting Go of Control and the Psychedelic Experience:

  • The relationship between patient and analyst becomes a template for trust, including trust in oneself.
  • Focusing intently on one thing (even a finger) can reveal bizarre or miraculous aspects.
  • Psychedelics dis-habituate us to the everyday and expand perceptual bubbles.
  • Safety (knowing one can't die) is crucial; the clinical setting is set up to handle even extreme physiological responses.

• Therapeutic Value of Psychedelics:

  • Changes in self-representation are a common denominator in positive outcomes.
  • Psychedelics can alter models of reality, including the model of the self ("I am a smoker," "I am depressed").
  • Expands perception of self.
  • Allow individuals to step out of old models, experience "duh" moments (realizing agency), and potentially reconsolidate traumatic memories.
  • Reshape neural circuitry and how one feels about themselves.

• MDMA:

  • Increases both dopamine and serotonin.
  • May be better for trauma as bad trips are less common and of a different nature.

• "Bad Trips" and Transcendental Experiences:

  • Bad trips can be related to transcendental experiences; reality and sense of self are shattered.
  • Surrendering to the experience vs. trying to hold on influences whether it becomes a bad trip.
  • Openness about psychedelics is increasing due to peer-reviewed research.

• Dangers of Psychedelics:

  • Profoundly destabilizing experiences.
  • Individuals with psychotic disorders (schizophrenia, mania) are at risk.
  • Bad trips can occur for anyone, especially at high doses or in non-ideal environments.

• Microdosing Psilocybin:

  • Claims include acting as a better version of ADHD drugs or antidepressants.
  • Peer-reviewed studies show no benefit, ranging from no effect to impairment in time estimation.
  • May feel a little impaired and a little high.
  • No studies have looked at specific microdosing protocols with specific formulas (e.g., Paul Stammits).
  • Antidepressant effects may be a real possibility.

• Neurological Injuries:

  • Anecdotes suggest psychedelics help heal the brain after head injuries.
  • Rodent research shows potential for neuroplasticity.
  • Potential to repair the brain after injury.
  • Exploratory work planned with retired athletes with repetitive head injuries and depression, exploring cognitive function and MRI changes.