Psychiatrists are key players and need to stay informed.
Psychedelic-Assisted Therapy Essentials | Part 2
Psychiatrists do not need to support psychedelics. Still, it may be wise to pay attention. The zeitgeist is changing and, soon, if not already, patients will begin asking about them or even stopping their SSRIs in search of a miracle cure. The well-being of patients may depend, in part, on their psychiatrist’s understanding of these historically controversial substances.
To be clear, psychedelics are not the miracle cure the media sometimes announces. However, they have re-entered serious clinical and scientific conversation. Professional psychiatric bodies in the United States1, the United Kingdom, Australia and New Zealand are all taking the field seriously. The American Psychiatric Association supports continued research while withholding endorsement for routine clinical use outside approved investigational settings. The Royal Australian and New Zealand College of Psychiatrists has issued guidance specifically to inform psychiatrists about the potential therapeutic utility of these substances2. The UK Royal College of Psychiatrists has gone further and stated that psychiatrists should be involved in their future therapeutic use and in the clinical leadership of multidisciplinary teams3.
Why should psychiatrists care?
First, patients are increasingly hearing about psychedelics and their potential healing value. As their psychiatrist, you may be the one professional your patients trust most. It is only natural that they may turn to you to make sense of this landscape. What would you say when a patient asks whether psychedelics could help with treatment-resistant depression, or when they ask for your opinion about the Costa Rica retreat they just booked? This is your opportunity to discuss risks, expectations, medication interactions, and contraindications. When the stakes are high, knowing how to respond or who to refer to becomes a form of care.
Second, the research is no longer peripheral. Major psychiatry journals and organizations are engaging the topic seriously. The British Journal of Psychiatry has published guidance and reflections to support psychiatrists as this area evolves. Likewise, in the United States, the APA has issued a Position Statement on the Use of Psychedelic and Empathogenic Agents4. Although the matter is far from settled, the subject has matured enough that informed clinicians can no longer dismiss it as fringe, especially when suffering patients are paying attention.
Third, people interested in using psychedelics need the involvement of their psychiatrists. This area of mental health care should not develop without psychiatric input. Guides, therapists, sitters, and ceremonial practitioners may all benefit from psychiatric expertise. Psychiatrists are especially well-positioned to contribute diagnostic clarity, assessment of comorbidity, medication expertise, adverse-effect monitoring, contraindication screening, harm reduction, and continuity of care.
This matters because psychedelic-assisted therapy is no longer confined to underground or countercultural spaces, and more people are willing to try it to address issues such as depression, anxiety, PTSD, OCD, and fear of death. However, as suggested earlier in this series, what can heal can also harm. That is why psychiatry should join the conversation. Not simply to approve or disapprove, but to bring clinical judgment, patient protection, and a broader view of care to an area that needs all three. The opportunity here is not only for psychiatrists to stay current. It is also for them to better support patients who are curious, hopeful, cautious, or already walking into this territory.
Over the years, I’ve worked with many caring psychiatrists who, while aware of the risks, also recognized the potential benefits of psychedelics and helped make ceremonies safer and more healing. Sadly, I’ve also been called to support people in the aftermath of experiences they pursued on their own, sometimes because they felt they had no place to discuss the issue openly. Of course, patients are responsible for their own decisions, but having informed professionals in their corner can make a huge difference.
Psychiatrists do not need to slay, dismiss, or fear the dragon. But they cannot ignore it either. What is needed is engagement and a better understanding of the territory, if only because more patients are already looking in that direction. Your patients are counting on you.
Next: Fire and the Dragon. On the numinous quality of psychedelic work, and why awe and humility belong together.
If you are a psychiatrist, clinic, or training program curious about this topic, follow this series or reach out for a grounded talk, consultation, or educational offering on the subject.
- https://www.psychiatry.org/News-room/News-Releases/Special-Issue-APA-Journal-Psychedelic-Medication ↩︎
- https://www.ranzcp.org/getmedia/4cfd1fea-171c-43fc-8dab-7b476b3f706c/cm-therapeutic-use-of-psychedelics.pdf ↩︎
- https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/position-statement—ps02_25-pars-for-medical-use.pdf ↩︎
- https://www.psychiatry.org/getattachment/d5c13619-ca1f-491f-a7a8-b7141c800904/Position-Use-of-Psychedelic-Empathogenic-Agents.pdf ↩︎