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UNC doctor studying how psychedelics can treat some mental illnesses

Research underway at UNC-Chapel Hill's School of Medicine is looking at a surprising way to treat mental illness — psychedelic drugs. In 2020, a lab run by Dr. Bryan Roth received a $27 million grant from the federal government to aid the research. Roth is a professor in the school's Department of Pharmacology, and he joins WFAE "Morning Edition" host Marshall Terry.

Marshall Terry: Just how can psychedelic drugs help people who are suffering from mental illness?

Dr. Bryan Roth
UNC-Chapel Hill
Dr. Bryan Roth

Bryan Roth: We don't know how they work, and that's a large part of the research that I do is try to find out how they might work. But the data that they are potentially effective in serious mental illness comes from a number of clinical studies that have been published over the past four or five years. They're preliminary studies but they're quite exciting.

And basically, what was shown was that a single dose, a single or two dose, two divided doses over several weeks of the active ingredient of the psychedelic mushroom psilocybin, also called magic mushrooms, basically was able to treat depression in seriously depressed individuals that had previously not found their depression adequately treated by their medication and or psychotherapy. And in follow-up studies, the majority of the patients were more or less depression-free at six months.

There's also evidence that they may be effective in treating anxiety, certain types of headaches, obsessive compulsive disorder. And, as well, there is a very nicely well controlled, what's called phase three clinical trial so this is a more advanced study, with ecstasy, which is not a psychedelic drug, which is commonly lumped into sort of that bit of psychedelic drugs, showing similar effectiveness in treating post-traumatic stress disorder. The effect of both of these medications is so large that the FDA has granted them breakthrough status for treating depression, anxiety and post-traumatic stress disorder. It's potentially transformative for the field.

Terry: What about the psychedelic effects of these drugs, the so-called tripping? How do you address that part of it is in patients? I mean, do they experience tripping?

Roth: Yeah. So they, so let me just say that I've not participated in any of these trials, so I can't speak first hand. But my understanding is while certainly the dose of psilocybin that they're given would be considered a large dose. And so they have what's described as a fairly intense psychedelic experience. And they're guided in the experience by at least two experienced clinicians sort of before and after. They have preparatory psychotherapy and then they'll have a debriefing session as well. It's similar for ecstasy. They have basically a full-blown experience. And then, you know, the next day or so, they're better. It's quite, quite astounding. And according to reports, they basically stay better for many, many months now.

Terry: Is it possible to take these drugs and remove the parts of them that cause the tripping and then just use that to treat the mental illness?

Roth: That's what my lab, among other labs, is currently trying to understand, as you can imagine, not everyone wants to, you know, even though they're afflicted with depression, not everybody would want to take a psychedelic trip to, you know, potentially remove their depression. And as well, there are a number of reasons why people can't take psychedelic drugs. So, for instance, if you have a first-degree relative with schizophrenia or some other serious psychiatric illnesses, then it's recommended that you not take psilocybin for the chance that it may cause an underlying propensity to schizophrenia to be manifested.

And certainly, you know, if we could have a medication that you didn't have to spend all day in a room listening to music with two guides, you know, if you could just basically take the pill at night and the next day you were fine, that would be more suitable to the vast majority of people. And so what my lab is trying to do is we're investigating how these drugs work at really the very basic level atomic and molecular level. We have clues that there may be ways that the drugs work that we can harness that are not psychedelic but might be therapeutic. So that's the idea that we're currently testing.

Terry: I want to go back to something you said just a moment ago about people who are taking doses of these drugs and they're sitting in a room and listening to music while they have these sort of psychedelic trips. And what kind of music do they listen to?

Roth: It's mainly classical music. The groups that do this have put together sort of a lineup of classical, spiritual music to help people guide. They found it to be optimal.

Terry: What are the legal questions raised with all this because psychedelic drugs are illegal in this country?

Roth: Yeah, so that's a great question. So it turns out that psychedelic drugs are in a class called Schedule I, which means that they have no recognized medical utility. And by definition, you know, let's assume the FDA approves them as medications for depression, anxiety, post-traumatic stress disorder and so on. By virtue of that ruling by the FDA, they now are considered to have a medical use, and they're no longer Schedule I. And so what that means is that they would be in a lower schedule. They could be prescribed by licensed physicians and other licensed health care providers legally.

Terry: What's something that you found in your research with all this that has surprised you?

Roth: So I've been studying psychedelic drugs and psychoactive drugs since the early '80s, basically, so I've had a longstanding interest in this area. The most unexpected things actually have been the clinical trials which have shown these really dramatic and unprecedented effects of psychedelics on, you know, illnesses that are very, very difficult to treat. And this is something I don't think anyone ever suspected. You know, it's really amazing that these drugs have, you know, potentially have this effect. And we're trying to understand how that might be so that we can ultimately create safer and more, even more effective medications.

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Marshall came to WFAE after graduating from Appalachian State University, where he worked at the campus radio station and earned a degree in communication. Outside of radio, he loves listening to music and going to see bands - preferably in small, dingy clubs.