Psychedelic-assisted therapy uses psychedelic substances combined with therapeutic support. Psychedelic assisted therapy is rapidly evolving field with some approved applications and many in research.
Current approved psychedelic therapy
Esketamine (Spravato):
- FDA-approved 2019
- Nasal spray for TRD
- Insurance covered
- Most established psychedelic-adjacent therapy
IV ketamine (off-label):
- Used in many clinics
- Not FDA-approved for depression
- Not insurance covered typically
Investigational/limited access
Psilocybin:
- FDA Breakthrough designation for depression
- Phase 3 trials ongoing
- Oregon legal program
- Colorado developing
MDMA:
- FDA rejected approval 2024 for PTSD despite Phase 3 data
- Methodology concerns
- Research continues
LSD, ayahuasca, others:
- Earlier-stage research
- Various contexts
Common features
Psychedelic-assisted therapy typically involves:
- Preparation sessions
- Dosing session(s) with therapist support
- Integration sessions
- Set and setting emphasis
- Therapist relationship important
Conditions being studied
- Treatment-resistant depression
- PTSD
- Substance use disorders
- End-of-life anxiety
- OCD
- Eating disorders
Risks and screening
Important considerations:
- Psychosis history typically excludes
- Bipolar disorder caution
- Cardiovascular conditions screening
- Drug interactions (especially serotonergic medications)
- Difficult psychological experiences possible
- Need for proper supervision
The legal gray zone
Various entities offer psychedelic services in unclear legal contexts:
- Religious exemptions claimed
- State-level legal programs
- Underground therapists
- Risks vary
Frequently Asked Questions
What psychedelic therapy is currently legal?
Spravato (FDA-approved). Psilocybin in Oregon. Limited contexts otherwise.
Should I try ketamine therapy?
For TRD, reasonable option in supervised settings.
Will MDMA-assisted therapy become legal?
FDA rejected 2024. Research continues. Future uncertain.
What about psilocybin clinical trials?
Active. Search clinicaltrials.gov.
Is psychedelic therapy a breakthrough?
Promising for some conditions but evidence still building. Not panacea.
The bottom line on psychedelic-assisted therapy
Field rapidly evolving. Spravato/ketamine established options. Other psychedelics in research with various legal status. Pursue through proper channels.