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Ayahuasca, magic mushrooms and psychiatry: an interview with Dr. Simon Ruffell

Psychedelics, plant medicine and ceremonies in the Amazon jungle — could this be the future of psychiatry? Ayahuasca, a brew of plants native to the Amazonian region, has been widely used in traditional indigenous medicine. The body of evidence for ayahuasca keeps building, with promising effects in anxiety and depression, in the short and the long term.


Disclaimer: This blog is by no means an endorsement, nor is it advocating illegal activities. It is purely a discussion about the growing interest in psychiatric research on the potential of psychedelics in novel treatment approaches in mental health. It should be noted that the use of recreational drugs such as psychedelics is, under law, a criminal activity. Psychedelics should only be used within the legal framework of one’s county and under the supervision of a clinician expert in their use.

 

Inspire The Mind is no stranger to psychedelics, we have recently published an overview of the history and evidence on the use of psychedelics in psychiatry and we have also introduced our readers to what is known about the new trend of microdosing. If you have read my previous blogs on the potential of yogic practices and the power of nature on mental health, you won’t be too surprised that I am also fascinated by plant medicine and its potential in psychiatry.


I’ve been talking to Dr. Simon Ruffell, a psychiatrist and researcher who has spent the last few years conducting studies on psychedelic drugs in the realm of psychiatry. Simon is based at the Maudsley Hospital in South London where he works clinically as a psychiatrist. Simon is currently completing his PhD looking into the Amazonian use of ayahuasca and its psychological effects, as well as working as a Senior Research Associate at King’s College London looking at the use of psilocybin in treatment resistant depression.


I started by asking what the most interesting finding of his research in the last few years is.


A rare moment of the call where my terrible internet signal allowed us to have our cameras on!

Simon: One of the most exciting things that we’ve seen in the effects of ayahuasca on mental health are improvements in areas such as depression or anxiety. Depression and anxiety scores seem to not only be affected in the short term — immediately after ayahuasca retreats, but we’re beginning to find that these improvements are maintained at our long-term follow-up (which is a 6 month follow-up), and that’s without taking any additional psychedelics. And so that in itself is really exciting!


Carolina: Did the participants in your research have any previous experience with psychedelics? Was that something you controlled for? I’d imagine that someone would participate in that kind of research has a predisposed openness that might mean that they might respond to treatment differently.


Simon: This is definitely true, the research that we do is observational in nature. The set up that we have is a research centre based in the Amazon rainforest where the participants come to do Ayahuasca retreats so obviously there’s a certain type of person that goes to the rainforest to participate in these retreats…so there is a big bias when it comes to the sample that we’re collecting data from. And that’s something that we need to be aware of when doing this research.


Ayahuasca Healing Empowerment Course, Photo by the Ayahuasca Foundation

Carolina: You had a paper come out a couple of months ago on Psychopharmacology, on the effects of ayahuasca in personality: “Modulatory effects of ayahuasca on personality structure in a traditional framework”. In this paper you investigated short- and long-term effects on personality traits after ayahuasca administration. Can you tell us a bit more about the findings?


Simon: We found that neuroticism (a personality trait associated with emotional instability) decreased both in the short term and in the long term, and agreeableness (a personality trait associated with empathy and altruism) slightly increased in the short term. We weren’t too surprised to find that neuroticism decreased, after spending two weeks in the forest, unplugged from society, spending some time with yourself.


What was particularly interesting was that 6 months later, when the participants had returned to their normal lives, those decreases in neuroticism were maintained. In the future we would like to look at even longer term follow up.


We also found that the decreases in neuroticism were linked to the degree of mystical experience- the participants thought that they had undergone — which is a broad term to describe overarching connectedness to everything, to the universe, having an appreciation of nature.


Carolina: So interesting and so challenging as well to then potentially try to embed it in clinical practice, which takes me to my next question which is: as a psychiatrist where would you see your research transform everyday practice, where do you think, in an ideal world, things could change?


Simon: This is a great question. We are running clinical trials using magic mushrooms (psilocybin), based at King’s College London. You don’t need to go to a shaman in the jungle like with an ayahuasca ceremony. For example, you can have people with treatment resistance depression, being referred to a special unit, through the NHS and being offered treatment with psilocybin. We may well see that within the next few years. That all depends obviously how the rest of the research goes.


When it comes to ayahuasca it’s not quite as simple. The main component is DMT, dimethyltryptamine, which is a serotonin receptor agonist (at a molecular level, works similarly to anti-depressants) and that’s very similar in structure to psilocybin. The main difference comes with the tradition surrounding ayahuasca: there’s a huge emphasis put on the ceremony, put on the role of the shaman, and for many people that involves going to the jungle. I don’t think that we’re going to see ayahuasca with a shaman in a ceremony on the NHS any time soon. And, you know, maybe we shouldn’t, but I think that there’s certainly could be a role for it as an alternative therapy. Perhaps a little bit like we see acupuncture used in the west, where it can’t be prescribed on the NHS but it’s part of complementary and alternative medicines.


It’s quite a good comparison because over the last year or two we’ve began to see plant medicine decriminalised in many places around the globe. A good example would be Oakland in the US and in Brazil you can legally drink ayahuasca for religious reasons, and in Peru you can drink ayahuasca for similar reasons too.

Carolina: Okay so what are the biggest barriers in conducting research with psychedelic drugs? Is it the strict regulations around these substances? Is it recruiting volunteers?

Simon: There is a problem when it comes to diversity, recruiting a diverse population. And that’s not just with psychedelic research but I think it’s a problem with research in general. It appears to be a very, kind of white, male dominated culture, and there’s a big lack of other people in research.

There is a hell of a lot of red tape, and when it comes to using psychedelic substances, I know that many studies looking at specifically psilocybin have been massively delayed due to this. I think getting the work taken seriously is quite a big thing. That’s beginning to change now, because of psychedelic research departments in places like King’s College and Imperial College London. But it’s still seen as quite leftfield, and maybe quite rightly so, we’re still in the early phases of this research.

It’s easy to get carried away and excited about this work, but then equally it’s easy to discredit it, and just thinking that psychedelics are just something that were used by the hippies in the 60’s.


Carolina: My next question is about misconceptions around using ayahuasca. There’s a lot of buzz around the potentials, especially for depression, of using ayahuasca. I’m sure you also want to give a balanced view of limitations, in terms of what can be expected clinically, and the cautions.

Simon: It’s quite easy for people to think of ayahuasca as a magic bullet, I mean there is no magic bullet. There are certainly conditions that ayahuasca can help more with, and conditions that it should probably be avoided, at least through a western lens. Ayahuasca is particularly good for conditions like depression and anxiety, things related to trauma, and in my experience things related to neurotic conditions.

We need to be particularly careful when dealing with conditions that may result in psychosis, so that can be anything from schizophrenia to bipolar disorder and personality disorders. There certainly have been reported cases of people having negative experiences when they suffer from these conditions. But again, this is a western way of thinking about treatments, and if we looked at it through the paradigm that the Shipibo’s use in the jungle, they would certainly have a different way of thinking about mental illness and treatments. They wouldn’t necessarily perceive, for instance, psychosis, in the same way that we do. That’s getting onto a whole other area, transcultural psychiatry (branch of psychiatry that focuses on with the cultural, ethnic and geographic context of mental disorders diagnosis and management).

Carolina: Just to close this I wanted to ask you, is there anything else you’d like to close this interview with?

Simon: I’d like to say a thank you to the rest of the research team, who’s Nige Netzband and WaiFung Tsang. We have been doing this work together for the last five years. And then also more recently we’ve started looking at epigenetics — so the way that DNA is expressed as a result of ayahuasca — and I’d like to say a big thank you to Professor Celia Morgan, Emma Dempster and Merlin Abraham. That later study looking at epigenetics, depression and anxiety should be coming out soon! I will keep you posted.


 

Thank you, Simon, for your time and we’re looking forward to hearing more about your research! Thank you, Celeste, for the excellent job of transcribing this interview!

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