Mushrooms on Empathy with Cory R. Weissman
Alisa Nappa
Do mushrooms make you more empathetic and social? Today we sit down with Cory Weissman to discuss his latest paper "The effect of psilocybin on empathy and prosocial behavior: a proposed mechanism for enduring antidepressant effects". We talk about the general benefits of mushrooms, some people who this might not have an effect on, suicidality, and more. Tune in and Shroom in to today's episode!
Here is a link to their research pre-screen ( Most of their trials is in brain stimulation): https://psychiatry.ucsd.edu/research/programs-centers/interventional-psychiatry-research/research-trials.html
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TRANSCRIPT
Unknown Speaker 0:00 Alex, Unknown Speaker 0:12 welcome, welcome. You are listening to the mushroom revival podcast. This is your host, Alex store, and we are absolutely obsessed with the wild and wacky world of fungi and mushrooms, we bring on guests and experts from all around the globe to geek out with us and go down this mysterious rabbit hole to try to figure out what the heck is going on with these fungal friends of ours. And today, we have Corey joining us to talk about how psilocybin can affect our mood and how we relate to other people and show up in the world and be empathetic and a good human being, hopefully. So Corey, how you doing? Man, Unknown Speaker 0:50 good, good, very good to be here and to be with your audience. Unknown Speaker 0:54 So for people who don't know you and your work, what are you up to in San Diego? Unknown Speaker 1:01 Yeah. So I'm a psychiatrist. So Unknown Speaker 1:04 full name, Dr Corey Weissman. I've been in San Diego for about three years, and I work at UCSD, so University of California, San Diego, and over here I am the medical director for interventional psychiatry. So what that means is I kind of oversee the interventional treatments for psychiatric patients with severe mental illness, so severe depression, severe suicidality, schizophrenia, bipolar disorder, drug use issues, And I help manage our ECT, TMS ketamine program, Unknown Speaker 1:42 but kind of on the side, I've had this interest in psychedelics, and I'm involved in a couple of clinical trials in psychedelics as well. So I'm helping to kind of build the psychedelic portfolio of UCSD, and try to kind of bring it, at least the clinical trial work into the mainstream and into our pro our program and our portfolio. So that's kind of me and what I do day to day. So I'm mostly dealing with patients with severe mental illness, mostly using FDA approved treatments, but I have my own research portfolio, and part of that is in psychedelics, and happy to talk about that work today. Unknown Speaker 2:22 Yeah, Unknown Speaker 2:24 before we get into it, I'm just curious how you originally got into this work, and I know you have an interest in mushrooms, in that that treatment protocol, but how did you get into mental health work, and specifically mushrooms or psychedelics as a whole. Unknown Speaker 2:43 Yeah, it's a long story, Unknown Speaker 2:48 multiple stories actually kind of coming together over over time. Unknown Speaker 2:54 I guess for me, it goes back to medical school. I had an interest in internal medicine, and then I was exposed to the clinical neurosciences, brain science and Unknown Speaker 3:06 neuroanatomy and how the brain functions, and this was a while back now, over 10 years ago, and I had very little exposure to that beforehand, and So being exposed to that both from a theory, theoretical perspective and a clinical perspective, and then doing a little bit of reading and neuro philosophy on my own, Unknown Speaker 3:30 I had a pretty clear sense I wanted to either be a neurologist or a psychiatrist, and I ended up spending a lot of time doing Neuropsychiatry, which is kind of like the overlap of those two fields. Unknown Speaker 3:43 So that was where the clinical interest came from. And then Unknown Speaker 3:47 I ended up in psychiatry residency in Toronto, Canada. I'm a Canadian originally, but here in San Diego now and in the early days my residency program, Unknown Speaker 3:59 there were some of the the more modern, I guess, revivalist type studies, modern studies looking at the use of psychedelics in clinical population psychiatry. And I thought it was super fascinating. And then, you know, parallel to that, I started doing some own, some of my own reading into like, you know, Ken Kesey stuff and that whole counterculture era back in the 60s, and the original psychedelic studies that were done in the 50s and 60s. And me and my my buddy and my residency program at the time, we decided to start a psychedelic interest group for our residency body. We had a pretty big residency, about 3035 residents. So in terms of psych residencies, that's actually pretty big. And we had Robin card Harris, who at the time was not very well known, just starting to figure out his niche in psychedelics and lead some clinical trials. We had him come out to Toronto and. Unknown Speaker 5:00 Give a talk to our group and to the residency audience, and we went for dinner with him, we chatted about things, and Unknown Speaker 5:07 I think around that time, it kind of cemented in my mind I wanted to continue to pursue research in this area and to develop our our interest group, and we grew our interest group, and we had people from outside University of Toronto join us, and we published a few papers on psychedelic micro dosing, which was an interesting experience. And then I developed my niche in the the scientific area of suicidality and suicide prevention, specific to brain stimulation, and parallel to that, again, I was continuing to do my own reading and research in psychedelics, and I worked with a few trainees to publish a few papers on the effects of psychedelics on suicidality. Unknown Speaker 5:54 So that's kind of how my interest began and how it sprouted, and it's evolved since that time. But that's, yeah, that's my, I guess, my origin story of my connection to mushrooms in this whole field, Unknown Speaker 6:07 and I, I know you through your, your kind of Unknown Speaker 6:13 research overview paper about the effect of psilocybin on empathy and pro social behavior. Unknown Speaker 6:20 For people who haven't read that paper, can you kind of give it a brief synopsis of of your findings and what the paper was about, Unknown Speaker 6:28 for sure? Yeah. So this is one of the more recent papers that I published in this area, and this was really led by a senior resident that I work closely with, Dr Kush bot. He's a senior resident here at UCSD, and he's also involved in our clinical trials here at UCSD as well. And so in this paper, Unknown Speaker 6:48 he had the idea of wanting to put together Unknown Speaker 6:53 a cohesive theory of how psychedelics are exerting their effect, specifically in individuals that that have depression. There's been a little bit of pilot data coming out over the past number of years which have shown some positive signals for the efficacy of psilocybin and depression so its ability to reduce depression symptoms and to do that over to up to a span of about six months after an individual session, which is pretty remarkable. The magnitude of improvement with psilocybin is not that unique. What's unique about it, I think, in the Depression population, is the length of time of someone staying in remission, of being well Unknown Speaker 7:39 beyond just one session or two sessions, and so this paper kind of explores that a little bit. And in this paper, we look at the concepts of empathy, different forms of empathy and affect or emotional states, and how those things can be catalyzed by psychedelic or psilocybin sessions, and then how there could be some sort of feedback loop in that these things coming together can lead to increases in pro social behavior, and the pro social behavior being like positive interactions with the people around you doing positive things for your community or the people around you, can then loop back and lead to more positive affect and more feelings of empathy with the people around you. And through this positive feedback loop, there could be an enduring antidepressant effect, and the key word there being enduring, because what we know around positive feedback loops is that they kind of build on each other. They're self generating. And so our thinking in this paper is maybe psilocybin, for some individuals with depression, is catalyzing this kind of positive feedback loop, which is then Unknown Speaker 8:56 its own sort of entity, in a sense, which leads to an enduring antidepressant effect, which can last more than six months. It's just a theory, but, you know, it's it was interesting to put this together and look at some of the source literature Unknown Speaker 9:12 pointing towards this. And so that's kind of this paper in a nutshell. Unknown Speaker 9:19 What I thought was interesting. I've never heard of positive empathy versus negative empathy. To me, it just was a general term empathy, you know, Unknown Speaker 9:29 could you? Could you describe the difference? Unknown Speaker 9:33 You know, there's a quote from the paper. It said differential activity appears to be dependent on contacts and effective valence, ie, positive empathy and negative empathy. So for people who don't know what those two terms mean and kind of what your key findings on the effects of Unknown Speaker 9:51 psychedelics on positive versus negative empathy? Unknown Speaker 9:56 Yeah, for sure. So you know, there's a lot of technical terms. Unknown Speaker 10:00 There, but they're just trying to use scientific language to explain something that I think is fairly basic. So, you know, empathy, the idea around empathy is that it's the concept of Unknown Speaker 10:15 relating to a person around you, in a sense, and Unknown Speaker 10:21 when we speak about the valence of that, Unknown Speaker 10:24 it means, basically the positivity or the negativity. Valence is just a way of describing a specific kind of spectrum. And so Unknown Speaker 10:34 when we think about positive versus negative empathy, the positive empathy has to do with the valence of the affect, and affect with an A is just another word for kind of emotional state. So there's positive emotional states, happiness, hope, joy, there's negative emotional states, fear, depression, sadness, anxiety, and so we can empathize with things in the positive side or the negative side, we can do both of those things, and it's possible. And in the paper, we talked a little bit about this. People who are depressed, they might have increases in empathy on the negative side, or they may have decreases in empathy on the positive side. There might be some combination of those things happening, and some people might have one or the other. Some people might have a combination of both those things. Unknown Speaker 11:29 And so with psilocybin, we're thinking that it can increase levels of empathy, and most of the studies that we're citing are showing increases in positive valence, positive affect Unknown Speaker 11:43 related to that sort of empathy, but it's possible, and when we think about kind of like bad trips or challenging experiences, that part of that could be increases in negative empathy. So these are the kinds of concepts we explored in the study. And I hope that answers your question, yeah, you know, I'm really curious about, Unknown Speaker 12:06 you know, the different balances of positive, empathy versus negative. And from what I've heard, and from my personal experience, I feel like, you know, younger generations now have just so much access to information in the world and and so many we're just constantly bombarded by a lot of negative news, you know, like rape and war and genocide and, you know, wealth inequality, Unknown Speaker 12:34 biodiversity loss, etc, etc. We're just like, constantly bombarded by that. And I've experienced this. I know a lot of people have expressed this just like empathy overload, and they're just exhausted by feeling terrible for all the injustice in the world, right? And so I'm curious, do you think that Unknown Speaker 12:56 there it's just an overload of negative empathy, and with the with the help of psilocybin, it will kind of address those balances and kind of increase positive empathy to kind of help those feelings of depression caused by that negative empathy overload. Does that make sense? Unknown Speaker 13:16 Yeah, Unknown Speaker 13:18 yeah. These are the questions of our time. These are, these are difficult things to ponder. Unknown Speaker 13:26 Yeah, and I know the Surgeon General, he just came out with Unknown Speaker 13:31 warnings around the use of social media and kids and the negative effects, and that probably touches on some of the things you're saying and and Unknown Speaker 13:41 expanses of negative empathy that kids are kind of developing because of what they're exposed to on social media and how that affects their their mental health. And, you know, development of things like depression, anxiety, suicidality, Unknown Speaker 13:56 there's probably some overlap there, you know, I, I think, you know, there's always been, throughout human history, Unknown Speaker 14:05 these things happening, terrible things happening in the world, but our access to witness them day to day is, you know, it's, it's skyrocketed exponentially. And so I agree with the Surgeon General on trying to cap the accessibility of these things to our kids and to youth, especially because, you know, they're in a developmental stage where, you know their frontal cortex, that part of the brain that really helps with managing and filtering what's what's relevant and what's important to the individual, and what can they manage as an individual that's not fully developed yet, and so, Unknown Speaker 14:51 you know, I wouldn't recommend adolescents or teens go use mushrooms to help them cope with the increase in all this distress. Unknown Speaker 15:00 Around social media use and all that, but Unknown Speaker 15:04 we do need to come up with ways to limit the negative effects of social media and to Unknown Speaker 15:12 bring some more normalcy into kids lives. When I say normalcy, I'm thinking like, you know, growing up back in the 90s or 80s, when Unknown Speaker 15:21 life was a little bit more simple, less access or no access to the internet, Unknown Speaker 15:28 yeah. But for adults, you know, it's also an issue. Unknown Speaker 15:34 I see a lot of patients who struggle with social media and phone use, who have severe depression, and it probably is a positive feedback loop in the negative sense. And for some of these individuals, Unknown Speaker 15:50 you know, psilocybin or a psychedelic could potentially be a treatment option for them. You know, I would only advocate for that within the context of clinical trials at this point, but it's moving in the direction where I think there will be FDA approval of some form of psychedelic for some patient population. And these drugs work differently than most of our other interventions, and so Unknown Speaker 16:18 I'm excited to see how we can use these tools to help manage some of these modern issues that we're facing that you brought up. Unknown Speaker 16:29 So I have another very complicated question that I I expect you to have an answer to, but, um, you know, on the on the complete flip side, you know, I read an article recently, I think it was double blind or something like that. I can't remember who who wrote it or where I read it, but it was talking about how they believe that a lot of psychedelics can be amplifiers, not healers, in some senses, where, if you already have a Unknown Speaker 16:57 existing belief Unknown Speaker 16:59 and you don't prepare and integrate properly, it could amplify that belief, for example, if you Unknown Speaker 17:08 maybe have a ton of positive empathy but zero negative empathy, and you're kind of spiritually bypassing yourself, and you're like, it's all good, we're all one love and no bad vibes. And, you know, like that kind of mindset of, Unknown Speaker 17:22 yeah, you could leave, or you're kind of leaning towards narcissism, and you're like, I'm God, and then you have this trip where you're like, you leave that experience being like, no, no, I'm divine, I'm God. And it Unknown Speaker 17:35 kind of amplifies that effect, right? And so on the flip side, I'm curious what your thoughts on that are like, Could Do you think that, depending on the person? Could it amplify it in the other way, where Unknown Speaker 17:53 you know some people? Yeah, I'm just curious on your thoughts on that, like Unknown Speaker 17:59 on me. I don't know if positive, too much positive empathy and too little negative empathy is the cause or or what it is, in your opinion? Yeah, Unknown Speaker 18:10 I would just be kind of speculating at this level. But Unknown Speaker 18:15 I think you can break that issue down in different ways. And in in psychiatry, we're always trying to think of things on multiple levels. So there's the we have a clinical level, which is our like bread and butter, of what we hold on to, and what we're trained in specifically. But we also need to be experts in the psychological level, in the biological level, how it overlaps with medical issues. And I think what you're kind of getting at is around patient populations that are suitable for these kinds of clinical trials and for these interventions. And you know, all the modern clinical trials have, for the most part, excluded people that have psychotic disorders or bipolar conditions, and so that psychological realm, which I think of like mania, as kind of being, Unknown Speaker 19:10 you know, Unknown Speaker 19:12 similar to what you're saying, those kinds of, those kinds of patients, tend to be excluded from clinical trials. And these are people that probably should not be going for these kinds of experiences, psychedelic experiences, because, you know, we don't have a clear sense of what these drugs will do to these individuals. And yes, most of the most of the modern research has kind of looked at psychedelics as mind expansion tools, as tools that can decrease prior beliefs, but that's in within a specific group of people that's been in Healthy People, depressed people and other other patient populations in which we generally think of them as more. Unknown Speaker 20:00 Uh, constraining type conditions. You know, the anxious depression OCD axis is very different than the bipolar psychosis axis, and in patients that have those specific conditions, it's quite possible that psychedelics would do something completely different and potentially do something like what you're saying, Unknown Speaker 20:19 build upon some sort of positive affect in a pathological way, Unknown Speaker 20:26 and leading to them developing these kinds of ideas of grandeur or manic type symptoms, and that could be dangerous in its own way. So we always say, you know, these things are not panaceas, and this is like a reason, a textbook reason as to why we wouldn't think that the fantasy is but having said that, you know, there were studies back in the 50s and 60s where they gave psychedelics to individuals with schizophrenia and individuals with bipolar disorder. And from my memory of reading some of these articles, there were a lot of cases of individuals who did improve with psychedelics. Unknown Speaker 21:04 There were cases individuals who jumped out of windows too. So Unknown Speaker 21:09 clearly, there were issues with those studies back then. But you know, I think as the science develops and the field develops, there will be specific Unknown Speaker 21:20 situations. Unknown Speaker 21:23 And use cases to borrow, like an engineering term Unknown Speaker 21:28 to eat for these, these kinds of compounds for individuals that have other psychiatric illnesses. So, Unknown Speaker 21:36 yeah, that's a long winded way of saying yes. It's it can be dangerous for certain people, and that might Unknown Speaker 21:43 be why I haven't seen any paper specifically on narcissism. But I don't know if you've come across of anything that's one that has been fascinating to me. I don't think I've, like, really ever interacted with someone who is, like, clinically narcissistic until like, a couple years ago, and it was the most fascinating thing to me. I was just like, you don't have empathy. Like, I can't, I shouldn't, like, wrap my head around it. I was like, wow, you you're like, Well, do you mind sharing what? Who was it? What happened? Oh, yeah, let me name drop, right? You know. Unknown Speaker 22:19 No, it's just, you know, and I think that's why, like, people are fascinated by these, like, serial killer documentaries on Netflix. It's like, holy shit. Like people out there are like that, like, I can't wrap my head around it or my heart around it, like, how, yeah, like sociopaths exist where it's just like, You're that cold and you don't have any empathy for another person. So long winded, way to ask, like, I don't know if there is any research on that, like people who have little to no empathy. Unknown Speaker 22:53 And you know, if there isn't any research, do you have any hypotheses on what you think would happen, whether you think it would help their empathy, or are there cases like you just feel like, yeah, they're they Unknown Speaker 23:09 just don't have empathy and there's no way to get it back, kind of thing. That's Unknown Speaker 23:14 a good question. Unknown Speaker 23:16 I think we can get some indirect answers to that through a couple of papers that are actually cited in the main topic of our discussion today, looking at how psychedelic use has affected individuals who have offended and are in jail, and levels of recidivism for those people, because in general, the jail population has a higher level of sociopathy and a higher level of what we call anti social traits. So, you know, anti social personality disorder is a specific personality disorder which is closely tied to narcissistic personality disorder and ASPD antisocial tends to be relatively common in the forensic population and in in patients. And there's people in general who go to jail. And so in those studies, which I think were survey studies, so the evidence isn't great, but it showed that people who, on their own, had used psychedelics at some point in their life, tended to have, Unknown Speaker 24:27 I think it was lower rates of recidivism and lower rates of of future crime. I think that's what they found in those studies. So that kind of indirectly answers that question, because you would, you would imagine that these individuals have lower rates of empathy, whether it's, Unknown Speaker 24:47 you know, implicit or explicit empathy all probably all levels are slightly lower, Unknown Speaker 24:55 but those are complex areas, and once you get to the point of dealing with individuals that. Unknown Speaker 25:00 Severe sociopathy, then this is not my area. But, you know, some of them have very high levels of empathy, from what I understand, but it's, it's, it's almost twisted in a pathological way, which is right, right? Yeah? Why they're so good at manipulating and things like that, that makes sense? Yeah? Because I hear people all the time. They're like, Oh, if, if only, you know, all the the world leaders and politicians took mushrooms, like the world would be a better place. And I'm like, Well, I don't know. Like, I don't, yeah, it's a good question. Like, what would happen, right? And I feel like I am super curious to to Unknown Speaker 25:40 find out more about, you know, like bipolar or narcissism, or like these kind of outlier pre existing mental states and the effects of like, could mushrooms help? Or would it just make it worse and kind of amplify that pre existing state? Or would it have kind of no effect, or kind of, like, how you ended off? Like, could it actually give them more empathy and be more manipulating? You know what I mean? Yeah, like, could it twist it even more in a weird way if they didn't integrate it properly or whatever? I don't know. I don't have an answer. I don't think we, any of us, do, but it's a good, it's a good question that I ponder, like, what would happen if it ate mushrooms to all the world leaders? I don't know. Unknown Speaker 26:28 Yeah, I don't know. Either, I don't know. And I think there's a bunch of them that probably wouldn't want to take them, right? Yeah, yeah. Oh, Unknown Speaker 26:38 but yeah. It's, it's an interesting thing to think about and hypothesize about. Unknown Speaker 26:44 So, yeah, Unknown Speaker 26:47 no, go on. You're about to say something. Well, you kind of touched on other conditions too, like autism, you know, dementia, and could there be roles for Psalm aside man or other psychedelic treatments for these conditions. And Unknown Speaker 27:03 we don't have an answer to that those questions yet either, but I think there are groups looking into that. And so I think that would be the next lower hanging fruit, Unknown Speaker 27:14 because obviously individuals with autism, they struggle with empathy too. That's a it's a major core feature. And so that would be interesting to see if, if psychedelics could help some of them Unknown Speaker 27:28 in terms of their day to day interactions other people and their ability to function. So, Unknown Speaker 27:36 right? We'll see Yeah. Next five years, I think we'll be telling Yeah. It is also interesting. I feel like with, Unknown Speaker 27:45 probably, except for dementia, maybe I feel like every, you know, with autism and and even like narcissistic traits, and, Unknown Speaker 27:54 you know, bipolar and things like that, it it seems to me and correct me. If I'm wrong, you're you're definitely the the professional, but it seems like they're all kind of on a spectrum, and we're all somewhere on the spectrum, and some people are just like, way further along. And so they can kind of be classified as like, yes, they're. They are clinically this definition. But is that a correct understanding that it's kind of like a spectrum specific to autism. You're saying, Unknown Speaker 28:28 I've heard it definitely with autism specifically. But even with depression, it feels like there's, like clinical depression, right? But then there's, you know, I feel like people get depressed all the time, and people get sad, and I feel like people are all on the different levels of of the charts. Would, would that be a correct assessment, in your opinion, or Unknown Speaker 28:54 sort of, yeah, I think, Well, it's complicated. It's depends what you're what we're talking about. Yeah, it depends on the condition, but Unknown Speaker 29:04 yes, different conditions have, you know, have spectrums as part of their phenomenology Unknown Speaker 29:13 and how they're described. Unknown Speaker 29:16 You know, we in psychiatry, we define things by a biopsychosocial and spiritual model and all those things can come together to engender some sort of psychiatric condition. I think you know, going back to your question on the spectrum and how it relates to different conditions, Unknown Speaker 29:37 it becomes more murky when we look at individuals that have very mild issues, so individuals with very mild depression, Unknown Speaker 29:47 mild issues with abilities to relate to people and emotionality and connection to others, Unknown Speaker 29:55 that's where it becomes a little bit more difficult to define. You know, we use the. Unknown Speaker 30:00 See the DSM as our way to diagnose conditions. The DSM is based off of a large body of evidence, but there are very few actual biological biomarkers to diagnose conditions, and so for the vast majority of individuals that develop depression, as an example, we use just basically what the individual is telling us and our own clinical experience to define if the person is truly depressed or not, and for someone that is severely depressed or moderately depressed, it's much easier to make that distinction. And you know, people use these terms in everyday language too. So it becomes confusing and say, Oh, I was depressed yesterday, or I was, you know, I was down the other day. And rarely is that a clinical depression. You know, clinical depression is something that is fairly pronounced where someone really becomes a different person for more than two weeks and has a whole host of symptoms. And it's, it's usually episodic, Unknown Speaker 31:04 but yeah, it's, it's overall, it's, it's, it's complicated, and a lot of the research we're trying to do is to develop biomarkers to help better differentiate these things and to help with our ability to diagnose, and I think that that will also help lead to better treatment, prediction, and the whole world of psychedelics and the research around that will fit into that, I think, in the future. Unknown Speaker 31:30 And so what has been your research on, and also other other research in the field right now, on psychedelics, on suicidality, and as a as a follow up question to that, I'm curious, Unknown Speaker 31:47 because suicidality is so tricky, and these psychedelics put people in a very vulnerable state, and kind of amplify feelings and traumas and stuff Unknown Speaker 32:00 I've heard from a lot of clinicians that Unknown Speaker 32:03 they will not administer psychedelics on someone who is suicidal, and you have to use talk therapy and other things to get out of that state and then do the psychedelic therapy, Unknown Speaker 32:16 because you're worried that it might amplify that to, You know, they jump out a window, right? So just curious on the current research, and then your Unknown Speaker 32:26 your opinion on like, when is the best time for someone to take psychedelics when they are feeling that way? Unknown Speaker 32:33 Yeah, those are some great questions. Unknown Speaker 32:36 I will preface my answer by saying this goes back to things we're talking earlier. Unknown Speaker 32:43 All the modern psychedelic clinical trials have involved a form of psychotherapy. So it's, it's psilocybin or psychedelic assisted psychotherapy. It's a package. And so you, you need to have the therapy as part of it. It's, that's just how it's been developed. And Unknown Speaker 33:01 we there's been, I think, very few, if any, studies lately looking specifically at the use of psychedelics, and I'm talking about, like, high dose, strong levels of psychedelics without any form of therapy. And so those things are, are at this point we think necessary and essential for a safe experience. And that's especially true for individuals that have heightened levels of suicidality, because there are different forms of therapy like DBT, CBT, dialectal behavioral therapy or cognitive behavioral therapy that work well to help reduce levels of suicidal ideation, suicide risk, and there's elements of those therapies that are worked in to the psychedelic system therapy model. And so those are things that are essential. Unknown Speaker 33:46 So I, you know, therapy isn't, is needed. You know, set and setting is something that we've in the psychedelic science space we talk about, even though it comes from, you know, a different, different field of inquiry. But Unknown Speaker 34:05 those things are, I think, are essential when we talk about suicidality and and managing it. But as I was going to get to before, having said that Unknown Speaker 34:16 most of the, and I actually think all of the modern clinical psychedelic trials have excluded individuals that have any elevated suicide risk, and so we do not have any great data on the effects of psychedelics on suicidality from modern research. And the research done in the 50s, 60s, 70s was not very well done, so going Unknown Speaker 34:41 to your question about the research that we've done. So we did a systematic review and did a meta analysis, synthesizing all of the evidence of the effects of psychedelics on suicidality Unknown Speaker 34:54 up to, I think, we published in 2021 so there's been a few publications since. But. Unknown Speaker 35:00 We looked at the relationship between suicidality and psychedelics outside of clinical trials, and then we looked at that relationship inside clinical trials. And then we also divided it further, just to make it complicated, into older research, so the first wave of science, and then modern research. And so what we found in general was that Unknown Speaker 35:25 when we look at the older research, psychedelics being used outside of clinical trials, was very dangerous when we look at suicidality as an outcome, and that's where the case reports around suicide deaths Unknown Speaker 35:40 really led to popularization in the media, and the was part of the drug war and all of that stuff. It's related to that. But when we look at clinical trials done back then, there actually was a signal for some effect to reduce suicidality in those patient populations. They weren't trials that were that were well done, and it was mostly kind of case series, and a lot of it was patients getting treatment against their will. I didn't even know what they were getting. So we don't do any that stuff today, but if we look at the modern research, though, and there's been some very nice, very large studies based off of National Drug surveys and other very large repositories of survey information. And there is an association, Unknown Speaker 36:28 I think Hendrix is the author who published a bunch on this. There's Association showing decreases in levels of suicidality and previous psychedelic use. So that was, you know, survey data is not good data, but that was something that I think it was encouraging for a potential positive association between psychedelic use and decreases in suicidality. And then we published a meta analysis looking specifically at the individual level, patient outcomes in suicide, items in depression scales. So when you do a depression trial, use validated depression scales, and in these scales, one of the items is usually a question around level of suicidal ideation. So it's not the best measure, but it's, it's rigorous in that it's, it's used throughout the trial, and it's standardized, and it's the same rater, and it's done on a specific time scale. And so we can tease out that that suicidal ideation item and the Depression Scale and see how it tracks over time for each individual across different clinical trials. Some of them were open label trials, so no control, no placebo some of them were crossover. Some of them had placebo control. And so when we look specifically at just the patients getting psychedelic treatment, LSD, psilocybin or ayahuasca, mostly, and Unknown Speaker 37:50 the level of suicidal ideation, we saw pretty consistent decreases in suicidal ideation across those trials, Unknown Speaker 37:59 I think, peaking at around several weeks out from their session, and still significant six months out. So similar to what we were talking before, around depression outcomes and long lasting levels of positive empathy, there seems to be long lasting positive effects on levels of suicidal ideation, Unknown Speaker 38:20 which is one component of suicidality. Suicidality is its own whole thing, but suicide ideation is one aspect of it which is a treatable component that we're trying to reduce. Unknown Speaker 38:32 Since that publication, there's been a few other papers that have Unknown Speaker 38:37 looked at Unknown Speaker 38:39 levels of suicide ideation changing over time in Unknown Speaker 38:43 clinical trials, and those results have been somewhat mixed, actually. So there have been a couple studies that have shown at higher doses of psychedelics, you may get a higher risk of emergent suicidal ideation and suicide attempts at some patient populations, there's caveats those specific cases and the ends, the number of patients is very low, so Unknown Speaker 39:07 I'm still optimistic that there is a probably going to be some treatment utility for psilocybin or other psychedelics to help reduce levels of suicidal ideation certain populations. But it's very, very early days for that space, Unknown Speaker 39:25 I would assume, and I'm just going off of gut feelings, but this is not based on any research, but I would, I would assume a lot of it has to do with integration. Unknown Speaker 39:36 And there, there was a point or a section in your your latest paper about bad trips and that there's still a Unknown Speaker 39:47 positive effect on pro social behavior and empathy even after a bad, quote, unquote bad trip. Unknown Speaker 39:55 And Unknown Speaker 39:57 so I would you know it. I. Unknown Speaker 40:03 How do I phrase this? Unknown Speaker 40:06 I feel like, you know, with people, Unknown Speaker 40:10 it's ideal to go into a psychedelic situation with a great set right like mindset, but some people like luxury to do that right? Especially if they have, like, they are suicidal and and it's like, it's hard for them to get out of that mindset, Unknown Speaker 40:31 but they want help, but there's, I feel like they would go into that that with a bad set, right? And so all you can do is create a really good setting with some really nice therapists, and have that talk therapy at this at the same time, and then just probably a lot more rigorous integration than somebody going into that session for something else, right? And a lot more eyes on them, and a lot more rigorous integration to make sure that they're okay, you know, and then they're taking for sure, and they wouldn't, that's my guess, but I'm just curious, because you are more in this field than I am. Like, if you had a patient that came to you and was like, I'm super suicidal. I can't get out of it, but I want to take this psilocybin. Like, what would you? Would you be like, Yeah, let's do it. But, you know, let's have you rigorously looked after afterwards. Or like, Unknown Speaker 41:30 let's wait and let's do talk therapy until you're in a better place. Or, yeah, what's your opinion on that? Unknown Speaker 41:38 So I'll say, firstly, you know, it's all somewhat theoretical, because I don't treat anyone with psychedelics outside of clinical trials. Theoretically, theoretically, in a few years, if I were to design a trial to help these, these specific individuals suffering with sociality like that, Unknown Speaker 41:59 it's a very good point, you know, and I haven't actually given it too much thought yet, but it would make sense to have a specific form of psychotherapy tailored to that patient population, not just the generic prep and integration sessions that are done in current psychedelic trials. And so you probably want to take elements of dialectical behavioral therapy DBT, which is a evidence based form of therapy, mostly used for individuals with borderline personality disorder, but also used for individuals who have depression and who Have suicidality. And so that model of therapy involves helping individuals kind of change their relationship to their own emotions and help them manage periods of distress in a more positive way, Unknown Speaker 42:55 using things like mentalization mindfulness. And I'm not a DBT expert, but I've seen a lot of patients go through it, and I've had great benefits from this. And I actually have a colleague who was a co author on those suicidality papers who is now working with the group in NYU, Rick Zieman, Dr Rick zieffman, he's a psychologist, and I think he's working on this specific thing. Unknown Speaker 43:23 We were gonna try to do this together, but our lives took us to opposite ends of the country. But he's looking into how to adapt these kinds of therapeutic approaches for suicidality in the context of psychedelic trial. So Unknown Speaker 43:39 maybe have him on the show and you can chat about that. Yeah, yeah. I mean, Unknown Speaker 43:44 it really goes into, Unknown Speaker 43:47 you know, I think every single person needs a different thing. You know, I was just talking to a clinical therapist on they said this woman came in and she was, you know, swearing a lot, and was really angry and Unknown Speaker 44:04 and the therapist, kind of like, used her language and started swearing back, and kind of got angry with her, and was just like, yeah, what the fuck you gonna do about it, you know? And she was like, she was like, just changes. She's like, Oh, yeah. Like, it's just like, I really appreciated that, because you're kind of meeting me where I needed to be instead of being, like, really sweet and spiritually bypassing and like, it's going to be alright, you know, like, and some people just need, like, to be thrown into the therapy. Can be tough therapy, yeah, tough. It's not, it's not all just like, rainbows and flowers. It's sometimes it's working through real difficult stuff, and you need, you know, dynamic ways of dealing with it, yeah, and some people need floaties and to go really slow and and other people just, you throw them in the deep end, and you're like, figure out how to swim, you know, depending on their their personality, their traumas and things like that. Unknown Speaker 44:59 Do you know Kalin. Unknown Speaker 45:00 He, Unknown Speaker 45:01 maybe not. He died a few years ago, I think in 2020 but he was a big proponent of taking, like, 3040 grams of mushrooms. Unknown Speaker 45:12 Was like, had its amazing speeches. And I Unknown Speaker 45:16 listened to one of his lectures, probably in 2015 and he talked about, he was like, this is very controversial, but we had a kind of a family friend who had schizophrenia, and, Unknown Speaker 45:28 you know, really wanted to heal, and there wasn't much research on mushrooms and schizophrenia. So, Unknown Speaker 45:36 you know, we gave him, like, seven grams of mushrooms, or whatever it was, and we locked him in a room, and I was with him in the room, and then we had two 300 pound, ripped dudes guarding the door so he wouldn't burst the door. And like, yeah. And then we went through it, and he had a really hard time, but at the end, he felt a million times better and Unknown Speaker 45:59 and to this day, like he was kind of, like, positively changed, and he's like, I don't recommend that to anyone, but this person specifically, like, kind of needed to be thrown in the deep end. And Unknown Speaker 46:11 I just think it's, yeah, it's something to think about. Of like, Unknown Speaker 46:15 it's important to set a rigorous standard for these practices, but at the same time Unknown Speaker 46:21 adapting to to what that person does is important, yeah, yeah. And I wouldn't condone doing that, but I'm happy that it worked out well, Unknown Speaker 46:31 um, yeah, Unknown Speaker 46:34 yeah. So what? What other further research would you like to see in the in the field, both done by you and then just in general, where do you think there's the biggest gaps? Unknown Speaker 46:46 So I think one area that really needs to be developed is just our understanding of the mechanisms of how the substances affect the brain, Unknown Speaker 46:58 and this needs to be done at the human level, and also in a model, in animal models and cell models, and there's tons of groups looking into these things right now, and in terms of how we're contributing. So I am part of one of the ongoing compass trials. So I'm sure you've heard of Compass companies, I think, based out of the UK, doing multi site trials, large scale trials, for their specific form of psilocybin and treatment resistant Unknown Speaker 47:30 depression. Now, when I first got into this space, there was a lot of pushback from any form of private industry being involved at all, and I was more so in that camp. But nowadays, you know, I've realized that you need money to get these things done. If you want to get FDA approval for any compound, you need a lot of investment in with a lot of money and a lot of time to get these studies done. And so Unknown Speaker 47:57 I'd rather be part of that process than than be on the side of it to help it Unknown Speaker 48:04 be be carried out as scientifically, appropriately and best as possible for our patients. Unknown Speaker 48:11 And so I'm working on that. I work with Dr Sid Zissou here. He's been at UCSD, seems like forever, and he's been, you know, working in this space for a long time, and he's a great mentor and friend of mine, and we've also started our own avenue of inquiry. So with Dr Kush bot, who co authored that paper, we talked about and kind of going off that paper, we got funding recently internally to look at psilocybin for physician burnout specifically, so looking at psilocybin as a treatment for burnout. So, you know, we talked about how there's like a spectrum of suffering and for different conditions, and burnout is its own thing, but is related to depression, and might be on the milder and in terms of how it affects functioning, but it many, many people are affected by it, and many physicians these days are significantly affected by it. There really, it really is a burnout epidemic for doctors, which is, it's really sad and it's, it's really just, it's not talked about and explored enough, and it's so difficult, because, you know, to be a physician into function, either you're going at 100% or you're not there. It's tough to be a part time, you know, with partial investment of your energy as a physician. And so we need to support those physicians that are working on 100% but are struggling with elements of burnout. And so we're going to do a part of the project. We're going to recruit some some doctors internally from UCSD to start, and I'm working with my co lead of the interventional program, Dr Greg Applebaum, who's a neuroscientist, does a lot of really fascinating Unknown Speaker 49:54 neuroimaging and neurophysiology work Unknown Speaker 49:59 to look at. Unknown Speaker 50:00 Changes in brain biomarkers, so changes in EEG, pre and post in this study, which will be interesting. And it's really, he's, actually, you'd probably be interested in this. He's on his on the side, he's, he's working with members of fish and and Grateful Dead to assess levels of like flow states when they're playing music with the audience, and so he's using some of that technology for this draw. Unknown Speaker 50:27 It's so it'll it's just a pilot project, but it's a first step to potentially build up a larger avenue of inquiry. Unknown Speaker 50:37 Yeah, it's huge. I feel like burnout has always been definitely a thing, but since COVID, has skyrocketed tremendously, and the amount of people just going through it, having a rough time has skyrocketed since COVID, so they need medical services. And it's just kind of a compounding effect, right? Unknown Speaker 50:59 So, yeah, I think that that's huge. I have a lot of friends in kind of the emergency space, and, Unknown Speaker 51:07 yeah, it's, it's super real, Unknown Speaker 51:11 like people are, yeah, having, having critical life changing experiences, 24/7 and you just have to be this, like, open vessel for them. Yeah, you just, it gets exhausting. Have Unknown Speaker 51:22 a lot of therapist friends as well, and I'm like, I don't know how you do it. It's just like, yeah, and it's probably a lot of the things you wouldn't imagine that are causing burnout. I think it's things like paperwork and just like changing demands, lack of control. You know, in general, healthcare workers, you know, they love working with patients, and they'll see tons of patients, and they like working with dynamic situations, but usually stuff around it that's causing the burnout, I'm sure. Yeah, you know, dealing with tough, emotional situations is its own thing, but Unknown Speaker 51:57 then to do paperwork on top of that, Unknown Speaker 52:01 not fun. Not fun. Yeah, cool. Where can people follow you and your upcoming work and kind of follow all the stuff you're up to? Unknown Speaker 52:13 Yeah? So, you know, we have our own website for the lab. Unknown Speaker 52:17 It's Unknown Speaker 52:18 not the exact URL, but it's IP trials, UCSD, interventional psychiatry trials, and we have our own Instagram page. And I Unknown Speaker 52:29 just started my own Instagram page too. So I'm at Dr Weissman, but I only have like 80 followers so far. So Unknown Speaker 52:40 yeah, social media is overrated anyways, exactly, as we talked about before, exactly. But it is a tool, too. And you know, I think if we can create more positive content on there, then it's overall a good thing, positive empathy, exactly, exactly. But on our website, we, you know, that's where anyone who's interested to learn about what we're doing or even potentially participate in our trials, if they're eligible, if they go to the IP trials website, there's a pre screener that they can do so they can just click on Unknown Speaker 53:18 the study pre screener, And then it'll ask a bunch of questions about that person's history, and then it'll automatically get sent to our team who, who's going to review it and then give you a call. So very easy to get involved if you're interested in any of our clinical trials. And yeah, so maybe I could find the exact URL, just to have that handy. Yeah, yeah. Send it to us. We'll put it in the show notes. Okay, so people can automatically click it. So yeah, but thanks, thanks for coming on and thank you everyone for tuning in and streaming into another episode of the mushroom revival podcast. We could not do it without you, wherever you're tuning in from from around the world. We appreciate you, and if you like the show you want to support, we don't have a direct way for you to financially donate, like we don't have a Patreon or anything like that, but we do have a mother brand, mushroom revival, and we have a whole line of functional mushroom products, from capsules to tinctures, gummies, powders, and if you're interested, we do have a coupon code just for listeners. It's pod treat for a surprise discount code. If you don't want to spend any money, that's totally fine. We have a giveaway going on. The link is in the bio, where we pick a winner once a month to win some some goodies. We also have a ton of free blog posts and all of our show notes of all the podcasts on our website, as well as some a bunch of free ebooks to download, from cooking recipes to microdosing guides to everything under the sun. Unknown Speaker 54:54 And my newest book, The Little Book of mushrooms, is on the site as well little cute coffee table. Unknown Speaker 55:00 Book talking about 75 different mushrooms. And yeah, if you want to, if you learn something cool on this episode, please tell a friend, tell a random person at the grocery store some some cool facts about mushrooms and and their effects on mental health. And, you know, start these conversations and keep that mycelium growing so as always, much love and may the spores Be With You. You. Transcribed by https://otter.ai
