Hannah McLane has made a big bet on a psychedelic future for mental health care.
Last month, the West Philadelphia physician and psychotherapist opened the SoundMind Center, a therapist training center, research hub, and mental-health clinic to treat depression, anxiety, post-traumatic stress disorder, race-based trauma, and other stress-related conditions.
The services at SoundMind, a nonprofit in the 4600 block of Spruce Street, will not be plain vanilla therapy, but psychotherapy enhanced by psychedelic drugs that advocates say can help patients access and process memories and feelings that are buried in the mind but can still wreck one’s daily life.
More than 300 people have already put their names on SoundMind’s wait list for treatments, some of which will involve eight-hour therapy sessions in which therapists stay with patients and address issues with them after they ingest drugs.
“People are just really excited,” said McLane, 40, who wants Philadelphia to be a leader in the field of psychedelic medicine, especially in figuring out how to make the new treatments accessible to patients who can’t pay.
For now, the only legal form of psychedelic-assisted psychotherapy uses ketamine, which is not a traditional psychedelic, but has mind-altering properties that have been found to relieve depression. As a party drug, ketamine is known as Special K. Like many prescription drugs, ketamine can be dangerous if used improperly. But it’s been shown to relieve symptoms of depression when used under the direction of medical professionals.
McLane went to medical school at Brown University and completed her residency in neurology and occupational medicine at the University of Pennsylvania. She has invested at least $850,000, much of it borrowed, to open SoundMind, and is looking forward to early 2023, when she and others expect the FDA to approve MDMA, known popularly as Ecstasy or Molly, to treat PTSD in combination with therapy. The results of a successful phase-three drug trial were reported in May.
Further off, advocates anticipate approval of psilocybin, the active ingredient in magic mushrooms, to help patients with treatment-resistant depression.
Investors are pouring millions into start-ups trying to create versions of naturally occurring psilocybin that can get the patent protection needed to make them profitable for investors. One company recently estimated that the market for psychedelics could be worth $100 billion.
The current push to bring psychedelics, some of which have ancient histories among indigenous populations, into mainstream medicine started about 15 years ago with research at Johns Hopkins University in Baltimore. And this ongoing effort is happening even as stigmas against the drugs originating in the 1970s’ backlash against the psychedelic `60s still run strong.
One concern McLane has heard is: “What happens if people just want to get high?” To that she says with a laugh, “it’s really easy to get high in a way that doesn’t involve eight hours of talking about your trauma.”
At the same time, favorable research published in top medical journals is accompanied by enthusiasm for the drugs as a means to transform individuals and society.
“They have immense potential to be agents of change in America,” said Aubrey Howard, who teaches “breath work,” a form of breathing as therapy, at SoundMind and views psychedelics as an aid in healing “from trauma, discrimination, and violence that occurs across multiple levels, individual, family, community, and society.”
Paul S. Appelbaum, a professor of psychiatry, medicine, and law at Columbia University, described a complex of forces propelling psychedelics toward the mainstream.
In addition to what he called psychedelic “true believers,” Appelbaum named medical professionals excited about the therapeutic potential of psychedelics, investors seeking a potentially huge market, and advocates of the decriminalization of drugs because of the disproportionate impact the drug war has had on Black people.
Appelbaum and William R. Smith, a fourth-year psychiatry resident at Penn Medicine, wrote an opinion piece published in the Journal of the American Medical Association last month urging a slower pace of adoption. “The data are not yet adequate to move quickly ahead,” Appelbaum said in an interview.
While MDMA and psilocybin are still not approved by the FDA, companies including Ketamine One and Field Trip Health are forging ahead with clinics specializing in ketamine-assisted psychotherapy, the same type of treatment SoundMind is starting this month.
Both are publicly traded and expanding rapidly. Field Trip has five centers and says it has eight more underway in the United States and Canada — and contemplates having 75 by 2024. The company opened one in New York a year ago and it will open another in Washington, D.C., in October, but has no plans for one in Philadelphia, a spokesperson said.
The company charges as much as $5,700 for a course of treatment, including a preparatory session, six ketamine therapy sessions, and three sessions to process what the patient learned during the treatment, according to an investor presentation.
Asked during a conference call how it picks locations for Field Trip clinics, a company official said that because insurance usually does not pay for the treatments, the company looks for markets with enough people who can pay themselves.
Ketamine-assisted psychotherapy costs $500 to $1,000 per session at SoundMind, McLane said. That includes one hour of preparation, two to three hours of monitored in-office therapy session, and a one-hour post-therapy session.
The treatment is expensive because the therapist is with the patient the entire time. If MDMA is approved for PTSD, two therapists will be present during the eight-hour session.
MDMA helps people with PTSD, backers say, because it allows people to tunnel into their traumatic memories, accept them, and then learn to live with them. The idea is that if “you can go back and feel those emotions you are able to move past it,” McLane said.
McLane is developing a sliding scale for people who can’t afford the full price and is trying to raise $150,000 from donors by Oct. 1 to subsidize care for low-income people.
SoundMind has at least one local competitor opening soon. Gail Serruya, a psychiatrist who took a class with McLane last fall, is opening Voyage of Healing, a ketamine-assisted psychotherapy clinic in East Falls this fall.
Statistics on ketamine-assisted psychotherapy clinics are hard to come by. Lucia Huang, cofounder and chief executive of Osmind, a San Francisco company that sells medical records software for private psychiatric clinics, estimated that there are 1,000 ketamine clinics now and that the number is tripling annually. Her company counts 230 of them as clients.
That growth is in anticipation of these new psychedelic therapies beyond ketamine, Huang said.
It was big news in psychedelic circles last spring when results of phase three trials for MDMA in combination with therapy to treat PTSD showed that 67% of the patients were cured compared with 32% of the participants who received a placebo in combination with therapy.
“It’s hard to overemphasize the enthusiasm about some of the positive findings thus far,” said Smith, the Penn psychiatrist. “I myself am quite hopeful about MDMA and quite optimistic that with a little bit more time psilocybin will be proven to be pretty robust in its response.”
Commercial research on psilocybin focuses not just on its effectiveness as a treatment for depression, but also on how to make it more efficient.
Compass Pathways PLC, for example, is working on molecules that will generate a shorter psychedelic experience — 30 minutes to four hours, down from six hours or more.
The English company’s cofounder and president, Lars-Christian Wilde, offered a note of caution during a July conference call with investors. “We do not know how short an experience can be while still maintaining durable antidepressant effects,” he said.
In addition, Compass has reduced the number of therapists present during a treatment from two to one. “We believe that is a scalable model,” Wilde said.
Some researchers are even working on ways to take the high out of psychedelic drugs while retaining their healing benefits.
The gold standard in clinical trials is that neither the patients nor the medical experts evaluating the patients know who received the placebo and who received the drug being tested. That’s virtually impossible in this field because it’s hard to disguise a psychedelic trip.
Another criticism of the research, according to Appelbaum, the Columbia professor, is that the positive results are based on a small number of carefully selected participants.
McLane knows that some experts are not sold on the research, but she thinks it’s important to recognize that psychedelics combine mind and body in a way that doesn’t usually happen in Western medicine.
“It has to be therapy and it also has to be this medicine, and we have just never done that before,” she said. “It makes sense that the numbers are actually different and that it actually heals people in a different way because it accounts for their full body and mind healing together.”