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19 July 2023

David Nutt: “It’s the biggest breakthrough in mental health for 50 years”

The psychiatrist David Nutt on psychedelic drugs as a treatment for depression.

By Rachel Cunliffe

David Nutt did not set out to find a revolutionary new treatment for depression. The psychiatrist and psychopharmacologist has spent more than five decades studying the impact of various drugs on the brain. As he puts it: “My claim to fame is I’ve probably given more different kinds of drugs to human beings than anyone alive.” Fifteen years ago, he decided to use neuroimaging techniques to examine the effect of psychedelics, on the grounds that “no one had done it yet”. After years of work to secure funding and approval, his team of scientists from Bristol University and Imperial College London ran the first brain imaging study on psilocybin, the active ingredient in magic mushrooms. What they found astounded them.

“We discovered that psychedelics switch off the parts of the brain that cause depression,” Nutt, 72, told me when we met in London at the launch of his new book, Psychedelics: The Revolutionary Drugs That Could Change Your Life – A Guide From the Expert. They applied to do another study (again, the bureaucracy took years), this time with patients with treatment-resistant depression. Subjects were given a low dose of psilocybin to make sure they could tolerate it, then a higher dose a week later; with two therapists guiding them through the trip. “It was a revelation, there’s no doubt about it. I’d genuinely never expected something to work so fast and so powerfully,” Nutt said. Two weeks after the trial, he recalls in the book, “ten out of 12 patients met the criteria for recovery from their depression… Within a week – and often within a day – it halved depression scores. For a few of the patients in our study, their depression didn’t come back over eight years.”

[See also: How to live forever]

Part scientific tract, part manifesto, Psychedelics is a lucid guide to how these substances operate on the brain and on their potential in medicine. Since those first studies, drugs such as psilocybin, LSD and DMT (the active ingredient in ayahuasca) have been trialled as treatment for some of the most devastating mental health conditions, as have other substances such as MDMA (ecstasy) and ketamine that are not classic psychedelics but have some similar properties. The theory is that they temporarily rewire the brain, enabling sufferers to break free of harmful thought loops and make long-term progress. In addition to tackling depression, there have been studies into treating addiction, post-traumatic stress disorder (PTSD), anorexia and obsessive-compulsive disorder (OCD). 

More than 200 people turned up to the book launch, held in conjunction with Nutt’s charity, Drug Science, at the Ethical Society’s Conway Hall in central London. The audience contained both drug reform campaigners and scientists from some of the UK’s leading universities. There were hopeful questions about the possible use of psychedelics for managing dementia, autism and brain trauma.

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“It’s the biggest breakthrough in the treatment of mental health for 50 years,” Nutt told me. (He has no commercial interests with companies working with psilocybin for depression, although he has advised a healthcare company working on psilocybin, and advises firms researching the use of ketamine and MDMA.)

These are not new drugs. Psilocybin is a naturally occurring substance: the earliest evidence of its consumption by humans dates from a cave painting made in Algeria more than 7,000 years ago. LSD, meanwhile, was synthesised by the Swiss chemist Albert Hofmann in 1938, and MDMA was developed in 1912 and used in psychotherapy in the Seventies. But the US ban on LSD in 1968, followed by President Nixon’s “War on Drugs”, which was mimicked across the world, put a sudden stop to research.

“The banning of these drugs was an attempt to eliminate knowledge,” Nutt said. “We censored research for 50 years: that is the worst censorship of research in the history of the world.” That decision has potentially led to millions of lives being claimed by suicide and addiction. Nutt points out that the founder of Alcoholics Anonymous, Bill Wilson, had the vision that led to his sobriety while on a psychedelic trip. 

In the UK psychedelics are classed as “Schedule 1” under the Misuse of Drugs Act, the category for substances thought to have no therapeutic use, meaning a special licence is required for their use in scientific trials. Much to the frustration of scientists such as Nutt, this makes psilocybin and LSD, which are non-addictive and do not carry the risk of overdose, much harder and more expensive to study than the Schedule 2 drugs such as heroin or cocaine. 

[See also: Clancy Martin: “The best medicine for suicide is to talk about it”]

Other countries are moving forward. As of 1 July (thanks in part to Nutt’s work) psilocybin and MDMA are now legal medicines in Australia to treat depression and PTSD respectively. Magic mushrooms are legal medicinally in the US state of Oregon, and psilocybin therapy centres exist in the Netherlands and Spain. But the UK remains stubbornly behind. When a parliamentary debate was held in May on the need to recategorise psilocybin from Schedule 1 to Schedule 2 to make it easier to study, the drugs minister, Chris Philp, didn’t even turn up (the Home Office sent the immigration minister instead). 

When I contacted the Home Office to ask if there were any plans to reschedule psilocybin, I received the following statement: “We sympathise with patients suffering from distressing conditions and can understand the desire to seek the best possible treatment available. The government responded last December to advice from independent experts on harmful drugs on reducing barriers to research with controlled drugs. We wrote again to the ACMD [Advisory Council on the Misuse of Drugs] this week to seek their views on removing licensing requirements for legitimate research with clinical trials approval.”

Nutt is very familiar with the ACMD: he used to chair it. In 2009 he was fired by the last Labour government for stating publicly that LSD and MDMA were less harmful than alcohol. (“That’s my other job, trying to save the world from alcohol,” he joked, referring to his company, Sentia, which makes a non-alcoholic spirit.) He set up Drug Science, an organisation dedicated to telling the truth about the harms (or lack thereof) of drugs, soon after. He believes there is a strong case for legalising many substances for recreational use, such as psychedelics, MDMA and cannabis, and that the medicinal case is even stronger. But while he has the support of some MPs from across the political spectrum, most don’t want to know. “They’re terrified of being vilified by the Sun and the Mail. The political discourse in this country is completely distorted.”

Misplaced fear about these substances has driven policymakers to absurd positions, Nutt believes. Canada’s law on medically assisted dying is expected to be expanded to those with severe mental-health disorders next year. “You [could] be euthanised,” Nutt said, “but you can’t be given psilocybin, because that’s ‘too dangerous’. How more paradoxical can you get?” Similarly, those with a terminal illness may be prescribed highly addictive morphine, but not psychedelics.

Aldous Huxley, dying of cancer, took LSD on his deathbed in 1963 and ended his life on a trip – an option denied to patients today. When we spoke, Nutt had recently returned from a conference in Denver at which a fellow psychedelics pioneer and friend, suffering from Stage 4 cancer, spoke at a dinner of how these drugs have helped him to come to terms with dying.

Now in his eighth decade, Nutt said it had made him pause. “As I’m getting nearer to the end, I’m actually thinking – it would be quite nice if we had that option for me as well.”  

[See also: David Edgerton: “The UK needs a politics of modesty”]

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This article appears in the 19 Jul 2023 issue of the New Statesman, How Saudi Arabia is buying the world