Asking a doctor about magic mushrooms: Are they the miracle cure, or just another way to get high?

NEWS | INTERVIEW | RONGOA / DRUGS

Written by Tess Vroegop, (she/they) | @minorinconvenience | Contributing Writer

Illustration by Gabbie De Baron (she/her) | @gabizzlesizzle | Graphic Designer

Picture this:

You’re at a party, and find yourself cornered by some guy who is telling you about how tripping on acid was a transformative experience. He says, with complete seriousness, “It changed my life, man. I’m a whole new person.” 

Sounds familiar, right? I’m sure many of us have experienced something similar, and disregarded it.

But what if these guys are on to something? With worldwide interest about psychedelics in a clinical setting growing, and researchers taking steps forward both here in Aotearoa and across the ditch, maybe it’s time to take a closer look at what these drugs can do.

In 2023, Australia legalised the use of psilocybin, the key psychedelic component in mushrooms, for treatment-resistant depression (a form of major depressive disorder that does not respond to standard therapies or medications). In June, associate Health Minister David Seymour announced that the first use of psilocybin in Aotearoa outside of clinical trials has been approved.

I sat down with Dr Paul Vroegop (aka my dad), a child and adolescent psychiatrist and chronic pain specialist who has worked in Aotearoa New Zealand for over twenty years, to chat about the use of psychedelic drugs as a treatment for serious mental health conditions. 

Give us a little bit of background. Who are you? 

I'm a psychiatrist, mostly working with young people and adults with chronic pain. As far as psilocybin goes, I've had a longstanding interest in using it in the treatment of mental illnesses, like depression or PTSD (post-traumatic stress disorder), because the ways that we have of treating these conditions are not particularly effective for most people who suffer with them.

How so?

Take depression, which is relatively common. Most things that we know help with depression are not biological medicines. Our social connections and relationships with people, and also things like exercise, are proven ways to manage it. We have psychotherapy, so talking therapies, which can be really helpful for some, but the problem is that they’re not as accessible in many parts of Aotearoa. Then we've got drugs. Medications for mental health issues can be really useful, but not for everyone, which is why alternatives such as psilocybin are being explored. Roughly 10% of people with depression, for any one medication, will have a fantastic response. Another 20 to 30% will have minor improvements, and the rest will not get any real benefit. If you add that up, only about 50% of people benefit from some type of medication. That's a broad ballpark figure, but it tracks with what I’ve dealt with as a psychiatrist. So for everyone who hasn’t improved with medications or therapy, where do we turn next? That’s where psychedelics come in.

So that was my next question actually! Could you explain, for those who aren’t aware, what exactly is psilocybin? 

Psilocybin is the major psychoactive ingredient in magic mushrooms. In this context, it’s a psychedelic medication. Essentially, they're chemicals that create an altered state of mind. 

How do they work? 

That's a really interesting question because nobody has figured that out yet! There’s some pretty solid theories, at least about how they produce some of their effects. But they’re still just theories. 

Because the brain is so complicated. 

The brain is so complicated. You know the world's most commonly prescribed and used medication on earth, paracetamol? We have no clue how that works, it just does. Psychedelics are the same. Psilocybin seems to affect the serotonin and serotonergic neural pathways in our brain, and it may create floods of serotonin in particular areas. How does that have the effects we see on the brain? We don’t know.

So what are these effects?

Most commonly, it gives you visual hallucinations, so you see things that aren't there. These perceptual changes can include visual distortions, like things being much bigger or much smaller than they really are, or seeing things being twisted or turned. The other aspect of psilocybin is distortion of your sense of time. People describe a minute as lasting for hours, or an eight hour trip as having gone past in a few minutes. Another core experience often mentioned is a dissolution of your sense of self, described in psychology as a loss of ego boundaries. So a sense that you are not just you, but you're merging into the rest of the universe around you. Some people in some circumstances will describe an “ego death”, which is where they feel that they cease to exist completely. 

Intense! But why is this useful in a clinical setting for treating mental health problems? 

This is where the really interesting parts come in. When you take psilocybin, there's good evidence that it increases our brain's neuroplasticity, which means the ability to form and make new connections. Brains work in a way that the neurons (brain cells) that fire together, wire together. Which is just a way of saying that when one neuron is triggered, it connects another neuron, which connects another, and then that pathway of messaging is much more likely to be activated the next time. It takes slightly less power for that same pathway to switch on. 

Because the links are already there?

Pretty much. The links in our brain grow stronger with use. An analogy might be water dropping on the very top of a mountain. Randomly, the first time it drips, it goes a certain way. The next time it drips, statistically, it's slightly more likely to go that same way because it's just worn away a tiny bit more. It takes the path of least resistance. Then in 10 years’ time, you have an actual stream running down the mountain. The initial state of it was random, but now it's much more likely to go a certain way. Using that analogy, what psychedelics can do is flatten and smooth out that probability path and allow new connections to be made.

So would this be something you would recommend that they put into law? That more psychiatrists can prescribe in New Zealand? 

Yes, I think we should be following in Australia's footsteps. I think these are potential new treatment paradigms that could make a significant difference to a number of people. However, the requirements are intense, and the evidence says you need quite a lot of psychotherapy in order to make the most of the change that the psychedelics provide. We're still going to be very resource constrained because although te drug is cheap to make, providing psychotherapy with experienced therapists is expensive. I think we should think very carefully about how we can ensure equity of access to these treatments, to people who need them most, rather than, as we're starting to see in Australia, people who can pay exorbitant sums of money to private providers for it.

So there are definitely still issues with it. 

To my mind, one of the problems is that there's a lot of hype about psychedelics, right? It’s often pushed by this idea that you can have a pill, you take it, and it's going to cure everything. That's not what the research suggests. What it shows instead is that psychotherapy is the core part of it. For many people, having a single dose of a psychedelic as part of a psychotherapeutic process is the thing that allows a significant change to occur. It’s not just giving you a drug and going, “I'm feeling better now.” We know that as part of a psychotherapeutic approach, it has had significant success in people with the hardest mental health conditions to treat, but I encourage people to be a little bit cynical. If anyone says, “This is the way, the truth and the light,” it's not. That's bullshit. Psychedelics are an aid, increasing our ability to learn and change. It’s a tool, and like any tool, you need to put in effort for it to be useful.

—

The legalisation of psilocybin in clinical settings is a huge step forward. Treatment-resistant depression is on the rise, and with Aotearoa’s health system being gutted by budget cuts and medical benefits quickly disappearing, it could provide a small ray of hope as a cheap and accessible treatment. 

However, we should always tread with caution when it comes to new medicines. Though it seems promising so far, there is no such thing as a “quick fix” when it comes to complex mental health problems. Tripping on acid in someone’s basement is more likely to cause issues than solve them. If you’re someone who is looking into psychedelic treatment, take it from the professionals: It won’t work unless you do too. 

Links to a couple of sources:

New-zealand-psychiatrist-granted-approval-to-prescribe-psilocybin

Medsafe-approves-sale-of-melatonin-and-prescribing-magic-mushrooms