Psychedelics specifically refers to a class of drugs that cause hallucinations, that is the primary effect is to trigger an altered state of mind. This “trip” can be perceived as an “expansion of consciousness”. The most common psychedelic drugs are LSD (Lysergic Acid Diethylamide), ketamine, mescaline, psilocybin, and DMT (Dimethyltryptamine). Psychedelics are not a current standard medication for mental health therapy, although some people do receive a positive mental health response to this class of drug. Although the chemicals themselves often have little evidence of causing harm, there is some evidence of a risk of permanent drug induced psychosis, health complications due to contaminants, and lifestyle health risk due to where these drugs are often sourced.
TLDR: Psychedelics show a small amount of promise to work in relieving depression and anxiety in people who find regular medications ineffective. For most people, regular medication and therapy is far effective. There are no valid providers of effective psychedelic mental health therapy in WA as of 2026.
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Understanding Addiction
Most people who use illicit substances or frequently use legal drugs are not morally corrupt, deficit or just making poor choices. Most people have either acquired a dependency due to poor substance management (such as pain leading to opioid dependency) or are self medicating for a physical or mental problem.
If you are experiencing difficulty with your substance use, please take a look at Understanding Addiction.
For the rest of this page, we are assuming that you have heard that psychedelics are a brand new way to treat depression or some other condition, and you want to know more about it.
How Psychedelics Work
Summary
Psychedelic drugs bind to a specific type of serotonin receptor, forcing it to turn on and disrupting the ability for the neuron it effects to properly manage intracellular signaling, messing up the ability for your brain to process sensory inputs (causing temporary hallucinations), and understanding (causing temporary psychosis).
Psychedelics can trigger neuroplasticity, the ability for neurons to grow and change. This can allow people to let go of old ideas, add new ideas and be prepared to make life changes. The long term effects of this are not strong, but show some potential.
Specifics
Serotonin Receptor 5-HT2A
Psychedelics bind to the Serotonin receptor 5-HT2A and trigger it on (a receptor agonist). The serotonin receptor 5-HT2A is found throughout the Central Nervous System (CNS), mostly near pyramidal neurons on the apical dendrite to regulate thalamocortical information (signals from that Thalamus). Serotonin receptor 5-HT2A is a GPCR (G Protein-coupled receptor).
Neurons send signals to other neurons, which in turn send more signals to other neurons. Each neuron is a mini calculator that works out if a signal should be sent or not (down axons), based on its inputs (from dendrites). A cluster of neurons signalling to each other creates a specialised circuit, such as Brodmann Area 22 which turns ideas into words ready to be internal or externally spoken. On the outside of this cluster of specialised neuron to receive cluster relevant input, a pyramidal neuron. A far off neuron, from the Thalamus (central brain, connected to the Amygdala in the Limbic region), sends a signal down its axon to the synaptic gap, triggering the release of serotonin which will then trigger the serotonin receptor 5-HT2A, which then informs the pyramidal neuron that a signal has been received. The receiving pyramidal neuron triggers intracellular signaling cascade via various mechanisms. Which cascade is triggered depends on which signal is received from the Thalamus. [“Structure of a Hallucinogen-Activated Gq-Coupled 5-HT2A Serotonin Receptor”, Sep 2020].
Normally, 5-HT2A and is only turned on intermittently, and it will signal the appropriate signal cascade based on the signal sent by the Thalamus. By binding to this receptor and forcing it on, the ability for the neuron to select whether to trigger a signal cascade, and which one to use is disabled. It is not clear which signalling cascade that is locked on causes hallucinations, distort sensory perception and altered cognition, however adjusting the psychedelics to bias towards β-arrestin pathways appear to not cause the hallucinogenic experience. Further research is needed. [“Identification of 5-HT2A receptor signaling pathways associated with psychedelic potential”, Dec 2023].
Neuroplasticity
Summary
Many psychedelics promote the expression of genes related to neuronal plasticity. While this sounds like a plausible mechanism for real change, in adults it appears that the actual neuron change is minimal and often irrelevant.
Specifics
We use the word plastic in the technical sense, to refer to changeable rather than fixed. Whenever your store information, you are making changes to your brain. When you store a method to do something, and prioritise that over a previous method, you have learned a skill, and that also changes your brain. The idea that your brain grows until you are 25 and then decays until you die was disproven back in the 1980s. What has changed is the rapid development of childhood slows down by around the age of 25 in most people, and now you have your adult brain. There are some later developmental changes that occur around 50 years of age, so you aren’t done yet.
Neuroplasticity specifically refers to how your brain’s neurons change. IEG (Immediate Early Genes) and BDNF (Brain-Derived Neurotrophic Factor) are triggered to release by psychedelics in some people, which can cause temporary neuron pathway reconfiguration and new neuron growth for quick adjustments that may not last very long. Some dendrite and synapse growth has been measured leading to longer term potentiation, and thus longer term changes. Most of these have been positively shown in animal studies, which was promising, however when psychedelics were tested in adult humans, the results were mild and contradictory, effectively inconclusive. [“Towards an understanding of psychedelic-induced neuroplasticity”, Sep 2022].
Psychedelics in Mental Health Therapy
Back in the 1970s psychedelics were experimented with as an adjunct to talking therapy. It was thought that perhaps the hallucination effect of new understanding would help the patient be more open to thinking in new ways, and thus changing the base cognitive or memory that was causing mental distress. Remember, back then it was thought that mental illness was caused by trauma, which caused a dissonance between the conscious brain and the unconscious desires. If this was true, then using psychedelics to try to change those causes makes sense.
We now know that this old idea of what causes mental illness is mostly wrong. While it is true that a healthy person who is harmed enough may change for the worse, this is actually fairly rare. What is mostly behind mental ill health is biology – which we’ve talked about in other areas extensively (Talking Therapies & Medicine Therapies).
There are three variants to how psychedelics might help in letting your mind adjust, all to do with dosage.
- Micro Dosing
- Regular dosing
- Heroic dosing
Micro Dosing
Microdosing (micro dosing) has become popular in Silicon Valley, the part of the USA that brought you Google and Apple. It is believed by these entrepreneurs that microdosing psychedelic drugs will enhance their mood, creativity and cognition.
Mechanistically, the dose of the psychedelic needs to be low enough that you do not feel like you are tripping, that is not affected in any meaningful way, aka sub-therapeutic [“The popularity of microdosing of psychedelics: What does the science say?”, Sep 2022]. It is hoped that the psychedelic will release an increased amount of BDNF to stimulate faster neuronal growth, and thus help people get smarter faster.
Evidence shows mixed, contradictory results with low effect sizes. That is, it doesn’t work.
Regular Dosing
It is hard to define what a regular dose of a drug that is illegal in most of the world is. For the sake of simplicity, we will refer to the minimum amount that most people would take to get a hallucinogenic experience, aka a trip. This is what is mostly purchased by drug users for recreational use. While the amount may vary per person, the variance isn’t that large when the user is asked “what is the least amount that you take to get an effect?”
There are some anecdotes of people having a trip and drawing a life changing conclusion from this. When listening to anecdotal data, we need to be aware of the squeaky wheel effect. All of the people who had a trip and did not draw a life altering conclusion didn’t write a post about it, or go out of their way to tell people about their not-life-altering-experience at parties, while those who did get something speak out, loudly, and often. That is, for every positive experience you hear, there are more negative experience and a mountain of nul experiences (nothing happened of note).
Mechanistically, as noted in the Specifics section above for How Psychedelics Work above, in adults, the presence of neurotransmitter markers in adults is variable and weak. Anecdotally, I have seen many clients who have used psychedelics at raves and other settings, who are continuing to see me because those didn’t work. The flip side of this anecdote is that if someone found that it did work for them, they won’t see me, so I don’t get to hear the other version and compared statistics.
In conclusion, if you have used psychedelics before and are still struggling with mental health problems, then more psychedelics aren’t likely to help you. If you haven’t tried them before, consider mental health medications first. It can be tricky to get the right diagnosis and the right prescription, which we have discussed in Talking Therapies & Medicine Therapies. If you are struggling, give us a call. Psychedelics should be one of the last solutions you look for when it comes to mental health.
Heroic Dosing
A “heroic” dose is considered to be 10 to 20 times that of a Regular Dose (as defined above). It has been used in research to test to see if neuroplasticity can be forced into action with a much stronger dose of psychedelics. The people who are going through the psychedelic experience have their hallucinogenic experience in a controlled environment with a support person who, after the trip is over, helps them process their experience.
So far, these experiments have been done in niche groups that are hard to treat, or have failed to benefit from other treatments. For example, this study tested 51 cancer patients with life threatening diagnoses, who also had symptoms of depression and or anxiety. Patients were divided into two groups: Low dose (sub therapeutic) and High dose (heroic). Staff and participants were instructed that no significant finding was expected from the trial. A combination of testing from staff observation, testing of the participant and community observers rated moods, behaviours and attitudes. It was found that 80% of the participants in the High dose group substantially benefited when re-assessed at 6 months.
This can look promising, but requires special permission (due to being experimental), substantial time with experts (during the trip and post processing). There are very few studies that have been released using this protocol, which can indicate that what we are seeing is the loud squeaky wheels, or just the early stages of a new treatment version.
So far as I am aware, this is not being trialled in this format here in Western Australia. Some private hospitals are offering Ketamine Infusions as a therapy for mental health via a protocol that doesn’t at all look like this.
Risks of Psychedelics
The risks for psychedelics are complex.
Mortality: Most psychedelics do not pose a direct chemical risk of death to most people, although your own personal biology may be different. Most of the mortality risk has been due to the actions people took while intoxicated and unable to make rational choices. [“Psychedelic-related deaths in England, Wales and Northern Ireland (1997–2022)”, Jan 2025]
Psychosis: Long term psychosis is poorly understood. A common aetiology story I received in my training is that the risk of long term psychosis rapidly increasing if the person has a predisposition to psychosis. What does that mean? That means that the person was likely to develop long term psychosis anyway – so was it the psychedelic? The evidence to show that a person gets long term drug induced psychosis from taking psychedelics is weak. Those who have a previously very good mental health prior to taking a substance are most likely to have been harmed by other compounds in the drug that they have purchased, often due to adulterated drug distribution. That is, the psychedelic itself likely didn’t cause the long term “drug induced” psychosis, the other agent in the drug did. That is one of the most compelling reasons not to buy drugs illegally.
The evidence isn’t zero though, and the consequence is very high, with the outcome that long term drug induced psychosis is a moderate risk.
Social: Often people who are taking psychedelic drugs are at high social risk. While you are intoxicated, you can easily be taken advantage of. The people who often sell illegal drugs are often not trustworthy. They may seem friendly, but that is often because they want your money, like any sales person who is being friendly – they generally do not actually care about your well being. Partners who are supporting your use of illicit substances are either scared of the sober you, or are gaining in some other questionable way. If you are frequently intoxicated, it is hard to make good judgement calls about the quality of your social circles. Problematic people will do their best to convince you that they are fine and that you are the problem, and in the absence of reasonable and rational people giving you a balancing view, you are likely to believe them.
Reference List
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