Can Psychedelic Therapy Go Mainstream?

In the August 3, 2025 episode of NPR's Up First, titled "Can Psychedelic Therapy Go Mainstream?", host Rachel Carlson delves into the burgeoning field of psychedelic therapy and its potential to revolutionize mental health treatment. This comprehensive exploration addresses the scientific advancements, regulatory challenges, and emerging business models shaping the future of psychedelic substances in therapeutic settings.

1. The Current Landscape of Mental Health Treatments

Rachel Carlson opens the discussion by highlighting the pressing need for alternative treatments in mental health care. According to Aisha Rascoe, approximately 13% of Americans over the age of 12 experience symptoms of depression (02:42). A significant portion of these individuals, about one-third, suffer from treatment-resistant depression—conditions where conventional treatments like antidepressants and SSRIs (e.g., Lexapro, Prozac) fail to provide relief (02:42). This gap underscores the demand for innovative therapeutic options.

2. Mechanisms of Psychedelic Therapy

Exploring the science behind psychedelics, Rascoe explains that these substances may enhance neuroplasticity, the brain's ability to form new neural connections (03:32). Neuroscientist David Olson from the University of California, Davis, uses a forest metaphor to illustrate this concept:

“Another way I like to think about it is if you have a very rich canopy, squirrels can hop from one tree to the other very easily, just like neuronal impulses can transfer from one cell to the next very easily.” – David Olson, 03:54

In contrast to traditional SSRIs, which often require weeks or months to take effect, psychedelics like MDMA and psilocybin could produce therapeutic benefits within hours or days, lasting for weeks to months after just a single dose (05:07).

3. The Psychedelic Renaissance and Regulatory Hurdles

Rascoe refers to the recent surge in interest and research as a "psychedelic renaissance". Despite promising developments, psychedelic substances remain illegal under federal law, classified as Schedule I by the DEA, and are not approved by the FDA for medical use (06:05). This legal status poses significant barriers to widespread clinical adoption and research advancements.

However, there has been a shift in federal sentiment. U.S. Health Secretary Robert F. Kennedy, Jr. expressed intentions to expedite the approval process for psychedelic treatments, signaling potential regulatory progress (01:39).

4. The Controversial Role of the Psychedelic "Trip"

A central challenge in integrating psychedelics into mainstream therapy is the psychedelic experience, often characterized by hallucinations and altered states of consciousness, colloquially known as a "trip" (08:13). While therapeutic benefits are promising, the unpredictable and intense nature of these experiences raises concerns:

“Tripping can be dangerous, especially for some people, like people who have bipolar disorder or schizophrenia. The trip can make those conditions worse.” – Aisha Rascoe, 08:59

This aspect complicates the feasibility of using psychedelics in everyday medical practice, where patients are expected to resume normal activities post-treatment.

5. Insights from the Heifetz Study: Rethinking Therapeutic Factors

David Olson spearheaded an innovative study aimed at isolating the pharmacological effects of psychedelics by eliminating the subjective psychedelic experience. By administrating ketamine—a substance similar to psychedelics but classified as a Schedule III drug—in a controlled, unconscious state during routine surgeries, Olson sought to determine if the drug alone could alleviate depression symptoms (12:18).

Unexpectedly, the results revealed that both the ketamine and placebo groups experienced significant improvements in depression, with no distinguishable difference between them:

“They were indistinguishable from the patients who got ketamine. So that was a surprise and actually very difficult for us to wrap our heads around.” – David Olson, 16:09

This finding suggests that non-pharmacological factors—such as patient expectations, hope, and the therapeutic setting—may play a critical role in the efficacy of psychedelic treatments.

6. The Rise of At-Home Ketamine Therapy

In response to regulatory barriers, companies like Mindbloom have emerged, offering at-home ketamine therapy as an alternative to traditional clinical settings (21:31). Mindbloom's model involves:

1. Initial Psychiatric Evaluation: Conducted virtually by a licensed clinician to assess eligibility.
2. Prescription Fulfillment: Ketamine is delivered directly to the patient's home.
3. Guided Sessions: Patients use a kit containing tools like an eye mask and blood pressure cuff, and are supported by digital tools such as an app with soundscapes and journaling prompts (22:21).

While this approach increases accessibility and reduces costs—offering sessions for $150 to $200 compared to clinic-based treatments that can cost up to $1,000 per session—it raises safety concerns. Potential adverse effects of ketamine include dizziness, nausea, increased blood pressure, and severe medical emergencies like stroke or heart attack (23:35).

Dr. Gerald Bush from the American Psychiatric Association emphasizes these risks, highlighting the lack of immediate medical support and consistent safety standards in at-home settings (24:50).

In response, Mindbloom outlines stringent safety protocols, including medical screening, supervised first sessions via Zoom, and mandatory presence of an adult peer monitor during administrations to manage emergencies (25:01).

“Not all ketamine therapy programs are created equal and its protocols are developed by leading experts in psychiatry.” – Mindbloom Representative, 25:01

7. Weighing the Benefits Against the Risks

The episode concludes by acknowledging the dual-edged nature of psychedelic and ketamine therapies. While offering hope to individuals with limited treatment options, these therapies come with significant risks and uncertainties:

“It's honestly still a really hard question to answer because in my reporting, I talk to all of these people who are weighing the serious risks and serious benefits of these drugs in really different ways.” – Aisha Rascoe, 26:33

Patients like Cindy Dahlman report feeling a profound sense of joy post-treatment, yet remain uncertain about the exact cause of their improvement—whether it was the drug, the therapeutic environment, or their mindset (27:15).

“I still felt joyful inside.” – Cindy Dahlman, 27:33

8. The Road Ahead for Psychedelic Therapy

As psychedelic therapy navigates the intricate balance between potential and peril, ongoing research and regulatory developments will be pivotal. The Heifetz study, in particular, invites the scientific community to reassess the essential components of successful therapy—suggesting that factors beyond chemical intervention may be equally, if not more, important.

With companies like Mindbloom pioneering accessible treatment models and federal attitudes beginning to shift, the mainstream adoption of psychedelic therapy remains promising yet contingent on addressing safety, efficacy, and regulatory compliance.

This episode of Up First underscores the transformative potential of psychedelic therapy in mental health care while meticulously examining the complexities that accompany its integration into mainstream medicine. For listeners seeking to understand the future of mental health treatments, Carlson's in-depth reporting offers a balanced and insightful perspective.