Psychedelics for Depression and Other Mental Health Conditions: The Way Forward With Guy Goodwin, MD

Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Guy Goodwin, MD, to discuss the potential of psychedelics in treating depression and other mental health conditions. Goodwin, who is the chief medical officer at Compass Pathways, highlights psilocybin's ability to induce profound experiences that can lead to long-term improvements in mood and anxiety. 

"I got the opportunity to go full time into a new position with Compass Pathways to develop psilocybin. I'd been interested already, I'd advised a little bit on how to design the phase 2 clinical trial. At the time that I did that, I was a little pessimistic about whether there was really a future in this, because it looked quite hard to raise money and quite difficult to do the studies. There were a lot of things that seemed to me potentially difficult, but many of these obstacles have become overcome by the people at Compass. That was the beginning of a new life," Goodwin said of his research evolution in psilocybin.

LSD, the first psychedelic, discovered in 1943 by Albert Hofmann,1 "was the stimulus to understanding serotonin metabolism and function, both in the brain and to a lesser extent, in the peripheral nervous system," shared Goodwin. 

Together, Goldberg and Goodwin evaluate the challenges of developing psilocybin, including regulatory hurdles and the need for careful clinical settings. 

Goodwin notes that psilocybin's effects are immediate and can be more effective than traditional treatments for some patients. They also touch on the potential for psilocybin to treat posttraumatic stress disorder (PTSD) and substance abuse, and the importance of understanding its pharmacodynamic properties and potential combinations with other drugs.

For example, in an open-label, small study of 22 patients with PTSD, Goodwin and investigators saw an approximate 80% remission rate in symptoms.2 In the follow up interviews with patients, Goodwin found a few details very striking: "One is that patients can have the trauma recur—the actual index trauma can be something that recurs in the experience under the influence of psilocybin—and it seems to be something that is tolerated by the patient. They kind of find an indirect route to feeling better about the trauma."

As to future directions, Goodwin believes we should start carefully: "We're advocating for very careful use. We're advocating reimbursement so that access is fair and equitable. Our objective is not to get this widest possible use of the drugs; Our objective is to get the proper use of the drugs in the right patient population."