Basically all psychedelic research has major methodology flaws and systemic issues behind it

Methodology: Expectancy bias - the control vs condition is usually abundantly clear to both the participants and researchers. The impact of the drugs are so dramatic that it’s fairly obvious what category they’re in. So then people on the drugs expect to see benefits and clinicians (unexpectedly or otherwise) reinforce this

Often co occur with talk therapy which confounds effect, eg which is helping?

Often go by subject self report and not any kind of objective measure of symptoms

Subjects are often highly selected, filtering comorbidities like bipolar disorder or suicidal ideation

Very few, if any, have explored effect beyond 1 year or so

There have been ethical issues on the part of therapists doing the trials (MDMA MAPS research specifically)

Studies for addiction specifically are preliminary and small but do show promise

Systemically:

There is a huge demand for novel treatments for treatment resistant depression and PTSD. This will be an extremely lucrative industry

There is a huge demand for a legitimized pathway to psychedelic drugs. If medical marijuana and ketamine treatment are any indicators there will be plenty of doctors that will be absolutely willing to meet you via zoom, basically ask “do you have ptsd?” and then write you a script for Molly. It’s positive that this will give users a safe source of these drugs free of adulterants and limit legal consequences but it will also reflect the above: lucrative industry.

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They likely have some benefit but are not the wonder drugs some people make them out to be. Mental health is complex, ptsd and depression are difficult and aren’t really cured as much as managed. Medications can help and novel medications are needed. There are likely no medications that would “fix” the issue on their own though. Patterns of behavior perpetuate sensitization to trauma and influence cycles of depression.

Medication may be a part of that puzzle of achieving remission of course. using psilocybin as an example: one of the reasons it’s promising as a method is because it increases cortical entropy, which increases variability in brain patterns. There is also disruption of the default mode network, which can change self referential and ruminative thought. These effects are obviously desirable. But if you immediately go back to a pattern of hiding from your trauma, a life devoid of meaning, or a cycle of deactivating behaviors the pattern will potentially re emerge

To expand on that last point this side steps the obvious elephant in the room of these treatments can’t fix systemic issues. I’ve been doing mental health treatment for over a decade and you can’t cbt or pills your way out of social issues. Even if mushrooms were a miracle cure for treatment resistant depression it would just come right back after spending a few months or years in a system where you constantly scrape for a paycheck to barely cover costs, dread the future you can’t afford to retire in, and recognize the system that will not throw you a life preserver when you are drowning.

A huge percentage of the people I work with that are depressed and can’t “beat it” aren’t that way because they haven’t found the right pills, talk therapy, or lack of trying. It’s because they are stuck in a system that gives them no resources to explore their passion and creativity. They were in high school and were interested in art, science, music, writing, dance, whatever. But then they entered “job mode” and the time and money they had for their hobbies diminished rapidly. Now it’s 5,10,20 years later and social spaces not dedicated to getting drunk are rare or expensive, they spend 50-70% of income on housing and medical expenses, they work 50+ hours a week in a job unrelated to their interests, that they “fell into”.

Imagine if they had equitable housing, a pension, and healthcare. The ability to be able to go back to school and study something they were more passionate about and make it work without incurring extreme debt or having to balance it with employment that impairs their ability to focus on studies. Would it work for all of them? No. But would you see a lot of people with “treatment resistant depression” start to just feel better and more secure