He is one of the world's leading names when it comes to psychedelic drugs. For decades, David Nutt, a psychiatrist and Professor of Neuropsychopharmacology at Imperial College London, where he heads the Brain Sciences division, has dedicated himself to studying the impact of these compounds on the brain, particularly in the treatment of mental illnesses such as depression and alcohol and drug addiction.
In Portugal, the use of ketamine - a substance already commonly used as an anesthetic - has reached the National Health Service through the Beatriz Ângelo Hospital (the only public one to do so in Europe) and there are already private clinics using it in therapies to treat chronic and severe cases of depression, such as The Clinic of Change, which recently opened in Lisbon and is a partner of Awakn Life Sciences, where Nutt is the director of research.
The 72-year-old doctor, professor and scientist spoke to CNN Portugal via video call a few days before joining the scientific conference 'Ketamine Psychotherapy - Clinical Evidence and Brain Mechanisms', which will be held on September 20 in Lisbon, by The Clinic of Change, in partnership with ISBE - Institute of Evidence-Based Health and ISPA - University Institute of Psychological, Social and Life Sciences.
Science began studying the effects of psychedelic drugs on mental health five decades ago. Fifty years on, is society ready to consider psychedelics as mental health allies?
I hope so, because in those 50 years we've had very little progress in other types of treatment. It's scandalous that we've been denied access to these treatments for 50 years because of concerns about recreational, non-medical use, which isn't actually that harmful. So this is one of the worst examples of drug prohibition leading to unnecessary and perverse consequences that has ever existed.
Currently, what is the main challenge in using psychedelics as a treatment? Is it skepticism within the scientific community itself or stigma and fear among the general public?
It's more stigma and fear among the medical profession. The general public is open-minded. The general public knows that science is good and strong, and the general public knows that we need innovation. But the medical profession is often insecure about these drugs because they've spent 50 years telling people that they're dangerous and now, suddenly, they have to tell them no, that they were wrong. So they're having to change their minds. And so we have to convince doctors that these drugs are not only safe and effective, but we also know their mechanism of action, which is very interesting, because they work in a completely different way to traditional drugs. And that means they give people a chance to respond when they can't respond to other drugs.
But what do psychedelics offer in the treatment of mental illness that other drugs don't?
They offer an alternative approach in terms of brain mechanisms. They often work where other treatments have failed, and they work faster. And that's remarkable. They often work in a single dose and not over weeks and weeks, as is the case with traditional treatments for depression or addictions.
Is it a more effective therapy in the medium and long term or more in the short term?
They work faster in the short term and have similar long-term prospects. But they're actually better than most current treatments, because most current treatments have failed in the people we're using them on. So in the studies in which they were compared to current treatments, they seem to have better results and be faster.
So where does the medical community's skepticism come from?
Because it's quite revolutionary and because it's not being taught in medical schools. I mean, to be fair, it's only now reaching the conferences where doctors go to learn. So, for the last three or four years, I've been lecturing on psychedelics at the main European conferences and now most conferences have at least one session on this topic. And there's a lot of interest. But, as you know, the interest of people who go to conferences is not the same as that of people who don't go to conferences. So we have to educate the doctors who might be a bit more stuck in their ways, who feel comfortable doing what they're doing, because actually, I mean, from my perspective, it's a very exciting new development, because it's not just the drug, it's the drug plus the therapy. So it gives doctors the opportunity to re-engage with their patients and to do psychotherapy, which they didn't do before. This is an interesting development. Perhaps some doctors don't want to have to go to the trouble of relearning. But on the other hand, when they see the results, I think they'll be pleased.
Professor David Nutt is coming to Portugal to talk about ketamine-assisted psychotherapy. Can you tell us what it consists of?
Ketamine is one of the new psychedelic drugs we're talking about. It's a drug we've had for a long time. We've used it as an anesthetic and to control pain. But now it's being used in a different way to treat disorders such as addiction and depression. And the way it's used is to produce an altered brain state for an hour or two, which allows people to escape the thought processes, the thought cycles, which are at the root of their problems. Then people undergo psychotherapy. A therapy session aims to help them understand the perceptions they have gained from the drug experience. This way, they can begin to realize that, during the experience, they may not have been depressed or addicted. And then we have to develop that so that they can develop new ways of thinking, like 'I'm not a drug addict', 'I'm not depressed'. And one of the interesting things about ketamine is that it produces a process called neuroplasticity. It makes the brain more capable of learning after you take it. [...]
In Portugal, ketamine has been gaining prominence in the fight against severe and chronic cases of depression. How can this drug be a potential solution to this illness, which has such a significant impact worldwide?
It's the first real breakthrough in the treatment of depression in 50 years. It works differently from antidepressants. It works where antidepressants didn't and acts on different parts of the brain. So it has a lot of different things going for it. And that's why it's exciting, because for the first time in 50 years, people with depression have an alternative treatment to traditional antidepressants.
And why is depression still such a challenging illness?
Because it's probably more than a disorder, because it's becoming more common due to the stress and uncertainties of life. If you're young and you look at the world and you see global warming and you think about how things have gotten worse in the last 10 years, you'll be terrified if things continue to get as bad as they are now. There's a lot of uncertainty in the world, and that leads to depression. And I think people are also more open to talking about it. Nowadays, people are willing to try to seek treatment, whereas before they might have suffered and ended up committing suicide. [...]
What can we expect from ketamine treatments in the future of mental health?
This is a revolution. I think this is going to be the future of mental health treatment. It's going to be the biggest innovation in the next 20 to 30 years. And it's going to transform treatment and give a lot of hope to a lot of people who currently have no hope.
