'More Real Than Real:' A Psychiatrist Discusses DMT
Oregon’s recent vote to legalize psilocybin therapy, and the IPO of pharmaceutial psilocybin company Compass Pathways are just the latest signs of surging interest and newfound respectability for psychedelics.
The psychedelic compound DMT (Dimethyltryptamine) isn’t as well known as psilocybin. But it is renowned in some circles for inducing an experience that Dr. Rick Strassman, a psychiatrist and professor at the University of New Mexico School of Medicine, described as “more real than real,” while only lasting about 30 minutes. WeedWeek spoke to Strassman about the compound, its potential benefits and why the psychedelic revival is long overdue.
This interview has been edited for length and clarity.
WeedWeek: Can you tell us a bit about yourself and how you became interested in DMT?
Dr. Rick Strassman: In college, I got interested in speculating about the biology of spiritual experience because of the similarities in descriptions between psychedelic drug states and certain kinds of Buddhist meditation. So I was thinking there must be some common biological denominator to the extent that those descriptions resembled each other, that their phenomenology overlapped.
I went to medical school to study the biology of consciousness, in particular spiritual consciousness. That’s why I became a psychiatrist and took a fellowship in psychopharmacology research.
I started off looking at the pineal hormone melatonin. In the late seventies or early 1980s, there was some evidence that it was psychedelic. And our study only demonstrated sedating properties of melatonin. And so by then I had learned about DMT.
WW: What is DMT?
Dr. Strassman: DMT is what’s called a tryptamine psychedelic, the smallest and the simplest psychedelic with this molecular structure. The tryptamine core is what’s behind both psilocybin, LSD and in some ways ibogaine. It’s been found in hundreds, if not thousands of plants.
It also is made in mammals. It was discovered to be in rodent blood, urine and spinal fluid in the early sixties. Then a few years later it was discovered in human body fluids. So it’s interesting because it is naturally produced and it’s quite psychedelic. I was thinking to the extent that giving DMT to people replicated features of spiritual experiences one could then argue for a role for naturally occurring DMT in those non-drug states like mystical experience, near-death states, the results of meditation, those kinds of things.
DMT stimulates the same receptors in the brain as other psychedelics do like LSD and psilocybin: Visual cortex, limbic system for emotions, the frontal cortex for thinking, and insights. DMT of itself was never used in psychotherapeutic studies back in the day. That was mostly reserved for LSD. But there were a couple of cousins of DMT that were synthesized in the laboratory, DET and DPT, which were used to treat end of life despair and for the treatment of alcoholism. There were some small, early pilot studies but they were promising.
There was also a flurry of interest in the question, if DMT is made in the human body, and it produces these extraordinary psychological effects, is there a role for endigenous DMT in psychosis, schizophrenia in particular? So there was a lot of research looking into whether there were elevated levels of DMT in schizophrenia, if schizophrenics metabolized DMT differently. They were even developing some antibodies to DMT to see if that might be a treatment for psychosis.
All of those human studies ground to a halt along with all other clinical research around 1970. Since the resurgence of interest in psychedelics there has not been a proportionate increase in interest in DMT.
The delivery of DMT is a problem too. It isn’t orally active. It needs to be injected or vaporized and inhaled. (There is an orally active form of DMT in ayahuasca, which is a brew from the Amazon that contains a plant that has DMT in it and a plant which inhibits its breakdown.)
WW: Do you see DMT as having a practical medical value?
Dr. Strassman: To the extent that psychedelics have practical medical value, I think the same could probably be said for DMT, although we don’t have the data yet. The main problem with DMT or pure DMT is the route of administration. It isn’t orally active so you need to inject it or smoke it. So there is interest in developing alternative delivery systems for DMT. Either like a nasal spray or a patch or subcutaneous injections. So the race is on for the most amenable way of a simpler manner of administering DMT that also extends the experience.
If you smoke it or you inject it, it starts in a few heartbeats. It peaks in two minutes and is over in 20 minutes. It requires a bit of holding onto your hat. It can be disorienting because of its rapidity. So if you can slow the onset, prolong the plateau and then extend the offset, you could work psychotherapeutically with people in a way that you can’t when you inject it, when it’s just so quickly in and out.
On the other hand, psychotherapy may not be necessary, as we’re finding in the case of intranasal ketamine, whose acute effects are also very short-lived.
Dr. Strassman: Ketamine is being used as an antidepressant in a nasal spray. With a relatively similar course of action, you could do psychotherapy with DMT.
So one can make an argument that the properties of ketamine, which have also been discovered to apply to DMT, which is increasing neural growth, increasing neuroplasticity, is the mechanism of action of these very quick acting antidepressants. You give ketamine and the depression’s gone in a few hours. You give ayahuasca and the depression’s gone in a few hours. You give psilocybin and the depression’s gone in a few hours.
WW: Like permanently?
Dr. Strassman: The neuroplastic effects begin immediately and are long-lasting; perhaps the time-course of the neuroplastic changes parallels that of the anti-depressant effects. If pure DMT turns out to be anti-depressant, we may be seeing the same mechanism. It’s worth noting that ayahuasca also increases neuroplasticity, and this may underlie its anti-depressants effects, too
WW: What’s your impression of this resurgence of interest in, in psychedelics?
Dr. Strassman: It’s long overdue.
WW: What do you see the primary benefit, practical medical treatment? Or are you interested in other aspects of it? What do you find most exciting?
Dr. Strassman: I think psychedelics open a window to a unique view of the human mind. So any conditions which would benefit from a better understanding of the human mind and ways to maneuver it towards greater health, or at least in the directions that you would like your mind in your life to take, then they’re valuable.
If you’re depressed, they might be helpful. If you’ve got PTSD, they might be helpful, if you’ve got OCD, end of life despair, addictions. In the proper setting, you can apply the effects of psychedelics for a benefit in all kinds of ways.
Remember, “psychedelic” means mind manifesting. They aren’t inherently anti-depressant, or anti-addictive. Rather they combine with set and setting—preparation for the experience, supervision of the session, and integration—to produce the effects you hope for.
You could use them for creativity, for wellness, for improving your meditation practice. They’re kind of a panacea in a way, depending on how they’re used. And because of that effect, you start wondering about the placebo response, which is a real biological effect. I mean, placebo analgesia is reversed by Narcan. So placebo, isn’t imaginary, it’s true. It’s a real biological objective response. But it occurs through activating a certain process in the mind, a mind-body linkage, which psychedelics seem to enhance.
With respect to psychedelics’ place in the medical armamentarium, heir ability to enhance the placebo contribution to healing suggests they’ll be especially useful in conditions with a large mental component. Depression, addiction, and psychosomatic illnesses like autoimmune disease, inflammation, asthma, irritable bowel, those types of conditions.
WW: How would you describe the DMT experience?
Dr. Strassman: When it’s given as an injection intravenously, the effects begin within a few heartbeats. The room breaks down visually. You close your eyes and you enter into a world of light. You lose awareness of your body. That state is full of intelligence, full of information. And sometimes “beings” appear that you interact with. They know you’re there. You know they’re there. You interact with them, you relate, they ask you questions, you ask them questions. They can harm, they can heal. They can instruct. They interact with you in a wide variety of ways.
One of the most impressive hallmarks of the DMT experience is that it feels more real than real. Everyday reality feels like a dim shadow, as it were. That’s one of the unique aspects of DMT. Even, when you take a large dose of LSD or a large dose of psilocybin, you pretty much know you’ve taken a drug. But with DMT, you’re completely transported into this free standing, separate level of reality. That’s a very common description. It feels more real than real.
The effects peak in about five minutes. They start fading at about 12 to 15, and you’re down pretty much within the half hour.
WW: Is there a way to think about, I don’t know what the right word is. But I think maybe responsible versus irresponsible use of DMT and other psychedelics?
Dr. Strassman: The most important thing in using psychedelics is the set and the setting, in addition to the drug (which takes us into the notion of dose). There are responsible ways of taking them and irresponsible ways of taking them. A responsible way of taking them is to optimize your state of mind and your health before the experience. Educate yourself, prepare yourself.
Optimize the setting, which is the environment in which you are taking the drug. Is it supportive? Is it therapeutic? Is it completely chaotic? Are you around people that you don’t like that don’t like you? In the middle of a scary part of some huge metropolitan spread. Or are you among friends or psychotherapists in an outdoor environment where everything’s comfortable. Do you have safety plans if a need should arise?
So it’s kind of like any other experience. Mountain climbing, running, hiking, going into town. You could do it recklessly, or you could do responsibly.
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