The World in 2022

November 24, 2021

Posted By: Morgan Kervitsky
Original Author Thieu Vaessen (translated from the Financieele Dagblad)

Just a little while longer and we will be tripping away our traumas

Tripping against depression? Indeed. Mind-altering drugs are in vogue as possible medicines against depression and post-traumatic stress. Many producers are also active in the Netherlands, which has a tradition of medical use of psychedelics such as MDMA, lsd and magic mushrooms.

Psychedelics such as magic mushrooms are the future in the psychiatrist's consulting room: as new drugs for depression. Illustration: Getty Images/FD Studio

In Brief

After a long silence, new drugs for depression are being worked on again. Several biotech companies are looking for the solution in psychedelics such as MDMA, lsd and magic mushrooms. The entrepreneurs build on the positive experiences of psychiatrists with hallucinogenic drugs.

Many companies are also active in the Netherlands, which has a tradition in the medical use of psychedelics. For decades, virtually no new drugs have been introduced against depression and other mental disorders, such as post-traumatic stress and anxiety attacks. Pharmaceutical companies have all but abandoned the development of new drugs, while existing ones - such as fluoxetine or Prozac - are far from satisfactory, in part because of their side effects.

But perhaps a turnaround is nearby. A remarkable turnaround. For a good number of young biotech companies are busy developing new antidepressants, under one common denominator: the active ingredient comes from mind-altering drugs. Indeed, salvation must come from psychedelic mushrooms and truffles, from the party drug ketamine, from lsd and from MDMA (the constituent of ecstasy).

Tripping with magic mushrooms? Against depression? More or less yes. Thanks to the mind- altering substances, patients can look at their psychological problems in a different way instead of just suppressing their feelings. By making new connections, psychiatrists say psychedelics can really change things in patients' brains.

The idea is that a sophisticated dose can be enough for a breakthrough in treatment. Usually in combination with psychotherapy. The Netherlands plays a prominent role in a lot of research, more on this later.

Back to the Hunger Winter

Many psychiatrists have long been familiar with the use of psychedelics as a treatment method. The originally Dutch psychiatrist Bessel van der Kolk, author of the bestseller Traumasporen, for example, experienced the impact of MDMA himself: he went back to the hunger winter he experienced as a two-year-old child. It enabled him to feel the pain again, as a kind of recognition of what had happened to him.

Pharmaceutical companies are building on this kind of experience. They are working on their own versions of psychedelics and hope to prove that they can provide an effective drug. A first drug has also already been approved: esketamine, a drug related to ketamine and sold under the brand name Spravato by Johnson & Johnson, the largest healthcare company in the world. For several months it has also been reimbursed in the Netherlands.

Admission of Spravato was less complicated than it will be for many other drugs because ketamine has been used as a medicine for a long time, especially to sedate patients. As a result, it usually falls under a less strict regime. In the Netherlands, this is the Medicines Act and not the Opium Act.

Huge market

Especially smaller biotech companies are currently investing millions in the development of psychedelics, with approval as a medicine and reimbursement by health insurance companies as the ultimate goal. Many of the initiators behind these companies have a history of growing cannabis. They foresee an enormous market for psychedelic drugs, of tens of billions of dollars or euros per year, because depression and post-traumatic stress are omnipresent.

The industry's flagship company is Compass Pathways, which is developing a drug based on psilocybin, the active ingredient in magic mushrooms. The British company has a study underway among 216 patients being treated for severe depression. This is the largest study to date with a psychedelic drug.

The study may provide the basis for approval of Compass' first drug. The company will have to take into account increased supervision, at least by the American DEA, because psilocybin is on the list of so-called controlled substances. In the Netherlands psilocybin is also on the list of controlled substances.

Mushrooms are not, truffles are

Meanwhile, a handful of companies working on psychedelic drugs are listed on the stock exchange. In addition to Compass with a market capitalization of $1.5 billion, these include MindMed, Field Trip Health, Mydecine and Cybin. Thanks in part to their IPOs, these companies have raised enough money to fund their research for the time being. Many of these biotech companies are active in the Netherlands in one way or another. For example, the three university medical centers of Groningen, Leiden and Utrecht are participating in Compass Pathways' patient research.

MindMed - with a market capitalization of €700 mln the number two company in the sector - cooperates with Maastricht University. The company has a study underway on micro dosing of lsd, in collaboration with senior lecturer Kim Kuypers. Field Trip Health is the only one to have its own branch in the Netherlands, in Amsterdam. There is the company already offers treatments with truffles containing psilocybin, which is not banned in the Netherlands, unlike magic mushrooms containing psilocybin. In fact, the legislation is even more lenient than for ketamine, because truffles fall under the Commodities Act. One treatment cost over 4000 euros and is not reimbursed by health insurers.

For the time being, the company makes no medical claims with its hallucinogenic truffles: Field Trip says it offers ‘a process of self-discovery and inner healing’. ‘At the moment in the Netherlands we are using more of an alternative care model,’ says Onur Yildirim, director of the Dutch branch. Yildirim obtained his PhD in neuroscience in Nijmegen and had previously pleaded with the large pharmaceutical companies Johnson & Johnson and Novartis for more research into psychedelic medicines, but the reluctance there was too great for his liking.

The Sixties

Mydecine in turn also has big plans in the Netherlands. The company also works with psylocibin and wants to open a psychedelic center of excellence in Oegstgeest next year. In addition to treatments, research will also take place there, as well as training of therapists. The center will have a broad set-up, away from Mydecine, assures CEO Josh Bartch, who visited the Netherlands this fall. In this way, Bartch says, the new institution can help to overcome "the stigma" attached to the sector. In other words, the institution must make clear that psychedelics are more than party drugs for parties and festivals.

The choice for the Netherlands cannot be seen separately from history: in the sixties, the psychiatrist Jan Bastiaans already experimented with psychedelics for the treatment of war traumas. Those experiments ended in chaos and bitterness, but Dutch psychiatry still has a tradition of open-mindedness that, according to Bartch, can benefit research into psychedelic drugs.

Mydecine is also going to do patient research in the Netherlands and has the support of Eric Vermetten, extraordinary professor at the LUMC in Leiden. Vermetten was affiliated with the Ministry of Defense as a psychiatrist for many years. The treatment of war veterans with post-traumatic stress is one of his specialties and is also one of the indications that Mydecine focuses on. The second indication is the remedy of smoking addiction.

Vermetten calls it high time for medications that allow for better treatment of patients with post-traumatic stress. 'It is a condition that is very difficult to treat. A person cannot think themselves out of post-traumatic stress. That's why I'd like to see drugs based on MDMA, ketamine or psylocibin given another chance.'

Break with pharma model

And the risks? Will patients jump out of the window one by one during a bad trip? Or is a new wave of addiction in the pipeline, analogous to the opiate crisis with addictive painkillers?

No, it won't be as bad as all that, according to everyone in the sector. Of course, psychedelics should only be used as medicine in the presence of trained therapists. But the chance of addiction? That would be negligible with hallucinogens - with the exception, perhaps, of ketamine.

According to Bartch of Mydecine, a major advantage of psychedelic drugs is that a few treatments can suffice: "It is a complete break with the regular pharmaceutical model that prefers to make patients dependent on a drug.

Now all that remains is to prove that psychedelic drugs are truly effective, in scientific studies with larger numbers of patients.

The world in 2022

This article is from 'The World in 2022', in which the FD editors look ahead to the coming year. Subscribers will receive the magazine with the FD of Friday, December 24.

Read the full article (in Dutch): weg-ixk1caS4HC5p