Psychedelics: think it’s a good idea, doc?

Robyn Anderson is a 4th year medical student at the University of Glasgow

‘When’s the last time you remember being happy?’

He stares at me, and momentarily I can see him try to retrieve the memories like a treasured old book from a dusty high shelf.

‘I was 10 and it was summer. When I think about it now, I honestly can’t be sure if it was real. There was so much damage after that. But that day, I can still smell that summer. Hot tarmac, soft under my penny black plimsolls, cushioning my step, and the smell of freshly cut grass assaulted my senses. The warm summer sun had melted the pavements, and abandoned sweet wrappers did acrobatics in the breeze. That was the day I met my best friend, although I couldn’t have known it then. The sky was full of blue and sparkling promise. Summer. Warm, hazy days that felt like they would never end.’

For a moment his face holds the memory. Then something shifts behind his eyes.

‘Then it all went to sh*t.’

Jack*, now nearing 30, has been my patient since moving to Glasgow two years ago. He is bright and engaging, but behind the bravado are deep emotional wounds that have been difficult to heal. His childhood was shaped by trauma. Divorce, parental abandonment, addiction, homelessness, poverty. Experiences that did not remain in the past, but followed him into adulthood. We have tried everything we have to offer. Talking therapies, medication, support groups.

Then he says something I wasn’t expecting.

He has been researching psychedelic assisted therapy and has booked a psilocybin retreat in the Netherlands.

‘Think it’s a good idea, doc?’

As a GP working at the deep end, Jack’s story is not unusual. Around one in three children experience trauma by the age of 18.¹ Those exposed are significantly more likely to develop mental health disorders.² For many, the effects do not end in childhood. They embed.

Early trauma does not just shape memory. It shapes biology. During childhood, the brain is highly plastic, rapidly forming and refining neural connections.³ Repeated stress shifts that process. Pathways of fear and hypervigilance are strengthened, while those involved in emotional regulation and decision making may be weakened. Over time, this can become a persistent way of being in the world. Hyperalert. Guarded. Quick to threat. Slow to trust.

Trauma focused cognitive behavioural therapy has transformed outcomes for many and remains a cornerstone of care. But for others, particularly those with complex trauma, recovery is incomplete. When memories are too overwhelming to approach, the very mechanisms that make therapy effective can become inaccessible.

Psychedelic assisted therapy is moving from the margins towards clinical reality, but unevenly. In Australia, tightly regulated models now permit MDMA for post traumatic stress disorder under specialist supervision.⁴ In Canada and Switzerland, access exists through compassionate, case by case pathways.^5,6 Alongside formal adoption sits a parallel, far less regulated ecosystem of retreats, particularly in the Netherlands and Jamaica, where experiences are offered under the banner of healing, often outside any medical governance.⁷ In the UK, these treatments remain confined to research settings.⁸

The result is a fragmented landscape. Patients are not waiting for it to resolve.

Psychedelics are not used as standalone treatments, but alongside psychotherapy. Among these compounds, MDMA is the most extensively studied. Often described as an empathogen, it enhances feelings of trust, connection, and emotional openness. In a therapeutic setting, this may allow individuals to engage with traumatic memories without becoming overwhelmed.⁹

The early results are striking. In one trial of treatment resistant PTSD, 83% of those receiving MDMA assisted psychotherapy no longer met diagnostic criteria, compared with 25% in the control group.⁹ For patients with complex trauma, many of whom have developed alexithymia. People with this condition still experience physical sensations and emotions, but they struggle to understand or articulate them as a form of psychological protection,¹⁰ this matters. Difficulty identifying and expressing emotions is not just a symptom. It is a barrier to conventional therapy. These approaches may help patients engage with work that was previously out of reach.

But this is not a simple solution. Psychedelics can induce intense and sometimes destabilising experiences. Some individuals report increased anxiety following use.¹¹ In uncontrolled environments, the risks are less predictable, and the evidence base has been built in carefully structured clinical settings, not retreat centres.

For GPs, this creates an uncomfortable reality.

We cannot prescribe psychedelic therapy. We cannot refer to it. We cannot recommend it.

But our patients are already seeking it out, often without guidance, and increasingly without us.

For those working in deprived communities, the patients most likely to explore these options are often those who have exhausted everything else. Treatment resistant depression, chronic pain, addiction, anxiety that resists conventional explanation. Conditions that frequently carry the imprint of earlier trauma. These are the patients who sit in front of us year after year, carrying wounds that have resisted every intervention we can offer.

Our patients are already there. They are booking retreats, crossing borders, and coming back to our consulting rooms with questions we are not yet equipped to answer. But when a patient sits across from us and asks if it’s a good idea, having it on our radar is the very least we can do.

*Authors’ note: The above is based on a fictional patient interaction.

References

1. UK Trauma Council. Available from: https://www.annafreud.org/get-involved/networks/uk-trauma-council/ [accessed 19/6/26]
2. Lewis SJ, Arseneault L, Caspi A, et al. The Epidemiology of Trauma and Post-Traumatic Stress Disorder in a Representative Cohort of Young People in England and Wales. The Lancet Psychiatry. 2019;6(3):247–56.
3. UK Trauma Council. Early childhood and the developing brain. Available from: https://uktraumacouncil.org/resource/early-childhood-and-the-developing-brain  [accessed 19/6/26]
4. Therapeutic Goods Administration. Authorised Prescriber pathway: psilocybin and MDMA for treatment-resistant depression and post-traumatic stress disorder. Australian Government; 2023.
5. Health Canada. Requests to the Special Access Program involving psychedelic-assisted psychotherapy. Government of Canada; 2023.
6. Brennan C, Gasser P, Berlowitz I, et al. Implementing psychedelic-assisted therapy: history and characteristics of the Swiss limited medical use program. Front Psychiatry. 2025;16.
7. Pilecki B, Luoma JB, Bathje G, et al. Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduct J. 2021;18:40.
8. Royal College of Psychiatrists. Position Statement PS05/23: Psychedelic-assisted therapy. Royal College of Psychiatrists; 2023.
9. Mohamed A, Touheed S, Ahmed M, et al. The Efficacy of Psychedelic Assisted Therapy in Managing PTSD: A New Frontier? Cureus. 2022;14(10).
10. van der Kolk BA, Wang JB, Yehuda R, et al. Effects of MDMA assisted therapy for PTSD on self experience. PLOS ONE. 2024;19(1):e0295926.
11. Bremler R, Katati N, Shergill P, et al. Case analysis of long term negative psychological responses to psychedelics. Scientific Reports. 2023;13(1).

Featured photo by Mirella Callage on Unsplash.