Tomáš Páleníček: There's a continuum of experimental psychedelic use in Czechia
Dr. Tomáš Páleníček is a leading Czech proponent of the use of psychedelics in certain kinds of psychiatric treatment. The psychiatrist and several colleagues recently appeared in a documentary named Doctor on a Trip that followed them to the Amazon rainforest, where they mapped brain activity during ceremonies centred on ayahuasca, a traditional hallucinogenic drink. I spoke to Páleníček at our Prague studios.
The recent Czech documentary Doctor on a Trip [directed by David Čálek] shows you and your team going to the Amazon fainforest and conducting tests with ayahuasca. What exactly were you researching there?
“Well, when we went there, that was still a pilot test.
“The idea was to evaluate the effects of ayahuasca on brain activity and brain synchrony and inter-brain synchrony, between multiple people, and also to evaluate long-term effects on the mood and well-being of people who go through the ayahuasca experience in the traditional ritual.
“So what we see in the film is kind of pilot testing of whether we are able to collect this kind of data. And all the people who were volunteering for the ritual were actually part of the research team.
“We did several trips and on one we tested the equipment, whether it would work. Actually we had two sets of equipment and one of them failed because of overheating.
“During the second run we imported seven EEG amplifiers and we tested synchronous recording during the ceremony.
“But we didn’t expect to collect some meaningful data; it was mainly to adjust, like, how to record, how to synchronise, how to adjust video and synchronise with the camera, how to adjust audio and synchronise it with the EEG.
“This is quite a complex task. And luckily when we were there the last time we had two occasions when we were able to record an ayahuasca ceremony with low dosage and one with higher dosage in the same volunteers.
“And we found out that we were able to collect the data synchronously from all participants that were wearing the EEG cap and these were collected to the amplifier.”
And you did find that the participants’ brains were synchronised during the ritual. But why was that important, or why is that important?
“One of the things that we are looking at in psychiatry and in psychotherapy is the effect of group therapy.
“Within psychiatry and psychotherapy, group therapy is a just normal therapeutic tool that is used.
“And current psychedelic studies typically involve a patient and sitters or therapists that are accompanying them throughout the experience.
“But in the traditional context, in the ritual context, it’s typical that there are more people present – and they go through the ceremony, or through the altered states of consciousness, together.
“And when we look at how these two things relate to the, let’s say, Western approach, the one-to-one treatment approach is very expensive, because the time the therapist spends with the patient is really extended.
“When we go to a kind of group therapy setting it might be more cost-effective – and it also it might have its own dynamics, which might be very different to what we observe one-to-one.
“So what we are looking at is to understand the dynamics of the group process and to see also how the stimuli that are present in the environment are related to the potential synchrony between subjects.
“Obviously most people who have had an experience with psychedelics might say, Yes, we feel connectedness to other people and so on.
“This is something we would like to measure, and it seems we can measure it with EEG. And the question is, what makes the connection? Is it the substance? Is it the ritual? Is it the shaman? Is it the song or the music which is presented?
“So these are variables that we would like to control for – and maybe in the future apply this to group therapy sessions. And also to look at whether any of these parameters can be more connected to long-term outcome on mood and well-being.”
Also in the film we see your own father, who seems at least a little bit sceptical about your findings, or about this whole area. Is he a psychiatrist too?
“No, not at all. He actually was a sound technician at Czech Television. Now he’s retired. He will turn 80 this year.
“He doesn’t like much about these psychoactive substances at all.
“So he’s from a completely different area.”
What led you to psychiatry, and specifically to this field of psychiatry?
“Hard to say. I have a hypothesis as to why I was attracted by these altered states and by these compounds.
“But actually I realised during my studies at high school that I was interested in biochemistry and organic chemistry.
“I was interested in alkaloids and studying what they do and how it’s possible that they alter our cognitive functions and perception and so on.
“Then I was accepted to study medicine and then, again by coincidence, in the fifth year I got in touch with my former supervisor and one of my best friends these days, Professor Jiri Horacek, who is also in the film, and he offered me PhD studies on animal models of psychosis.
“At that time I wasn’t sure if I wanted to go directly into clinical practice and he said, Well, you can study what you’d like to study – animal models of psychosis are typically modelled by psychoactive compounds; we typically use ketamine, but other things like LSD are also used in this context.
“I said, OK, let’s give it a try. I started to do my PhD in preclinical science and in the second year of my PhD I wrote a project proposal that was accepted by the grant agency.
“And that project proposal was already focusing on LSD, psilocybin [‘magic mushrooms’], mescaline, MDMA – all these compounds in animal models. That’s where it started and that’s how I got to it.
“And maybe the complete beginning – it’s my hypothesis – was when I was a child, I was three years old, I was completely burned by hot tea.
“I was for three months an inpatient at a hospital, having plastic surgeries, and all of that. What we know, in the case of burns, is that patients are nearly continuously on infusions of ketamine.
“People in a recreational setting don’t use such high doses compared to what we use in our experiments.”
“So that’s my hypothesis as to what’s behind it – maybe I was somehow imprinted, at just three, to somehow have this pathway.
“But I’m not sure. This is speculation.”
My next question was going to be, When did you have your first psychedelic experience? But maybe you had it at the age of three and you didn’t know?
“Probably. It’s hard to say if this was psychedelic, because ketamine is kind of different.
“And of course as teenagers we had experiences with LSD and mushrooms.”
So uncontrolled?
“Uncontrolled, like most people. But honestly, the first real powerful experience I had in our institution, as a healthy volunteer, in a ketamine trial.
“Then, I think it was 2007 or something like that, we went to Chile and we had an experience with San Pedro cacti. It was in a very old, ritual, indigenous place, up there in the Atacama desert, and that was also very intense.
“Then there was another powerful experience as a healthy volunteer with psilocybin.
“But honestly, usually people in a recreational setting don’t use such high doses compared to what we use in our experiments. So I definitely had the real, full psychedelic experience for the first time in the lab.”
You’re the co-founder of the Psyon clinic here in Prague, which says that it’s the “first medical facility in Europe to offer psychedelics-assisted psychotherapy”. What conditions are you mainly treating?
“Actually we focus mainly on ketamine, because this is the only available medication which is approved.
“And the inclusion criteria are mainly for depression, but we also offer treatment to people with general anxiety disorder, post-traumatic stress disorder, anxious-depressive disorder and some others.
“We’ve dosed some patients with anorexia nervosa in order to see whether it helps or not, because there is some evidence in some other rare conditions.
“What is new is we have a license now to work with psilocybin and LSD.”
“Now, what is new, we also have a license now to work with psilocybin and LSD. And we have two commercial trials coming on-site, one from [biotech firm] Compass Pathways, which is treating treatment-resistant depression with psilocybin.
“We have a site at Psyon and also at the National Institute of Mental Health; the other one is with LSD and general anxiety disorder.”
What kinds of patients are most likely to benefit from these kinds of approaches? People who have tried psychotherapy but it didn’t work for them?
“The concept of Psyon is that we prefer to have people who are already in the therapeutic process. And the ketamine-assisted therapy is on top of that.
“It’s kind of facilitating the therapeutic process. It’s kind of an accelerator of the process. Also the biological effect of ketamine might help improve the mood quickly and bring quick relief from suffering. This is the concept of Psyon.
“Of course, there are other ways. Not all patients require psychotherapy, not all patients want psychotherapy, so we also have biological approaches, focusing only on the pharmaceutical effect of the drug, the pharmacological effect of the drug.”
How quickly can these alternative substances start working for the patient, compared to normal anti-depressants, for instance?
“The experiences we have show that ketamine is quite efficacious. It can induce, in this context, quite long-lasting improvements, though of course not in all subjects.
“Also from the data that we have from around the globe, it seems like it’s like every other treatment: about a third of patients can have immediate relief and improvement, for about a third it’s so-so and about a third are non-responders.
“This is kind of true for all treatments in psychiatry until now.”
So from what you’re saying you’re now bringing in the use of LSD, for instance? Is that the case?
“It’s not us. It’s actually the MindMed [US] company that’s running the trial in the Czech Republic. We are one of the sites. And it’s focusing on general anxiety disorder.”
I feel like every five years or so I see a headline saying, LSD could be used in psychiatric treatment. But it never really seems to go anywhere. Why is taking so long?
“Well, in the real world if you want to approve a medication to treat something, it needs to follow certain steps, according to the FDA or according to the EMA, the legal authorities in the US and Europe, or others in other parts of the world.
“Not all patients require psychotherapy, not all patients want it, so we also have biological approaches.”
“That means it has to go through phase one, phase two and phase three studies. And today we are with some of the compounds, like psilocybin or LSD, in phase three studies.
“Most of them are sponsored by industry, so their intention is to get approval of this drug for the treatment of specific diagnoses and to register it for this treatment.
“This happens with all compounds – and that needs time.
“There was this issue with MDMA-assisted therapy for PTSD that MAPS [Multidisciplinary Association for Psychedelic Studies] invested a lot into and actually the FDA just put it off the table.
“They had to do a new study to convince the regulators that this was adequate treatment.
“So this is how long it takes. Honestly if it’s 10 years from phase one to registration, that’s perfect.
“And phase three trials have started of different companies, and there are also academic phase three trials that are currently ongoing.
“So it could be a relatively short time before these companies would go for approval – let’s say in two or three years, and we’ll see.”
So yes, how soon do you think this could be a real thing that people are benefiting from?
“That’s what I say: In two or three years I would expect, if there are positive outcomes of the trials, that the industry will go for registration.
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“We will see then how the authorities will react.
“It could happen that they will be approved. It could happen that the trials will not be as positive as they look.
“It could happen that they will have some issues with how the studies were designed and they will say, No, you need to do more studies.
“That’s the uncertainty.”
Are you also doing research into the use of cannabis? It’s not usually seen as a psychedelic drug.
“We did some research with cannabis in the past. But there are so many things ongoing so I’m not doing too much on it right now.
“We do have some pre-clinical studies with synthetic cannabinoids, cannabidiol and its derivatives, not in the psychotomimetic direction, but mainly we study the effects of cannabidiol and its analogues as potential therapeutics in other cases.
“So that’s where I am. I’m also counselling [firm] CB21 Pharma, which is a company that produces CBDs [cannabidiols], so yes, I’m kind of interested in if it could be used therapeutically.
“But as so much is happening in the psychedelic domain I need to focus more on this topic.”
Was it the case that LSD was tested in Czechoslovakia in the 1960s?
“Yes. Not only LSD but also psilocybin. And it wasn’t only tested – it was used for treatment.
“There were several departments where they used it extensively, including at the National Institute of Mental Health, which before was the Prague Psychiatric Centre, and before that was the Prague Research Psychiatric Institute, or something like that, translated into English.
“That’s where Stan Grof [pioneering psychiatrist Stanislav Grof, who moved to US in 1960s] also worked, and others.
“So there’s a kind of continuum of experimental use and therapeutic use of psychedelic substances in the Czech Republic.
“And lots of patients were treated in Sadská [psychiatric clinic near Prague] by Dr. [Milan] Hausner, and all diagnoses. Lots of depression, anxiety, alcohol use disorder – at that time there were no other drugs for alcohol use disorders, typically.”
Why was that kind of research discontinued? Was it because Grof left for America?
“No, it was because of the regulations. Actually the research continued a bit longer, after 1971.
“But it was because of the international regulations, that all these compounds were placed in the category of drugs with ‘no medical used’, so they were banned technically.
“There is a nice documentary on YouTube about how LSD was used experimentally in troops of the Czechoslovak Army.”
“There was only limited medical use, meaning for clinical trials and so on – that’s where we are now – but the real therapeutic approach was destroyed.”
I have a vague memory of reading an article about that fact one of the guinea pigs in this testing in the 1960s [in fact the early 1970s] was Jan Švankmajer, the artist and filmmaker.
“I’m not sure if he was a guinea pig, but he definitely had the experience.”
He was a soldier, I think, in those days. He was one of the people they tested it on.
“It could be the case, yes, I don’t know. There is actually a nice documentary that’s available on YouTube about how LSD was used experimentally in military troops of the Czechoslovak Army. It’s quite funny to see them, how they react, how they are completely disorganised in the team.
“So yes, there were these military experiments also happening, but who went through them I don’t know.
“I know one police officer who collaborated with us who said, Yes, I had it at that time and it was a very interesting experience.”
Preparing for this interview I came across a quote from you where you said, “Maybe if Putin took a good dose of LSD he would change his attitudes and rethink how he behaves and what he does.” This man is responsible for unspeakable atrocities and barbarism. Isn’t it naive to think that he could be somehow improved if he took acid?
“Well, I’m kind of exaggerating, because we know psychedelic experience can change or alter psychological states, but they definitely cannot completely change the personality.
“And his personality is petrified. The hypothesis behind this is that the people who experience this profound experience and connectedness to nature and the universe and other people probably… well, we would expect they wouldn’t accept the kinds of behaviours that would lead to killing and mass murders and whatever.
“I feel, technically, anyone healthy can get some teaching and can learn from the experience.”
“But Putin is a very special person, I believe. He has very special training and we don’t know what KGB agents went through when they were in the service.
“So we don’t know what kind of experiences he had and maybe he had this kind of experience in the past, I don’t know. But it definitely wouldn’t change his personality.”
But essentially as well as believing that psychedelics can be useful in psychiatric treatment, you also believe that everybody would benefit from taking psychedelics?
“It’s not definitely, like, everybody. There are people whose mental state it might worsen. There are people who for now are completely contra-indicated for psychedelics.
“Even though indigenous people treat it differently, we have psychotic patients that have a clear contra-indication now.
“As I said, in the patient population one-third benefits completely, one-third so-so and for one-third it doesn’t do anything.
“I feel, technically, anyone healthy can get some teaching and can learn from the experience, but the question of how he will benefit and how he will integrate it, is unknown.
“So many people can have an important, transformative experience if it’s performed in a safe and good environment. But I wouldn’t generalise it to everyone.
“That’s always kind of like an exaggeration, a little bit.”
My final question is, honestly, how optimistic are you that 20 years that we’re talking about will be regularly used in psychiatric treatment?
“If we find them to be efficacious, I hope it will be earlier.
“Ketamine is already becoming standard in psychiatric care, so I believe these compounds will also become standard treatment.
“But, again, as with anything, not all patients will benefit, so we will have more information on which diagnoses benefit, on how it should be combined with psychotherapy and what are the main benefits of combining with psychotherapy.
“I’m quite optimistic: I think it will become part of regular psychiatric care in the future.”
“There’s the Swiss school of psycholytic therapy – continuously, even since the 1971 – and they use psychedelic sessions, or psycholytic sessions, on top of continuous psychotherapy and it seems to be really beneficial.
“So I think there’s a lot to learn from this group of therapists.
“We will see how it will be implemented, but I’m quite optimistic: I think it will become part of regular psychiatric care in the future.”
