Czech law allows a revolutionary new treatment for severe depression. From Based in Bohemia.
Dr. Tomas Palenicek sits down on a park bench and tells me about magic mushrooms.
The sun bathes Prague’s Nusle neighborhood in its warmth. The Czech capital is experiencing its first real day of spring. It’s hard not to feel optimistic – about life, the universe, everything.
“We’re witnessing something of a psychedelic renaissance,” he says.
Palenicek is a clinical psychiatrist at the Czech Republic’s National Institute for Mental Health. He’s also the head of the institute’s Psychedelic Research Center.
He’s devoted much of his career to studying the power of psilocybin – the chemical compound in magic mushrooms – to help people with severe depression.
Psilocybin is especially promising for those patients who no longer respond to antidepressants – those who remain locked in their prison of depression for months or years.
“Psychedelics are different compared to traditional drugs in that in many people – if they are effective – they can bring about a rapid switch in mood,” Dr. Palenicek says. “It’s why we call them fast-acting antidepressants.”
When Palenicek says fast, he means hours or days. Patients who have been overwhelmed by crushing depression for years have seen improvement almost immediately after a single dose of psilocybin.
For some, the change is long-lasting. They’ve felt better for weeks, months, even – in several cases – a year.
And they’re patients who have been weaned off their regular antidepressants.
This sounds miraculous, I venture. A veritable wonder drug.
Dr. Palenicek is keen to temper my enthusiasm.
“A third of patients respond strongly. A third show a moderate response. A third show no response at all,” he says.
Still, it’s something.
Magic mushrooms are still illegal in Czechia, at least for recreational use. Psilocybin remains a “controlled psychotropic substance” under the Czech law on addictive substances.
Possession of a “small” amount (generally understood as being up to 40 fresh mushrooms or about five grams of dried) for personal use is a misdemeanor punishable by a fine.
Possession of “more than a small amount” technically becomes a criminal offense. As is cultivating, selling, or distributing psilocybin.
In medicine, however, things are different.
For several years the healing potential of psilocybin has been the subject of clinical trials by Dr. Palenicek and others.
But this year, the law was amended. There is now something called “psilocybin for medical use”.
It means the Czech Republic has become one of just three countries in Europe (after Germany and Switzerland) that allows psilocybin to be administered to patients as a therapeutic tool, not just as part of clinical trials.
Psilocybin can only be used with those suffering from what you and I would call “severe” depression. Doctors like Palenicek prefer to call it Major Depressive Disorder (or MDD when they’re scribbling it down on their notepads).
It can also be used to treat conditions such as end-of-life anxiety and Obsessive-Compulsive Disorder.
For psychotic disorders such as schizophrenia, it is very much not suitable.
For now, its use is still fairly limited. This is largely due to the restricted availability of the synthesized psilocybin used in sessions, which needs to be imported.
I ask Dr. Palenicek exactly what psilocybin does to the depressed brain, and quickly regret it.
He uses phrases like downregulating serotonin 2A receptors and increasing synaptic neuroplasticity. Things my ‘O’ level biology do not permit me to fully comprehend.
I don’t tell Dr. Palenicek this, but I myself have done some research into psilocybin.
It was far less rigorous than that carried out by him and his colleagues. This was research undertaken by me and my housemates at Coventry Polytechnic in the late 1980s.
It involved spreading magic mushrooms on slices of bread and eating them. And subsequently walking through a local graveyard.
I don’t recommend it. At all.
“Psilocybin is not a miracle drug. It doesn’t help everyone, and it’s not appropriate for everyone,” says Dr. Vivian Winkler, a psychiatrist and psychotherapist at the Psychedelic Research Center. “We absolutely do not recommend recreational use, particularly for vulnerable people.”
But Dr. Winkler tells me the story of a woman in her 50s who was recently treated with psilocybin at the institute.
The woman had been suffering from major depression for years. She was unable to work. Relations with her family had become strained.
The woman was given a single dose of psilocybin. It was administered in a controlled clinical setting after doctors had gradually tapered off her antidepressants.
“The session went beautifully. She had lots of moments of emotional catharsis. It was very spiritual,” Dr. Winkler says. “She kind of reconnected to her spirituality or her relationship with God, which is something that she said had been important to her when she was young, but then for many years she abandoned it.”
Dr. Winkler says the woman had experienced an epiphany in her relationship with her children, a relationship that had been causing her pain and grief.
“There was a lot of emotional release. She was crying a lot, but it was a mixture of tears of sadness and gratitude,” Dr. Winkler recalls. “She said afterward it was a life-changing experience, one that she could only compare to giving birth to her children.”
Dr. Winkler tells me she had seen the woman a few days before we spoke. She said she was feeling great.
She’s since reconnected with her husband and children.
Dr. Palenicek and his colleagues are in fact continuing a long tradition of research into psychedelic substances such as psilocybin and LSD.
Czechs were trailblazers in the field as far back as the 1950s. One of the founding fathers of the discipline is Dr. Stanislav Grof, who’s still lecturing – at the age of 94 – in the United States.
In the 1950s and 1960s there was growing evidence that these compounds could be useful in psychiatry. A documentary film called LSD Made in CSSR features Grof and others recalling how Communist Czechoslovakia explored the potential of such drugs – for good and ill.
It includes now legendary footage of an experiment in which Czechoslovak Army officers are dosed with LSD and then try (and fail, hilariously) to follow orders.
However, psilocybin and LSD were banned in the 1970s. Research was halted for decades.
I joked earlier that I knew nothing about serotonin receptors and neuroplasticity. That’s not completely true.
Like so many people I experienced my own depressive episode, about 20 years ago. It started as a downward spiral of insomnia, anxiety, Xanax, and panic attacks. It evolved into a maelstrom of terrifying symptoms including depersonalization, derealization, and major depression.
It was finally resolved by an SSRI antidepressant whose name I’ve gladly forgotten.
It was a miserable 18 months. I don’t think I was ever truly suicidal. But I do remember one day – shortly before the SSRIs were due to kick in – when I could no longer see the point in living.
Anyway, it feels like a long time ago, and I made a full recovery into the happy and slightly annoying 56-year-old I am today. The only controlled substances that enter my body these days come from the hop fields of West Bohemia and the coffee plantations of Brazil.
It’s left me – a bit like the former Prince Andrew and his inability to sweat – with an inability to get anxious about things. Which is great, frankly.
But most of all it’s given me a lasting sense of compassion for those trudging through the quicksand of depression. As well as a deep admiration for those – like the doctors Winkler and Palenicek – who are trying to help them climb out of it.
Rob Cameron is a journalist and broadcaster based in Prague. He is the BBC correspondent for the Czech Republic and Slovakia and a regular contributor to Deutsche Welle, ORF, RTÉ, and Monocle Radio.
This piece originally appeared in Rob Cameron’s Substack, Based in Bohemia. Republished by permission.
