Psychedelics are having a moment and women could be the ones to benefit
Nikhita Singhal's breath still catches when she talks about how her life changed. A psychiatry resident at the University of Toronto, Singhal says it was using psychedelic drugs-ayahuasca, ketamine, and MDMA-that finally addressed the eating disorder she'd had since she was seven years old.
It was really emotionally and psychologically painful," she says, recounting a particular ayahuasca trip she took with her parents. I felt like I could see myself and I was in the middle of this storm of chaos where I felt comfortable and safe being sick because it was so entrenched for 20 years. I couldn't ever imagine shifting my mindset, but now I'm in a place I would have never thought possible."
Singhal's experiences in and out of treatment centers growing up prompted her to go into psychiatry as a profession. Now, she imagines a not-too-distant future where she's able to offer psychedelic therapy herself. It's mind-blowing to see the huge leaps that [patients] can make in a [psychedelic] session that might have taken years and years in traditional psychotherapy," she says. They come out utterly changed."
Psychedelics are having a moment. After decades of prohibition and vilification, they are increasingly being employed as therapeutics. Drugs like ketamine, MDMA, and psilocybin mushrooms are being studied in clinical trials to treat depression, substance abuse, and a range of other maladies. And as these long-taboo drugs stage a comeback in the scientific community, it's possible they could be especially promising for women.
Not just Singhal but several other women interviewed for this story described how they had successfully experimented with psychedelics-not for recreational purposes, but to heal. One woman recounted how psychedelic-assisted therapy addressed her postpartum depression. Another described how microdosing psilocybin alleviated symptoms of premenstrual dysphoric disorder (PMDD) and an ayahuascatrip eliminated her condition altogether. Online, women on Reddit and in Facebook groups share how they've used psilocybin, LSD, ketamine, and MDMA to address PMS, menopause, low sexual desire, postpartum depression, and PTSD from sexual trauma. Jennifer Gural, a psychotherapist in California, spoke of how psychedelics helped her, and how she's seen them help her female patients: It shifted the focus of my life. It really helped me to tackle how my brain works and how I was thinking ... It was such a profoundly life-changing experience. I have done ayahuasca and I've done psilocybin. I don't know if I'll ever do it again, but I'm open to that if it's needed-which I think is how we should use psychedelics."
I think it speaks to a desperation in women's health. And part of the reason for that is we all know that nobody bothers to study women, and nobody listens to women, especially when we report our specific mental-health issues."
Ayelet Waldman
After Ayelet Waldman's book A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life came out in 2017, chronicling her monthlong experiment with microdosing LSD to treat severe mood storms," thousands of women from all over the world reached out to her. I think it speaks to a desperation in women's health," she says. And part of the reason for that is we all know that nobody bothers to study women, and nobody listens to women, especially when we report our specific mental-health issues."
Much of modern medicine is built on research performed exclusively on cisgender men: clinical research was not required to include women until the 1990s, when Congress passed the National Institutes of Health Revitalization Act. This means the science that informs medicine-including the prevention, diagnosis, and treatment of disease-routinely fails to consider the crucial impact of sex and gender. As a result, women's pain and symptoms have been, and continue to be, consistently dismissed by doctors. In the case of more than 700 diseases, women receive diagnoses significantly later than men, sometimes waiting up to 10 years for the correct diagnosis. They're also at greater risk for adverse side effects from medication; a recent study found that 86 medications approved by the US Food and Drug Administration were more likely to cause such problems in women than men.
The rising tide of women self-treating with psychedelics may be a result of frustrations with our existing health-care system, and it does pose risks such as dangerous interactions between psychedelics and prescription drugs, or-worse-psychedelics that are adulterated with other substances, like fentanyl. But more official research around these drugs has begun to emerge over the past few years.
Women are more likely to have PTSD than men, and transgender and gender-diverse individuals are at a much higher risk of developing PTSD than the general population. Women also experience depression more often, with one in seven women suffering from postpartum depression alone. Studies suggesting good results from just a few doses of MDMA or psilocybin combined with therapy have led the FDA to designate those drugs as breakthrough therapies (a priority status given to promising drugs proposed to fill an unmet need) for PTSD and treatment-resistant depression, respectively.
Gender is also a factor in eating disorders such as anorexia nervosa, which is three times as prevalent among women as men. The Multidisciplinary Association for Psychedelic Studies (MAPS) is currently conducting a study on MDMA-assisted therapy to treat anorexia, bulimia, and binge-eating disorders; the treatment works by reducing activity in the amygdala, the part of the brain that processes fear and threat. The Centre for Psychedelic Research at Imperial College London is also leading a clinical trial on psilocybin-assisted psychotherapy as a treatment for anorexia.
Is this the beginning of a brighter future for women's health, one where common mental disorders, symptoms of chronic pain, and intense mood swings are managed with mind-altering trips? Psychiatrists are optimistic, but they are rightly concerned about the potential for abuse in psychedelic-assisted therapy.
Enter the pharmaceutical companiesThe search for psychedelic drugs that specifically address women's health conditions has already begun. Felicity Pharma, a biotech company focused on mood disorders in women," developed a proprietary drug that uses a psychedelic to treat PMDD and postpartum depression. Olivia Mannix, the CEO and founder of Felicity, says the drug is currently ready for proof-of-concept pilot studies, but her long-term vision is to shake up the stagnant antidepressant market.
I have done ayahuasca and I've done psilocybin. I don't know if I'll ever do it again, but I'm open to that if it's needed-which I think is how we should use psychedelics."
Jennifer Gural, a psychotherapist in California
The problems with conventional antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are well-known. SSRIs will only take you so far," says Julie Holland, a psychiatrist, author, and medical advisor to MAPS. There's some emotional numbing, there's some physical numbing; it's harder to cry, it's harder to climax. I think psychedelics for a lot of women are really more of a thorough solution to their problems instead of a Band-Aid."
People who study the brain know that SSRIs may gradually increase neuroplasticity, which is the brain's ability to form new connections between neurons. Neuroplasticity can be impaired among depressed people. A 2021 study conducted at Yale suggests that psilocybin has the ability to prompt neuroplasticity, disconnecting some of the hardwired, repetitive thought patterns often involved in conditions like depression and eating disorders, and research shows that psychedelics like psilocybin may also be as effective as SSRIs for treating depression, if not more so.
Whenever you're talking about any kind of rigid, compulsive behavior that you do over and over again, [as in] anorexia or obsessive-compulsive disorder, you really need to be quote-unquote rewired,'" Holland says. The psychedelics are going to do a much better job at that than SSRIs, because they can often really get more to the root cause of what's going on and unpack what's driving the behavior as opposed to just sort of slapping a plaster over it."
In Holland's psychiatric practice, many of her female patients are taking antidepressants, and she often sees low libido as an unfortunate side effect of these drugs. These days, she's particularly interested in the potential of rare" psychedelics that can reliably enhance sexual experiences-like 2C-B, which was sold in Europe in the 1990s as a party drug and aphrodisiac.
Eastra Health, another startup working on psychedelic medicine specifically for women, has filed two patents for treatments that use 2C-B to alleviate female sexual dysfunction and PMS symptoms. Jeremy Weate, Eastra's CEO, told me his working hypothesis is that 2C-B can flatten the rise and fall of estrogen levels experienced during the menstrual cycle. Research and development have been slow, however, because the company has struggled to secure significant funding.
But funding is flowing into psychedelic-assisted therapy, especially around one drug in particular: ketamine. Over the past few years, ketamine-assisted therapy (which is legal in the US) has surged in popularity as an effective-albeit expensive-alternative treatment for depression and anxiety. (Typically, ketamine treatments in the US range from $600 to $1,200 per session, and the standard course of treatment is six sessions.)
We started our company knowing that women over 40 are prescribed antidepressants at more than three to four times the rate of men, which has led to one in every five women taking an antidepressant to get through the day," says Juan Pablo Cappello, cofounder and CEO of the ketamine therapy platform Nue Life, which is FDA approved and raised $23 million in April.
Through platforms like Nue Life, or in one of the hundreds of ketamine therapy clinics across the US, patients can take a controlled amount of a psychoactive substance under the careful guidance of a trained clinician to induce an altered state of consciousness (a trip). Having received tons of airtime in recent years for its supposed ability to treat PTSD, anxiety, and substance abuse, ketamine is now being studied as an effective way to alleviate symptoms of postpartum depression as well.
A recent study in the Journal of Affective Disorders suggests that in patients at high risk of postpartum depression, a single dose of ketamine administered before anesthesia during cesarean sections could be effective in preventing it. Another ketamine therapy startup, Field Trip, is also about to start in-person, phase I clinical trials for FT-104, a psychedelic molecule that's similar to psilocybin but has a much shorter trip time. (Nikhita Singhal's father, Sanjay Singhal, an entrepreneur who started audiobooks.com, is an advisor to Field Trip.) FT-104 has all the characteristics that make psilocybin so interesting and attractive from a therapeutic perspective-safety and efficacy-but with a very short duration of action," Field Trip cofounder and executive chairman Ronan Levy told me. According to Levy, Field Trip's existing preclinical studies signal that FT-104 will leave the body after 12 hours, meaning breastfeeding can hypothetically resume within 24 hours-something that will need to eventually be validated in human trials and undergo scientific peer review.
Kelsey Ramsden, the former CEO of Vancouver-based psychedelics company Mindcure (which was researching MDMA-assisted psychotherapy to help women with a lack of sexual desire until it shut down earlier this year for lack of funds), also says the postpartum depression market is appealing for psychedelic development because there's currently only one drug for the condition (Zulresso). Ramsden is a believer in part because psychedelics worked to alleviate her own symptoms after she had her first child. The change in my lived experience resulted in recurring depressive cycles, and it wasn't necessarily a hormonal thing that was the ongoing problem," she says. It was just the change in my experience as the result of becoming a mother in a society that expected me to be a certain way." She says she tried SSRIs and traditional therapy at first, but she finally arrived on stable footing after trying psychedelic-assisted psychotherapy.
Ramsden believes that the entire psychedelic industry is still in its earliest days. But she can envision a culture where it is normal for women to openly take psychedelic drugs. When something health-related works for women, she believes, the good news spreads like wildfire.
Allison Feduccia, who has a PhD in neuropharmacology, believes that the best evidence we have of how psychedelics affect women is still mostly anecdotal. For example, there are accounts suggesting that peyote boosts milk production, an idea supported by preliminary research from the 1970s. For years, folks have reported the ways psychedelics have altered their menstrual cycle, linking them to heavier periods, a period that arrives early, or-alternatively-a more regular cycle. Research has shown that estrogen intensifies the brain's dopamine reward pathway, so it's also possible that a woman's reaction to a particular drug is more pleasurable depending on the phase of her menstrual cycle.
Feduccia posits that psychedelics might be particularly helpful for the rites of passage" that most women go through. Psychedelics could bring better perspective when you get your first period, have your first child, and then go through menopause," she says. I just hope that women can benefit [from psychedelics] without having to drop $20,000 for a guided approach."
That guided approach is not only expensive but fraught with ethical concerns. Multiple high-profile cases of abuse in psychedelic therapy have made headlines in recent years. Richard Yensen, an unlicensed therapist who was a sub-investigator for MAPS, was accused of sexually assaulting a PTSD patient during a MAPS clinical trial on MDMA. Allegations of sexual abuse were also made against Aharon Grossbard and his wife, Francoise Bourzat, leaders of a prominent group in the Bay Area that has been practicing psychedelic-assisted therapy for over 30 years.
I've been hearing stories about psychedelic therapists molesting their patients or shamans molesting their clients for decades," Holland says. She notes that while it shouldn't be women's responsibility to fix this issue, her peers in the field who are also women-researchers, doctors, and founders-are informally discussing potential solutions. The ideas include setting up a governing body to report transgressions to and establishing clearer guidelines for consent before a person enters into an altered state of consciousness.
So many people in the psychedelic community are so worried about the progress being jeopardized by these reports," Holland says. The truth is, [the space] is too big to fail. It can withstand some scrutiny now, because if not now, when? If we're building the foundation of something that's going to last, we better make sure the foundation doesn't have any cracks."
Taylor Majewski is a writer, editor, and producer living in California.