Psychedelics for Treating Mental Disorders | Dr. Matthew Johnson

Psychedelics for Treating Mental Disorders | Dr. Matthew Johnson

Huberman LabSep 20, 20212h 52m

Andrew Huberman (host), Dr. Matthew Johnson (guest), Narrator, Narrator

Definitions and pharmacology of psychedelics (classic, NMDA antagonists, MDMA, salvinorin A)Serotonin, dopamine, and how psychedelics alter perception, self, and predictive modelsClinical psilocybin therapy protocol: screening, preparation, dosing, monitoring, and integrationMacrodosing versus microdosing: evidence, claims, and safety concernsRisks and contraindications: psychosis, bipolar disorder, bad trips, HPPD, and safety monitoringLegal and regulatory landscape: Schedule I status, decriminalization, FDA breakthrough therapyFuture directions: addiction, PTSD, chronic pain, traumatic brain injury, and philanthropy’s role

In this episode of Huberman Lab, featuring Andrew Huberman and Dr. Matthew Johnson, Psychedelics for Treating Mental Disorders | Dr. Matthew Johnson explores inside Psychedelic Therapy: Mechanisms, Risks, Promise, And Future Regulation Andrew Huberman interviews Johns Hopkins researcher Dr. Matthew Johnson about how psychedelics such as psilocybin, LSD, DMT, MDMA, ketamine, and others affect the brain, perception, and sense of self, and how those effects can be harnessed therapeutically.

Inside Psychedelic Therapy: Mechanisms, Risks, Promise, And Future Regulation

Andrew Huberman interviews Johns Hopkins researcher Dr. Matthew Johnson about how psychedelics such as psilocybin, LSD, DMT, MDMA, ketamine, and others affect the brain, perception, and sense of self, and how those effects can be harnessed therapeutically.

Johnson explains what qualifies as a psychedelic pharmacologically and experientially, details their action on serotonin and other systems, and contrasts high-dose, guided “macrodose” therapy with popular but unproven microdosing practices.

They walk through a full psilocybin depression trial from screening and preparation to dosing, monitoring, and post‑session integration, highlighting how profound changes in self‑representation and agency can relieve depression, addiction, and cancer‑related distress.

The discussion also covers real risks (psychosis, bad trips, unsafe behavior), flashbacks and HPPD, legal and regulatory trends, philanthropy’s role in restarting human research, and early, exploratory ideas about psychedelics for traumatic brain injury and cognitive recovery.

Key Takeaways

Psychedelics are best defined by their ability to profoundly alter sense of reality and self, not by a single receptor mechanism.

Johnson distinguishes several pharmacological classes under the “psychedelic” umbrella: classic 5‑HT2A agonists (LSD, psilocybin, DMT, mescaline), NMDA antagonists (ketamine, PCP, dextromethorphan), kappa‑opioid agonists (salvinorin A), and MDMA as an “entactogen. ...

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Therapeutic benefit seems to hinge on profound, guided macrodose experiences that change self‑representation, not on subtle microdoses.

In Johns Hopkins trials, single or few high‑dose psilocybin sessions, embedded in extensive preparation and integration, can produce durable changes in depression, addiction, and cancer‑related anxiety—often lasting many months. ...

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Microdosing remains largely unsupported by controlled data and may carry underestimated risks if done chronically.

Popular claims that tiny, sub‑perceptual doses enhance creativity, focus, or mood are not borne out by the few double‑blind studies to date, which show little benefit and sometimes mild cognitive impairment (e. ...

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Set, setting, and structured support are critical both for safety and for translating acute experiences into lasting therapeutic change.

Research protocols involve rigorous psychiatric and cardiovascular screening; several hours of preparatory meetings with two guides; high‑dose psilocybin given in a quiet room with eyeshades and music; continuous monitoring of vital signs; and multiple integration sessions plus written reflection afterwards. ...

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There are serious but manageable risks—especially for those with psychotic or bipolar vulnerability and for unsupervised high‑dose use.

Johnson stresses that people with schizophrenia, schizoaffective disorder, or bipolar I–type mania (or strong family history) can be destabilized, so such individuals are excluded from trials. ...

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“Flashbacks” are often misunderstood; persistent perceptual changes (HPPD) are rare and not clearly specific to psychedelics.

True Hallucinogen Persisting Perceptual Disorder—ongoing halos, trails, visual distortions that are distressing and last months—is very rare and has not appeared in modern or historical clinical trial cohorts. ...

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The legal path will likely be medical first (MDMA and psilocybin as FDA‑approved therapies), with broader regulatory reform much further off.

MDMA‑assisted psychotherapy for PTSD is in phase 3 trials and has FDA “breakthrough therapy” designation, as does psilocybin for major depression. ...

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Notable Quotes

All of the so‑called psychedelics share the ability to profoundly alter one’s sense of reality—and that often means profoundly altering the sense of self.

Matthew Johnson

I think of the self as the biggest model—‘I am a thing that’s separate from other things’—and psychedelics can radically change that self‑representation.

Matthew Johnson

Normally you tell a depressed person, ‘Don’t think of yourself that way,’ and they can’t do it. Under psilocybin, people can actually have an experience where they feel, ‘My God, I can really just decide to change,’ and it sticks.

Matthew Johnson

Microdosing is the thing everyone talks about, but none of the credible placebo‑controlled studies have shown clear benefits. If anything, we see a little impairment and people feeling a little bit high.

Matthew Johnson

These can be profoundly destabilizing experiences. That’s why screening, preparation, and the right container matter so much—anyone can have a bad trip if you push the dose high enough in the wrong environment.

Matthew Johnson

Questions Answered in This Episode

In your clinical trials, how do you distinguish between people who have a terrifying ‘gateway’ experience that ultimately leads to positive transformation and those who might simply be traumatized or destabilized by a bad trip?

Andrew Huberman interviews Johns Hopkins researcher Dr. ...

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Given the concerns about 5‑HT2B‑mediated valvulopathy, what concrete cardiology monitoring or study designs would you want to see before feeling comfortable with any long‑term microdosing protocol in humans?

Johnson explains what qualifies as a psychedelic pharmacologically and experientially, details their action on serotonin and other systems, and contrasts high-dose, guided “macrodose” therapy with popular but unproven microdosing practices.

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You mentioned that underground therapists often claim psilocybin works well for PTSD; what specific features of psilocybin’s subjective effects make you think it might perform differently from MDMA in a head‑to‑head PTSD trial?

They walk through a full psilocybin depression trial from screening and preparation to dosing, monitoring, and post‑session integration, highlighting how profound changes in self‑representation and agency can relieve depression, addiction, and cancer‑related distress.

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If psilocybin and MDMA become FDA‑approved, how do you think we should handle the training, certification, and accountability of psychedelic therapists to prevent harm from under‑qualified or exploitative practitioners?

The discussion also covers real risks (psychosis, bad trips, unsafe behavior), flashbacks and HPPD, legal and regulatory trends, philanthropy’s role in restarting human research, and early, exploratory ideas about psychedelics for traumatic brain injury and cognitive recovery.

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For the proposed studies on retired UFC fighters with repetitive head impacts, what objective cognitive and neuroimaging endpoints would convince you that psychedelics are doing more than just improving mood—that they’re actually aiding neural repair or reorganization?

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Transcript Preview

Andrew Huberman

(uptempo music) Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today, I have the pleasure of introducing Dr. Matthew Johnson. Dr. Johnson is a professor of psychiatry at Johns Hopkins School of Medicine, where he also directs the Center for Psychedelic and Consciousness Research. As many of you know, there's extreme excitement about the use of psychedelics for the treatment of various disorders of the mind. Dr. Johnson's laboratory is among the premier laboratories in the world understanding how these compounds work, how things like psilocybin and LSD and related compounds allow neural circuitry in the brain to be shaped and change, such that people can combat diseases like depression, or trauma, or other disorders of the mind that cause tremendous suffering. Dr. Johnson is also an expert in understanding how different types of drugs impact different types of human behaviors, such as sexual behavior, risk-taking, and crime. Dr. Johnson and his work have also been featured prominently in the popular press, such as articles in the New York Times, in Michael Pollan's book, How To Change Your Mind, and in a feature in 60 Minutes about psychedelics and the new emerging science of psychedelic therapies for treating mental disorders. During the course of today's conversation, Dr. Johnson and I talk about psychedelics at the level of what's called microdosing, whether or not it is useful for the treatment of any mental disorders. We also talk about more typical macrodosing, what those macrodosages entail, and he walks us through what an experiment of a patient taking psychedelics for the treatment of depression looks like in his laboratory from start to finish. The conversation was an absolutely fascinating one for me to partake in. I learned so much about the past, present, and future of psychedelic treatments and compounds. And indeed, I hope to have Dr. Johnson on this podcast again in the not too distant future, so that we can talk about other compounds that powerfully impact the mind and human behavior, and perhaps can also be used to treat various diseases. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Athletic Greens. Athletic Greens is an all-in-one vitamin mineral probiotic drink. I've been taking Athletic Greens since 2012, and so I'm delighted that they're sponsoring the podcast. The reason I started taking Athletic Greens and the reason I still take Athletic Greens once or twice a day, every day, is because it covers my foundational nutritional needs. It has the vitamins I need, the minerals I need, and the probiotics are important to me, because there is now so much data about the importance of the so-called gut microbiome, maintaining healthy gut bacteria, and the ways in which those gut bacteria impact things like inflammation and keeping inflammation down in the brain and body, as well as supporting things like quality mood, endocrine function, metabolic function, just so many factors. The great thing about Athletic Greens is that it also tastes very good. I mix mine with water, a little bit of lemon juice, and as I mentioned, I drink that once or twice a day. If you'd like to try Athletic Greens, you can go to athleticgreens.com/huberman, and if you do that, you'll get the Athletic Greens plus you'll get five free travel packs. The travel packs make it very easy to mix up Athletic Greens when you're on the road, in the car, on the plane, et cetera. And you'll get a year's supply of vitamin D3 K2. There's now a lot of evidence that vitamin D3 and K2 are important for various aspects of metabolic health, cardiac health, and so forth. So, once again, that's athleticgreens.com/huberman to get Athletic Greens, the five free travel packs, and your year's supply of vitamin D3 and K2. Today's podcast is also brought to us by InsideTracker. InsideTracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals. I've long been a believer in getting regular blood work done, and now with the advent of quality DNA tests, you can get a lot of information about your genetics and how that also impacts your immediate and long-term health. The reason I'm such a fan of getting blood work done is that it is really the only way to understand what's going on in your system at a level that can really inform your decisions about your immediate and long-term health. The problem with a lot of blood and DNA tests, however, is that you get numbers back about your hormones and your metabolic factors, et cetera, but you don't know what to do with that information. With InsideTracker, they have a very easy to use dashboard that gives you that information, and then gives you some suggestions and directives about things you could change about your nutrition, about your exercise, and other lifestyle factors that can help you move those numbers in the direction that's best for you and for your health. If you'd like to try InsideTracker, you can go to insidetracker.com/huberman to get 25% off any of InsideTracker's plans. Just use the code Huberman at checkout. Today's podcast is also brought to us by Belcampo. Belcampo is a regenerative farm in Northern California that raises organic, grass-fed, and finished certified humane meats. I eat meat about once a day. In general, my lunch or my breakfast consists of some meat, and that meat has to be a very high quality, and generally I'll eat some vegetable as well. And then I tend to eat pastas and rice and things of that sort later in the day or in the evening in order to facilitate the transition to sleep. So, I'm eating meat about once a day, and I always insist that the meat that I eat be of the very highest quality, and that the animals were raised and maintained humanely. While conventionally raised animals are confined to feedlots and eat a diet of inflammatory grains, Belcampo's animals graze on open pastures and seasonal grasses, resulting in meat that's higher in nutrients and healthy fats. In addition, they raise their animals in a way that's not just better for our health, but also has a positive impact on the environment.They practice regenerative agriculture, which means the meat is climate positive and carbon negative, so you can feel good about what you're eating at the environmental level and for sake of your health. You can order Belcampo's sustainably raised meats to be delivered to you by using my code Huberman at belcampo.com/huberman and entering my code Huberman to get 20% off your first time order. I'm partial to the ribeyes or the New York steaks, so on one day, I might have a ribeye, the next day I might have a New York steak. I also really like the meatballs. I'm a particular fan of the meatballs. So again, that's belcampo.com/huberman and enter the code Huberman at checkout to get 20% off your order. And now, my conversation with Dr. Matthew Johnson. Well, Matthew, I've been looking forward to this for a long time. I'm a huge fan of your scientific work, and I'm eager to learn from you. So-

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