MHM Magazine

12 | MENTAL HEALTH MATTERS | 2025 | Issue 1 MHM The so-called psychedelic renaissance has generated polarised reactions amongst South African healthcare providers. While some herald psychedelics as breakthrough medicines that should be more widely accessible to patients, others show concern about their potential for harm, possible over- exaggeration of their healing potential and even worry they are not nearly as helpful or enduring in their therapeutic effects as proclaimed. Whether you’re a psychedelic evangelist or a concerned sceptic, this article is intended to offer a neutral, evidence-based overview of this treatment option. Here we’ll look at its mechanism of action, indications, inherent risks and the data supporting it, so you can continue to inform your perspective and understanding of this increasingly common intervention. It’s worth beginning with the definition of a psychedelic, the applicability of the term itself is an area of some theoretical debate in psychiatric circles. The term psychedelic, coined in 1952 by Dr Humphrey Osmond (psychiatrist and pioneer in this field), refers to the ‘mind manifesting’ potential of a molecule. While some researchers contend only molecules that cause widespread activation of serotonergic pathways in the brain are psychedelics (for example, psilocybin, ayahuasca and LSD), others feel these are better considered as classic psychedelics as other compounds may have the same effect through different mechanisms of action. These compounds are referred to in the literature as non-classic psychedelics. One such example of these molecules is ketamine. Ketamine, first synthesised by Dr Calvin Stevens in 1962, as a less toxic alternative to phencyclidine, is now recognised on the World Health Organization’s (WHO) list of essential medicines. At a dose north of 1mg/kg of body weight, ketamine is an anaesthetic. At a dose between 0.4-1mg/kg of bodyweight, ketamine has a dissociative effect that also allows for a mind manifesting experience. By antagonising N-methyl-D-aspartate (NMDA) in the frontal lobes, the typically inhibitory and repressive functions of the prefrontal cortex are deactivated allowing for repressed (or unconscious, if you prefer) emotions, memories and perspectives to spring forward. A wide and deep interconnectivity of brain regions is allowed in this non-ordinary state of consciousness (NOSC) which allows the patient to become more deeply connected to all aspects of themselves than is typically the case. When managed properly, this can allow for deep catharsis (emotional release) and unique insights into the origins of psychological symptoms. The diagram below is a connectogram. The different sections of the ring correspond to different brain regions while the lines in the ring indicate which areas of the brain are communicating with one another at any given moment. As becomes clear when comparing the placebo and ketamine conditions, the NOSC engendered by this dissociative can allow for a deep By Dr. Anthony Townsend Profession & Designation: Clinical Psychologist, PhD Sandton, Gauteng email: atownsendpsych@proton.me KETAMINE-ASSISTED PSYCHOTHERAPY: GIMMICK OR BREAKTHROUGH? MHM | 2025 | Volume 12 | Issue 1 | Ketamine-assisted psychotherapy: gimmick or breakthrough? H