Vital Signs

My Mind is Terrorizing Me

Episode Summary

Psychedelic drugs could be a path to a cure for severe anxiety in cancer patients. Dr. Stephen Ross’s research into magic mushrooms and other drugs offers people new hope.

Episode Transcription

Season 1 Episode 6 - My Mind is Terrorizing Me 

Features: Dr. Stephen Ross, MD and Octavian Mihai 

Narration: Maggi van Dorn

Octavian Mihai: When I first walked into the room where the experiment was going to take place, uh, there was a couch. Um, it had some noise canceling headphones on it. There was a face mask for your eyes. I think a statue of a Buddha. I remembered the way the light was hitting the room was also interesting to me. And this was before I took the medication. And then I took the pill and uh, they sent me down on a couch in that room. Um, and they just told me to wait. My name is Octavian Mihai.

Maggi van Dorn: Not long before Octavian found himself in that room, on that couch, he was a carefree student at  New York University. That is, until he was diagnosed with Hodgkin's lymphoma.

OM: On a daily basis, I would wake up and constantly feel for lumps in my neck. I would just consume myself constantly with feeling these lumps and checking whether or not they have changed in size. I would probably check my neck 100, 200 times a day.

MVD: Octavian is not alone. It’s very common for cancer patients to experience anxiety. But not everyone seeks help for this problem. And even if they do, what does this help look like? 

Dr. Stephen Ross: My name is Steven Ross. I'm an Associate Professor of Psychiatry at the NYU Grossman School of Medicine and I am the Co-director of the NYU Langone Health Psychedelic Research Group.

MVD: Dr. Ross is one of just a few researchers looking at how psychedelic drugs might help cancer patients dealing with anxiety and depression.

SR: I was very skeptical about this study. I thought that, you know, these people have anxiety. We're giving them a drug that can create panic and terror in certain situations. So I was really scared we were going to do harm. But participants were telling us, I feel so much better.

MVD: From SiriusXM and NYU Langone Health, this is Vital Signs, where medicine is made personal. I'm your host, Maggi van Dorn.

SR: It's a strange thing, but I feel extremely comfortable with really sick, psychotic patients. It's my favorite sort of place to be in the hospital. And the sicker they are, and I just gravitated towards them and I guess, sort of like, speak their language. I sort of come from crazy people.

MVD: Dr. Ross was born in Johannesburg, South Africa, where early on, he was exposed to the power of other people’s emotions. 

SR: I grew up with real intense chaos, emotional, psychological chaos, and strong willed people. I learned to kind of, like, have like a calmness amongst the storm. And I think that that sort of led me to be able to deal with really difficult, out of control people. That I had some good training from, from my family, and enormous empathy and love for them that, um, I understood why they were like that. 

MVD: Dr. Ross’s family immigrated to Los Angeles when he was seven years old, which was around the same time his father began suggesting that he study medicine. At first, Dr. Ross  thought he might become a cardiac surgeon. But bouts of teenage anxiety led him away from the heart, and toward the head. 

SR: There's a lot of people that have their own sufferings that then go into it. And think my own sort of mental suffering really helped me be a better psychiatrist. 

MVD: It also helped that Dr. Ross felt immediately at home in the halls of Bellevue, America’s oldest public hospital and NYU’s historic hub for research and training. 

SR: I walked into Bellevue and I thought, wow, this, this is an amazing place. And there was something about, like, the history of it, and I came to learn that Bellevue was the birthplace of psychiatry in America. And that's where I caught this, like, public health bug where I want to do good for the community. I realized that I really like taking care of big groups of people. I got involved in psychedelic research through pure serendipity and complete randomness. I had no idea about it at all. It was an enormous part of psychiatry and yet by the time I went to medical school in psychiatric, general psychiatric training and addiction fellowship, I learned nothing.

MVD: Psychedelics are a class of drugs that induce hallucinations and other sensory disturbances. One of the best known psychedelics is LSD, which was discovered accidentally by a pharmaceutical company in 1943. 

SR: It started this kind of like golden age of psychedelic research that lasted a long time up to 30 years. They were hailed as a sort of like breakthrough wonder drug. There were 40,000 participants that were studied. The most promising indication was the use of LSD to treat alcoholism, followed by the use of LSD to treat terminal cancer related psychiatric and existential distress. 

MVD: But all of this exciting research came to a screeching halt in the 1960s. LSD had become a defining element of the counterculture movement and this didn’t sit so well with President Richard Nixon. 

SR: He thought that, mostly middle class white kids who were like thinking differently, not wanting to go to war was a real problem for the kind of hierarchical establishment. And he came down very hard on psychedelics. Nixon in 1970, in conjunction with Congress, enacted the Controlled Substance Act.

(News clip of Richard Nixon): America’s public enemy number one in the United States is drug abuse. 

(Announcer): Any substance capable of inducing a psychoactive effect, whether it be over the counter, controlled or non-controlled, may be mis-used and abused for non-medical purposes. 

SR: Which essentially placed all psychedelics LSD, psilocybin into what's called the Schedule 1 category. Schedule 1 means very addictive, no therapeutic utility. And it was a political move. The idea was to shut up a group of people. And actually, that's been going on a long time - the targeting of certain ethnic groups with drugs. That, you know, happened with the Chinese and opium. It happened with marijuana and Mexicans. It happened with, you know, African Americans and crack cocaine.

MVD: But when President Nixon placed psychedelics into the Schedule 1 category, he did more than shut up a group of people. He shut down an entire field of research. That is, until a few psychiatrists at institutions like UCLA, Johns Hopkins, and NYU tried to revive it. 

SR: I started like trying to find the literature on this. And you didn't have to look very hard because kind of like hidden in plain sight was this body of knowledge. There were over a thousand papers written. And I started looking and I was just, like, astounded that this research had happened, that the National Institute of Mental Health, the NIH, had spent several million dollars funding psychedelic research. Because of the Controlled Substance Act, even though it made it illegal for the public, there was always a route for clinical researchers to do research. 

I thought, okay, let's, let's do it. 

MVD: As you might imagine, it’s not easy to get a banned drug approved for medical research. But Dr. Ross made a strong and compelling case.

SR: In my research, one of my main focus has been in terminally ill patients. So even there where they are dying and there is no hope to help them medically, you know, there's hope to help their psychological distress or existential spiritual distress. Cancer is a horrible illness. And when you have anxiety and depression and existential distress with cancer, it's really terrible. It, it doubles the rates of suicide. Um, people get disconnected from sources of meaning and attachment from their family and from their spirituality. And they just kind of wish life would be over already and then they, they hurt themselves.

MVD: Dr. Ross’s study would look at how people living with cancer-related anxiety and depression might benefit from taking a dose of psilocybin. Psilocybin is the psychoactive compound that naturally occurs in magic mushrooms. For clinical research, it’s  engineered in a lab.  Dr. Ross  set up a randomized controlled trial, which means participants are chosen at random to either receive the treatment or a placebo. On top of this, the study also required specific parameters. 

SR: You have to be careful in screening. The psychedelics can create psychotic symptoms and in people that are predisposed to psychosis, like people with schizophrenia, they, it can make them psychotic. I was very skeptical about this study. I thought that, you know, these people have anxiety. We're giving them a drug that can create panic and terror in certain situations. So I was really scared we were going to do harm. 

MVD: When Octavian Mihai moved to the United States from Romania at the age of 18, he wanted  to study medicine. Little did he know, his life would soon be consumed by it.

OM: When I was around 21 years old, I was in school studying, uh, and I remember being at my desk and touching my neck and feeling this lump on the right side. I didn't make much of it at the time, but, uh, seeing that it wouldn't go away after a few months, I decided to go to the health center of NYU and to get it checked out. As I did investigations and a complete workup, it came out that I had, uh, Hodgkin's Lymphoma.

MVD: Hodgkin’s Lymphoma is a cancer of the lymphatic system. Survival rates for this kind of cancer are good - around 80 percent. And Octavian’s doctor told him so.

OM: He basically told me that I was lucky to have an easier type of cancer. And then he kind of made me picture it in the following way: Out of 10 NYU students, eight with Hodgkin's lymphoma, eight are going to survive and two are going to die. Even though it is statistically a pretty good chance, I was devastated because I couldn't imagine myself being one of those two at 21. After that, I remember getting kind of angry and upset and feeling that I just don't have time to deal with this right now because I had just gotten into a medical school and I didn't want anything to interfere with my new plans.I don't think I was able to really process what was going on. So I was switching between thinking that I'm going to die and being okay with it kind of in a dramatic way. And then going to, oh, I'm going to beat this really quickly. I'm just going to go through it and be done, like it’s nothing.

MVD: Octavian underwent chemotherapy, which made him tired, nauseous, and sometimes short of breath. Most of his hair fell out, and his eyebrows too. And he had no idea if this treatment would work.

OMD: I knew that I had a pretty good chance of getting better, but I knew that if the treatment doesn't work, then my chances of survival really go down by a lot. Not only that, but that would mean that I would have to do another type of chemotherapy that had a lot more side effects in the long run. So even if I survived, the long term side effects from the medications would have been pretty devastating. I remember reading about congestive heart failure later in life, fibrosis of the lungs. So any way I looked at it, it would have been pretty devastating even if I had survived. And that really scared me.

MVD: After six months of chemo, Octavian received the news any cancer patient wants to hear: it was gone. His anxiety, however, was not.

OM: To me, this wasn't really a relief. If anything, I think my anxiety got worse because I felt like for the past six months, I had been disciplined, going to treatments, suffering the consequences but for a good purpose. And everything had stopped. All the attention from the doctors, all the medications, all the work that I was doing to beat the cancer. And I was doing nothing any more, which made me feel like I'm not taking care of this cancer anymore. I'm not keeping it in check. This cancer can come back any time. And so there was really even more anxiety-producing. 

OM: On a daily basis, I would wake up and constantly feel for lumps in my neck. I would also feel for the lumps that I used to have and that had shrunk but that were still there. And I would just consume myself constantly with feeling these lumps and checking whether or not they have changed in size, if there is a new one, if it's not new, if it's there and I forgot about it. I would probably check my neck a 100, 200 times a day.

MVD: As the anxiety began to take over, Octavian sought a way out. 

OM: I decided to go to Paris and Germany. And while I was there I was incredibly anxious doing the same thing, partying, drinking, uh, trying to forget about it. But the anxiety got so bad while being there that I cut my trip short by about a week and I just bought another plane ticket home. And I came straight back to New York, and the next day, straight back into my doctor's office because I was completely convinced that one of my lumps had changed in size and that the cancer had returned. He met with me and he did a fine needle biopsy, which is basically a simple procedure to check whether or not there are any cancer cells in that lymph node. And of course it was clear and there was nothing there. 

MVD: His doctor prescribed some Xanax to calm his nerves, but it provided only temporary relief. Octavian was running out of options - until his doctor mentioned a clinical trial at NYU Langone. 

OM: I remember the doctor mentioning the psilocybin  experiment and he just told me there that there are some doctors at NYU that are running the study and that it involves this substance that is a part of the magic mushroom, which is a psychedelic. And when I heard it, that sounded kind of interesting. I had never tried psychedelics, so part of me was curious. 

MVD: Following a series of tests that confirmed his extreme anxiety, Octavian was enrolled in the psilocybin study. First, he met with Dr. Ross for some talk therapy, and after a few sessions, it was time for dosing day.  

OM: When I first walked into the room where the experiment was going to take place, uh, there was a couch. It had, uh, some noise canceling headphones on it. There was a face mask for your eyes. I think a statue of a Buddha. I remembered the way the light was hitting the room was also interesting to me. And this was before I took the medication. It was really calming and a really warm. 

SR: The dosing days are eight hours long. They come in and we do a little ritual with them as a nod to, to kind of an indigenous use of psychedelics. We hold hands together. We have them state their intention for the day because it really frames the experience. 

OM: We still stood up in a circle. We kind of held hands. while holding hands, I stayed in my intention for the day, which is of course to get rid of my anxiety and be able to get back to my normal life. And then I took the pill and uh, they set me down on a couch in that room..

SR: They’d sit down on this couch that was made into a bed. We then give them the pill. 

OM: And they just told me to wait for about 30 minutes, 45 minutes to see if anything happens. Because we weren't sure if it's going to be the placebo or the real pill.

SR: We turn on music, we play preselected music, and after about half an hour, we'd have them lie down into the default position, which is on their back, give them eye shades, preselected music for the next six hours. 

OM: It was kind of an eerie playlist with a lot of odd songs. And then they gave me this blindfold to put on my eyes and just, they just told me to relax, try to focus within, go within myself as much as possible and see if anything happens. And I remember doing that for a while and really I couldn't feel anything happening, so I thought it was the placebo. So then I asked them, you know, and I'm gonna use the restroom. And I did. And while I was washing my hands in front of the mirror, I looked at it and I sort of wanted to jump through it. The first part of the experience was just so overwhelming that I, I really couldn't register anything. I remember describing it to them as like infinite nothingness. There was just nothing. Absolutely nothing. 

MVD: But soon...something started to happen.

OM: I started to be able to catch on to trips, like sort of like stars that are flying. Um, and I would be able to like hold onto one trip and like go with it and see what happens. And I started having really nice experiences. I remember having a trip where I met with my parents who live in Romania and who I hadn't seen in awhile. And I remember just being with them and feeling so much harmony and love and peace. But it was a very pure feeling. Something that I hadn't felt before. It was just like pure harmony, pure love, untainted by any other type of emotion or experience. It really nourished my soul. After that I had a lot more trips. I traveled to a bunch of worlds, mostly based on the music.

MVD: An important part of taking psilocybin for this study, and what sets it apart from eating magic mushrooms on your own, is trying to mold these experiences into something useful. It’s why Dr. Ross remained  with Octavian the whole time.

OM: So while I was going through the trips, I was mostly lying down on the couch and listening to music, focusing within. And every now and then if the trips got unbearable, there was just too much going on, I would get up and I would try to put it into words for the therapists. I found that to be really, really hard. And they explained to me that that's the ineffability of the experience. I couldn't really articulate what was going on, but as much as I could, I explained to them sort of like where I was and what I was feeling and what was going on. And then they would, uh, explain certain things to me. Sometimes put me at ease, guide me, suggest directions I should go into. 

OM: I was really worried that I will never come back to normal and that I will always be in this like, confused state where I'm tripping and what if I never go back to normal. And uh, I remember Dr. Ross got up from his chair, and just sat down next to me and he started drawing a diagram for me of how that  drug works in my system. And he showed me that I was somewhere after the peak of the experience and that from now on it's just going to continue going down. So that really calmed me down. I think what calmed me down a lot was that he sat next to me instead of across from me, and he just put me at ease. And then I kind of realized that my mind is terrorizing me. And the whole experience with the cancer, with the anxiety, and I can control it. And I can choose to not allow it to terrorize me. And that was really a big relief. Because I realized that I don’t have to let it terrorize me, there’s no reason. I can decide not to, as my option. 

MVD: Recognizing the power his cancer had over him and his ability to control his reaction to it, was a major revelation for Octavian. It was just one of several breakthroughs he experienced that day.

OM: I had a different trip where I was in front of the hospital where I had been treated for cancer. And I saw myself being carried out on a stretcher by two people that worked at the hospital. And I came out through the doors and it sort of signified to me that my cancer treatment had finished and that physically I was done with this disease. And then the stretcher stopped in front of the hospital and I sort of at that point saw this black smoke coming out of me while I was on the stretcher. Sort of like a black mushroom cloud type of thing. And I felt like it's gone. This whole thing that was terrorizing me is now gone. I've pushed it away and I'm done.. I'm treated.  I can just live my life normally from now on. And there's this beautiful life ahead of me.

SR: We kept hearing stories like that. That something about the scary aspects of cancer came to them, they would be scared. But we reminded them if that happens, don't run away from it. The worst thing you can do is run away from the fear. Look it in the eyes and go into it, go into it and pass through it. And that kept happening with patients. And I just kept seeing the same thing - that by the end of the day, the participants were telling us, I feel so much better. My anxiety is melted away, my depression is melted away, I feel calmer, I have a different perspective. And also from an existential distress perspective, they had less demoralization, less hopelessness. And then the next day they would say that. The next week. And then months later, they continued to say from one dose of psilocybin that they just felt so much better psychologically, emotionally. 

MVD: It almost sounds too good to be true. And yet, this was certainly the case for Octavian. A few days after he took the psilocybin, he met with Dr. Ross to talk about what had happened.

OM: Dr. Ross I remember told me that all these things that I've experienced and that I have now solidified are tools that I can put in some type of metaphorical toolbox. And anytime I feel anxious I can always go back to those experiences and I can use them to calm myself down. Most of the effects after the dosing session lasted for maybe a couple of days a week, two weeks. But the experiences that I had in the state that I was in, that I remember, are still with me today.

MVD: Octavian did try to return to the psychedelic state. He took mushrooms a few times by himself, but the effect wasn’t the same. Eventually, he turned to talk therapy, which helped him develop and hone the skills he needed to keep his anxiety at bay.

OM: The difference between psychedelics and therapy is that in therapy you raise your levels slowly by building mental muscle. So once you, once you get there, you don't fall back. With psychedelics, you see a glimpse of where you can be if your consciousness level was up there. But then because you have no mental muscles, you can't stay there, and you go back to where to where you are. 

MVD: By any measure, Octavian is a success story about the power of psychedelics to transform - and maybe even save - someone’s life. And he’s  not the only one.

SR: 80% of the people one day after a psilocybin no longer met criteria for cancer-related depression. They were, like, completely in remission. And when we looked at that seven weeks later in six and a half months later, it endured. So there was a huge difference between the effect of the psilocybin versus the placebo. 

MVD: That study was published in 2016. It found that a dose of psilocybin, combined with talk therapy, could ease anxiety and depression in cancer patients. It proved the power of psychedelics to help people, at least in the short term. And then, in early 2020, Dr. Ross released a major update. Of the 15 people involved in that initial research, the  majority still had less anxiety and depression three to four years later, after just a single psilocybin dose. And yet, despite these exciting results, many people suffering from cancer-related anxiety will go untreated. These drugs are still illegal. Doctors can’t prescribe them, and patients can’t benefit from them, unless they’re enrolled in a clinical trial. 

SR: I don't know what's next. You know, we did it all this stuff. And I don't know what's next. And not only that, we have thousands of people that have contacted us and it's the most heartbreaking stories. So, this like thing went off me where I was like, Oh, we have to take this to the next step. And I thought if there's one last thing I do in my career, I'm going to move forward to work with cancer. 

MVD: r. Ross is in the midst of planning a phase three study that will make psilocybin a legal treatment for advanced cancer patients. But for now, there’s at least one person who remains forever changed.

OM: To Dr. Ross, I would like to thank him for giving me the opportunity to have this type of experience. It's probably top three most meaningful experiences I've had in my life. And I think it was, a turning point in my entire life, together with the cancer experience. Ever since I did this study and I realized it's potential for me and its effects on me, I’ve been talking about how this should become more mainstream. Because having taken Xanax, having used alcohol and other substances to try to cope with the anxiety, I realized that this kind of experience and this kind of medication was the only one that actually went to the source of my anxiety and changed something for good. It wasn't a bandaid, it was a solution.

VO: Vital Signs is a co-production of NYU Langone Health and SiriusXM. The podcast is produced by Jim Bilodeau, Julie Kanfer, Rob Schulte and Keith King with sound design by Jim Bilodeau and writing from Julie Kanfer. SiriusXM’s executive producers are Beth Ameen and me, Maggie van Dorn in partnership with Allison Clair and Jim Mandler at NYU Langone Health. Don't miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone, tune in to Doctor Radio on SiriusXM channel 110 or listen any anytime on the SiriusXM app. For the Vital Signs podcast. I’m Maggie van Dorn. Join us next time as we bring you the stories of medicine made personal.