For some mild mental health conditions, talk therapy alone may be sufficient.
More severe or persistent disorders, however, often respond best to a combination of psychotherapy and medication.
While pharmacological treatments do not cure mental illness, they can significantly reduce symptoms and improve quality of life.
One emerging area of treatment involves psychedelic medicines, which alter perception, mood and cognition, and are used in psychedelic-assisted therapy.
Also known as classic or serotonergic hallucinogens, they are known for inducing altered states of consciousness, sometimes described as “trips”, which can involve changes in sensory perception, thought patterns and self-awareness.
Monash University Clinical Psychedelic Lab head Dr Paul Liknaitzky explains that psychedelic-assisted therapy involves using specific psychoactive substances to enhance psychotherapy.
“Psychedelic therapies are used to augment traditional talk therapy using certain psychoactive drugs,” says the senior research fellow based in Monash’s Clayton campus in Melbourne, Australia.
“Classic psychedelics include substances such as psilocybin and lysergic acid diethylamide [LSD], as well as psychedelic-like compounds such as MDMA [3,4-methylenedioxymethamphetamine] and ketamine, which aren’t, technically, true psychedelics.
“These are used in psychotherapy for mental health issues and addiction.”
A work in progress
The most reliable evidence so far is for MDMA-assisted therapy in post-traumatic stress disorder (PTSD) and psilocybin-assisted therapy for treatment-resistant depression.
“But that doesn’t necessarily mean that psychedelic-assisted therapy is best suited for those conditions,” says Dr Liknaitzky.
“It simply means that those research programmes are more advanced than others.”
Dimethyltryptamine (DMT), for example, shows promise as a potential antidepressant, but clinical evidence for it managing major depressive disorder remains limited.
He explains that psychedelic therapy appears to have transdiagnostic effects, meaning that it could tackle the mechanisms of more than one mental health condition.
“Psychedelic therapies may target underlying drivers of distress and dysfunction, rather than just the diagnostic features of a specific disorder.
“For example, it is unlikely that psilocybin-assisted therapy would be effective only for depression, but not for anxiety,” he says.
“Depression and anxiety share common underlying factors, and psychedelics appear to address these shared mechanisms.”
However, psychedelic therapies may be better suited to certain patient profiles, either for safety or effectiveness reasons.
“Currently, we cannot reliably predict who will respond well to psychedelic therapy and who will not because the available data are still limited,” he says.
Most clinical trials and research are conducted in the United States, Europe and Australia.
A new perspective
Dr Liknaitzky describes psychedelics as “learning enhancers” that help people gain new perspectives on themselves and the world.
“Psychedelics activate both the prefrontal cortex, which is involved in complex thinking, and the limbic system, which mediates emotional processing,” he explains.
“Many users report experiencing a deep understanding of concepts they already knew, but had never truly felt before. It feels like therapy, but with emotion.”
Often, people know what they need to do, but do not feel enough urgency to change.
“For example, smokers may understand the risks, but not fully feel the impact on their lives or loved ones,” he explains.
“With psychedelics, people often report experiences in which they feel deeply connected to the consequences of their actions.”
Psilocybin can reliably induce altered states of consciousness, regardless of the context.
MDMA, by contrast, is more context-sensitive and appears particularly useful for PTSD.
When used in therapeutic settings, MDMA may help patients gain new perspectives, though these insights may not occur in non-therapeutic contexts.
In PTSD treatment, one commonly-used approach is exposure therapy, which involves revisiting traumatic memories in a safe and structured setting.
While effective, it can be difficult for patients to tolerate.
“If exposure therapy is conducted without re-traumatising the patient, it can be very effective,” says Dr Liknaitzky.
MDMA appears to increase tolerance for distress, allowing patients to process traumatic memories without becoming overwhelmed.
“With therapeutic support, patients can reshape their relationship with traumatic memories so that they no longer react in the same way,” he adds.
Clinical trials involving MDMA, especially among first responders and military veterans with chronic PTSD, show significant improvements in the participants.
Risks and side effects
While psychedelic therapy holds significant promise for treating mental health conditions, it is not without risks.
“The main psychological risks are panic, re-traumatisation and destabilisation,” says Dr Liknaitzky.
He describes psychedelic therapy as “talk therapy on rocket fuel” because it can accelerate psychological processes.
“This can be risky, as individuals may encounter new perspectives so quickly that they struggle to process or integrate them safely,” he explains.
In PTSD, for example, many individuals experience memory gaps related to traumatic events.
This typically occurs as a coping mechanism.
“With MDMA, those defences are lowered, and the person may suddenly access memories they had blocked out,” he says.
While this can be therapeutic – allowing patients to process traumatic memories and change their automatic responses – it can also be overwhelming.
“That is why it is essential that individuals are well supported before, during and after their psychedelic dosing sessions.”
Without proper preparation and therapeutic guidance, individuals may struggle to navigate these experiences.
In some cases, this may lead to what is commonly described as a “bad trip” – a highly distressing and prolonged psychological experience.
A bad trip can be psychologically harmful and is associated with reduced clinical benefit.
Dr Liknaitzky adds that distress often arises when individuals try to resist or avoid the experience.
For this reason, patients are taught beforehand how to relax and trust the therapeutic process.
“In almost all psychedelic trials conducted worldwide over the past 25 years, the safety profile has been excellent, often even better than in traditional antidepressant clinical trials,” he says.
However, this strong safety record applies only when qualified healthcare practitioners conduct a well-designed, purpose-built psychedelic therapy protocol.
Who is suitable?
Psychedelic therapy is not suitable for everyone.
Careful screening and professional supervision are essential, as certain conditions may increase the risks.
Dr Liknaitzky explains that while cardiovascular risks are generally low, they remain an important consideration.
“Psychedelics are sympathomimetic, meaning they stimulate the sympathetic nervous system, which can raise heart rate, blood pressure and body temperature,” he says.
For most healthy individuals, this increase – typically around 10-20% – is modest and well tolerated.
“Physical exercise often raises heart rate and blood pressure more than a psychedelic would,” he notes.
However, for older adults with untreated high blood pressure or significant heart disease, these effects may pose a risk.
Mental health history is another important factor.
Dr Liknaitzky notes that: “Individuals with a history of psychosis or a strong family history, such as a first-degree relative with schizophrenia, are typically excluded from trials due to concerns about triggering psychotic symptoms.
“Although some researchers are exploring the use of MDMA for certain symptoms of schizophrenia, this remains complex and is mainly focused on negative symptom profiles.”
Bipolar disorder is also generally excluded from clinical trials.
While it has not been extensively tested in controlled settings, reports from non-clinical use suggest psychedelics may trigger manic episodes in susceptible individuals.
“Bipolar disorder is cyclical, with periods of depression and mania,” Dr Liknaitzky explains.
“Some research suggests that psilocybin may help during depressive phases, but could worsen symptoms if taken during a manic phase.”
Current status in Malaysia
In Malaysia, psilocybin, LSD, MDMA and DMT remain strictly controlled under the Dangerous Drugs Act and the Poisons Act, limiting their use to highly-regulated research settings.
However, ketamine and esketamine are clinically approved by the Health Ministry for treatment-resistant depression, notes Monash University Malaysia neuroscientist Associate Professor Dr Satoshi Ogawa.
“Hence, applications for psychedelic clinical trials are not entirely impossible, but they require approval and clear guidelines from the Health Ministry,” he explains.
He adds that researchers in Malaysia and Australia are working towards pilot clinical studies on psychedelic-assisted therapy, starting with depression.
The initiative begins this year (2026), bringing together psychiatrists from several public universities, alongside regulatory experts from Malaysia and Australia who have experience in psychedelic research.
“These groups are forming dedicated taskforces, and the aim is to generate local clinical evidence through small-scale trials involving Malaysian patients [using drugs approved for research],” he says.
The next phase includes a symposium next year (2026), where experts will conduct workshops to train psychiatrists and psychotherapists in psychedelic-assisted therapy.
