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This spring, the FDA moved a classic psychedelic into its one-to-two-month review queue, after President Trump issued a presidential executive order that accelerated psychedelic studies. In treatment-resistant depression and PTSD, three companies are getting psilocybin-and MDMA-based treatments a National Priority Voucher for a 10-12 months review period. The FDA commissioner has proposed that they may be available by late summer or fall 2026.This is real progress. But it masks a more profound understanding: psychedelics are beneficial at least in part because they replicate a process that the brain naturally does each night while sleeping. We have spent 10 years and a billion dollars to construct a medicinal path to one of the most common experiences of our lives.
In modern psychiatry they are still focused on the conscious mind. The assessment of PTSD is made through intrusive thoughts; depression, daily reports; and psychosis, alertness in sterile consultation rooms. Almost all diagnostic procedures and therapeutic techniques rely on the assumption that the “real” mind can be studied only when it is awake, conscious, self-monitoring and aware of being observed, a peculiar premise because the conscious mind is the one best equipped to conceal and do the normal thing. Every night, without any effort or expense, the brain changes, and these changes are often more revealing than anything recorded in the waking consultation.
Pay attention in the twilight zone between wakefulness and sleep, where the brain’s self-censoring systems shut down before sensory processing. Unfocused fears and relationships emerge; the kind used by artists, like Dalí and Edison, but not so much by clinicians. But the nightmares go even further. Most recent PTSD therapy simply dampens them down, either through medication such as prazosin, or by using imagery rehearsal therapy, which will reshape the dream to be something less threatening. However, this simply views episodes of distress to be filtered away as “noise”- the clearest snapshot of what is happening in the fear system is one’s fear evaluation of threat. We do have EEG and fMRI which have the ability to explore REM sleep in detail, but typically we only use them to check if a nightmare has taken place rather than to question what it reveals.
Lucid dreaming takes this one step further, allowing individuals to remain conscious of their dream state while being able to experience raw subconscious content without risk which acts like an exposure therapy with safety. Psychedelics are cousins to these natural states. Psilocybin, MDMA, and ketamine seem to function in part by transiently normalizing the same rigidity of the executive control system and default-mode network that is believed to be at the root of OCD, PTSD and depression, creating a window of plasticity. Stakes are high: more than 14 million U.S. adults suffer from serious mental illness; 30-35% of major depression cases are unresponsive to their second, third and fourth medication attempts of proper antidepressant treatment; only two FDA-approved medications for PTSD have been available in two decades, and both are limited. Psychedelic research exists on its own, independent of sleep science and dream research, and without a single compelling reason for why altered states would be more effective than waking states for some conditions. This does
not mean to say that traditional psychiatric treatment isn’t still important, of course. It is time to consider altered states – hypnagogia, nightmares, lucid dreaming, psychedelic experience-as the subjects to be studied, rather than footnotes. The FDA’s newfound enthusiasm is a rare opportunity. It would be a mistake to patent molecules just because it was not the same mechanism that plays out nightly in an ordinary bedroom. We have the tools and what we lack is will to study the third of life which we call sleep.
These pieces are being published as they have been received – they have not been edited/fact-checked by ThePrint.