Healthcare > Psychiatry

Are Psychedelics The Next Breakthrough, Or The Next Illusion?

After years of institutional failure, Americans are right to question the promises.

Renée Kohanski | April 21, 2026

America is being sold another miracle. After years of institutional failure, collapsing trust, and a mental health crisis that shows no sign of slowing, the public is once again being told that salvation may come in the form of a pill. This time the promise is not SSRIs or ketamine. It is psychedelics. The enthusiasm is loud, and the claims are getting ahead of the evidence.

This class of drugs is now gaining clinical attention, rather than just recreational fascination, even though the substances themselves are hardly new. Many readers followed Carlos Castaneda all the way to Ixtlan under the guidance of Don Juan Matus, a Yaqui “sorcerer.” Others remember the LSD era shaped by Harvard psychologist Timothy Leary. Even the name of this class suggests an exotic mechanism of action.

They fall under Schedule I, which the federal government defines as having a high potential for abuse, no accepted medical use in the United States, and a lack of established safety even under medical supervision. Why even consider it? One answer is that federal law does allow research on Schedule I substances. Another is that the morbidity and mortality associated with psychiatric illness are staggering. PTSD, addiction, and severe depression can be incapacitating and, in many cases, fatal.

The alternative is not always noble. Our northern neighbors have embraced MAID, offering medical assistance in dying to people who have not exhausted treatment.  That is not a path we should be eager to follow. If there are treatments worth exploring, even experimental ones, we owe patients the chance to consider them.

At the same time, we are confronting data suggesting that even standard antidepressants may not work as well as once believed. Doctors are often pressured by time constraints and societal expectations into prescribing an SSRI the moment a quick screening tool flashes “positive.” Pills do not fix everything, nor should they. But they also should not be dismissed outright. Anyone who has seen a refractory OCD case become manageable understands that these medications still have a place.

Where, then, do psychedelics fit in? To answer that, we need to understand how these drugs work and how they differ. SSRIs block the serotonin reuptake pump, slowly increasing serotonin signaling over several weeks and stabilizing mood circuits without producing an immediate psychological effect. Psychedelics operate through a completely different mechanism. They are direct 5 HT2A receptor agonists. This means they activate one specific serotonin receptor, and that activation triggers cross talk between brain regions. That receptor activation also drives a downstream burst of glutamate, the brain’s primary excitatory neurotransmitter. It is this glutamate surge, not serotonin itself, that produces the immediate, intense, and activating subjective experience associated with psychedelics. The two drug classes act on the same neurotransmitter system but in fundamentally different ways, and they should not be viewed as interchangeable.

There is interest in whether psychedelics can influence BDNF, a natural protein the brain uses to strengthen and reorganize its connections. Early studies suggest these compounds may temporarily increase BDNF activity, which could help the brain shift out of rigid patterns of thinking or behavior. This is promising, but still early. The connection between psychedelics, BDNF, and lasting clinical improvement is not established and needs careful, controlled research rather than enthusiasm alone.

It is important to remember that understanding a drug’s mechanism does not guarantee we understand its clinical value. Psychiatry has a long history of explaining mechanisms that later turn out to have little to do with why a treatment works, if it works at all. SSRIs are a perfect example. The serotonin story was simple and appealing, but it never fully explained clinical outcomes. Psychedelics may follow that same pattern. The receptor activity and glutamate surge are measurable, but whether they translate into meaningful, lasting benefit is still unknown.

Before we assume psychedelics will deliver on their promise, it is worth looking at the last drug that was promoted as a breakthrough.  Ketamine was billed as the new savior and breakthrough drug. Ketamine works through a rapid, glutamate driven mechanism that can lift mood within hours. That part is real. But the results have been mixed. Some patients respond dramatically, others barely respond, and many require repeated dosing to maintain any benefit. There are concerns about dissociation, blood pressure spikes, and the small but real risk of triggering mania in vulnerable individuals. Clinics have expanded faster than the evidence base, and the long-term data are not strong enough to call ketamine a cure.

Are these drugs ready for prime time? Not yet. They remain Schedule I, and that must be respected. But the ethical question of the right to try is important. It must be balanced with the right to try what, and under what conditions. Medicine is now trying to regain trust after losing it in ways that were entirely self-inflicted, and patients have not forgotten. One question is whether psychedelics help restore that trust or simply deepen the mistrust already surrounding a system that failed when it mattered.

We also need to ask why our society is struggling so profoundly with mental health. What happened to our resiliency? Why are so many people collapsing under pressures that previous generations managed to withstand? And what role should pharmacology play as we confront that question?

If we cannot answer that honestly, then no new compound, no matter how promising, will fix what is broken. The crisis is not simply biochemical. It is cultural, institutional, and moral. Until we face that directly, psychedelics will become just one more illusion in a long line of promised breakthroughs that never delivered.

Renée S. Kohanski, MD, is a board certified psychiatrist with fellowship training in forensic psychiatry. Her work spans clinical practice, expert testimony, and public commentary. She writes about the intersection of mental health, ethics, and culture, bringing a psychodynamically informed lens to contemporary debates.

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