Unlocking Young Minds: Could Psychedelic-Assisted Therapy Transform Youth Mental Health?
Written by Ioanna Artemis Vamvakopoulou
The Crisis in Youth Mental Health
Mental illnesses today present an urgent challenge for young people. Conditions such as depression, anxiety, and behavioural and eating disorders typically peak around the age of 15, with up to 75% of lifetime psychiatric illnesses emerging by the age of 25. According to the World Health Organization, mental health conditions account for 15% of the global burden of disease among individuals aged 10 to 19, with suicide standing as the third leading cause of death for those aged 15 to 29. Despite these statistics, formal treatment is often delayed by years.
The developmental period between ages 12 and 25 is characterised by heightened neuroplasticity, a window of brain adaptability crucial for learning, identity formation, and independence. However, this elevated plasticity acts as a double-edged sword; while it facilitates growth, it also leaves young people uniquely vulnerable to environmental stressors, trauma, and mental illness.
Despite the growing demand for effective interventions, psychiatric drug development has largely stalled. Most psychotropic medications prescribed to under-18s are used "off-label", meaning they lack rigorous safety and efficacy data specific to younger populations, leaving clinicians, young people, and families with limited therapeutic options.
The Emergence of Psychedelic-Assisted Therapy
To address these unmet needs, research and clinical interest have turned towards psychedelic-assisted therapy (PAT). Research in adult populations has demonstrated significant therapeutic promise for serotonergic ("classic") psychedelics, including psilocybin, LSD, and DMT, which have shown efficacy in treating major depression, anxiety, and substance use disorders, amongst other conditions. Research with non-classic psychedelics, such as MDMA, has produced strong results in treating post-traumatic stress disorder.
Given these promising outcomes in adult trials, a central scientific and clinical question arises: Can psychedelic-assisted therapy be safely and effectively adapted for young people?
What Do We Actually Know About Psychedelics and Young People?
Clinical Research in the Modern Context
Modern clinical trials evaluating PAT in youth remain remarkably limited. While a recent systematic review identified no published contemporary clinical trials, several pioneering studies are currently underway:
Psilocybin for Self-Harm: A double-blind, placebo-controlled trial examining psilocybin-assisted therapy for young people aged 16–25 who engage in self-harm.
MDMA for Social Anxiety in Autism: A clinical trial investigating MDMA-assisted psychotherapy for autistic young adults aged 16–25 experiencing social anxiety.
MDMA for Adolescent PTSD: Upcoming trials evaluating MDMA for treatment-resistant PTSD in adolescents (personal communication).
Psilocybin for Anorexia Nervosa: A clinical trial investigating the safety and tolerability of two high doses of psilocybin with psychological support in young adults aged 16–35 with anorexia nervosa.
Traditional and Ritualistic Use
Observational data from traditional contexts offer valuable safety insights. Researchers evaluated adolescents aged 15–19 from the syncretic União do Vegetal churches in Brazil who regularly ingested ayahuasca, a DMT-containing brew, within legal religious ceremonies.
When compared with matched non-consuming adolescents, ayahuasca-consuming adolescents exhibited:
Lower rates of anxiety, body image concerns, and attentional difficulties.
Significantly lower rates of alcohol consumption.
Equivalent performance on neuropsychological assessments measuring memory, attention, and cognitive flexibility.
Better-quality family relationships and social functioning.
These observations indicate that ayahuasca used within a legal, religious context and accompanied by a supportive family environment could be beneficial for young people. However, it is still unclear whether these findings are the result of ayahuasca use, the ceremonial setting, or a combination of both.
Real-World Observational Data and Safety Profiles
Observational studies of non-medical psychedelic use among youth reveal safety considerations alongside associations with some positive mental health outcomes.
Depression and Well-Being: Young people aged 16–24 reported improvements in mood, self-esteem, mindfulness, and psychological well-being following psychedelic use, matching findings in adult cohorts.
Suicidality: Population surveys of US adolescents aged 12–17 indicated that lifetime psilocybin use was associated with reduced odds of suicidal ideation and attempts. Interestingly, this was not the case for other psychedelic substances, with LSD showing higher odds of suicidal ideation and behaviour, and MDMA and mescaline showing no association at all.
Psychosis Risk: While triggering psychotic symptoms remains a central safety concern, longitudinal twin, community, and cross-sectional studies of adolescents and young adults have shown that although psychedelics can be associated with a higher risk of psychotic symptoms, when adjusting for genetic vulnerabilities (e.g., schizophrenia or bipolar I disorder), psychiatric diagnosis, and stimulant drug use, the association weakens significantly.
Age-Specific Vulnerabilities and High Psychedelic Doses
While psychedelics have shown the potential to improve well-being and other mental health outcomes, research so far indicates that they may also come with risks that could be age-specific. Compared with older adults, younger individuals report a higher incidence of anxiety, challenging psychedelic experiences, temporary visual perceptual changes, and intense ego dissolution.
In contrast to adults, for whom higher-dose-driven ego dissolution has been linked with positive treatment outcomes, the opposite has been observed in young people, possibly because at a younger age the sense of self is not fully formed and the disintegration or complete dissolution of the ego can be more frightening and disruptive. It is important to note that the research reporting these findings partly attributed this higher risk to the use of higher doses of psychedelics in unsupervised environments.
Adapting the Therapeutic Model for Young People: Recommendations
Because an adolescent's sense of identity and self-concept is actively evolving, high-dose experiences that can cause ego loss may be psychologically destabilising. Translating PAT to younger populations therefore requires tailoring the therapeutic approach.
Incorporating Systemic and Family Support
Unlike fully autonomous adults, young people operate within family systems and may be reliant on primary caregivers. Following a PAT session, individuals may enter an "afterglow" period marked by heightened emotional openness. Returning to an unsupportive or chaotic home environment during this state could compromise therapeutic benefits.
Engaging parents and caregivers through structured education could help address stigma surrounding these substances and encourage a supportive environment at home. Thus, potentially involving family members in preparation and integration sessions could improve overall recovery outcomes. However, therapist teams must carefully balance parental involvement with the young person's autonomy and right to privacy.
Psycholytic Therapy: A Low-Dose Alternative
Rather than prioritising high-dose sessions aimed at inducing intense mystical or breakthrough experiences, youth interventions may benefit from the use of lower doses.
One therapeutic model worth investigating is psycholytic therapy. Practised commonly in Europe in the 1960s and 1970s, psycholytic therapy utilises lower, serial doses of psychedelic substances combined with structured psychotherapy. Low doses could allow young patients to stay grounded and maintain cognitive control while processing emotionally challenging material during the psychedelic experience. This could enable therapists to integrate modalities such as cognitive behavioural therapy, mindfulness, and mental imagery manipulation in real time, with the potential to reduce the risk of severe acute distress.
Although this approach has not been widely used since the 1970s, perhaps this is the time to reintroduce it to the psychedelic research community, when the need for alternative, novel, and safe interventions for young people is so pressing. Further research is warranted in this area, with one of the first psychedelic studies involving young people now kick-starting this journey.
Cost Considerations
It is important to consider that the initial implementation of specialised PAT protocols for young people may be more costly, especially when incorporating the above recommendations. However, delivering effective early interventions during adolescence may yield long-term health returns. Interrupting the trajectory of chronic mental illness early could preserve quality-adjusted life years and significantly lower lifetime healthcare expenditures for the individual, healthcare system, and wider society, potentially allowing new generations to enjoy more of their lives without illness.
The Path Forward
The expanding crisis in youth mental health requires evidence-based innovation. Psychedelic medicines are not a one-pill-cures-all solution, but they might have the potential to help young people with mood disorders, substance use disorders, PTSD, and other conditions if used in a safe and supported environment.
Moving forward, research specific to young people is needed to demonstrate the medical potential of psychedelic medicines. Prioritising youth-focused research will help ensure that young people are not left behind as novel psychiatric treatments advance.