Psychedelic-Assisted Therapy and Perimenopause: What the Research Actually Shows, and What It Doesn’t
Psychedelic-assisted therapy is generating real interest among driven women in perimenopause who are looking for something that finally reaches the parts talk therapy hasn’t touched. As a trauma therapist, I think the research on psilocybin, MDMA, and ketamine for depression and PTSD is worth taking seriously, and I think the gap between that research and what’s being marketed to midlife women is wide enough to drive a truck through. This is an educational review, not a recommendation, not a treatment plan, and not a guide to finding or using these substances on your own.
Last updated: July 2026 by Annie Wright, LMFT
- The Spreadsheet and the Question She Couldn’t Answer
- What Psychedelic-Assisted Therapy Actually Is
- What the Research Actually Studied, and What It Didn’t
- The Perimenopausal Brain: What We Know and What We’re Guessing
- How This Shows Up in Driven Women
- What Can Go Wrong: Risks, Contraindications, and Why Screening Matters
- Both/And: Real Signal, Serious Infrastructure
- The Systemic Lens: A Regulated Frontier Being Marketed Like a Luxury Good
- What a Legal, Regulated Path Actually Looks Like
- Where This Fits Next to the Foundation
- Frequently Asked Questions
1. The Spreadsheet and the Question She Couldn’t Answer
Joy is 48, a hospital systems director, the kind of person whose calendar is color-coded three months out. She’s sitting across from me on a Tuesday in March, laptop bag still on her shoulder because she came straight from a budget meeting, and she pulls out her phone to show me a folder. Not a note. A folder. Six subfolders inside it: Ketamine Clinics, MDMA Trial Enrollment, Psilocybin Retreats, Peer-Reviewed Studies, Red Flags, Questions for Annie.
“I’ve been reading for three weeks,” she says. “I can’t sleep past 4 a.m. anymore, I’m crying in the car between meetings, and my psychiatrist wants to add a second medication on top of the one that stopped working. And then I read one article about psilocybin and depression and I thought, what if this is the thing. What if talk therapy has just been managing symptoms for two years and this is the thing that actually gets underneath it.”
I felt something specific sitting with Joy that afternoon, something I’ve felt with a number of driven women in the last two years. Not skepticism, exactly. A kind of caution that comes from watching a legitimately interesting body of research get flattened into a wellness pitch. Joy hadn’t found her way to a bad idea. She’d found her way to a real body of science that was being marketed several steps past what it has actually shown, especially for a woman her age going through the specific neurological weather of perimenopause.
This post is my attempt to give her, and you, the version of this conversation that isn’t trying to sell anything. What the research says. What it doesn’t say yet. Where perimenopause fits into the picture, and where it doesn’t. And why the excitement and the caution both belong in the same sentence.
A note on scope before we go further: this article is an educational review of emerging clinical research. It’s not a recommendation to pursue any specific treatment, not a substitute for individualized medical or psychiatric care, and not instructions for how, where, or from whom to obtain any substance discussed here. If you’re considering any of this, the only responsible next step is a conversation with a licensed physician or psychiatrist, and ideally participation in a regulated clinical trial rather than an unregulated or underground setting.
2. What Psychedelic-Assisted Therapy Actually Is
A therapeutic model in which a substance such as psilocybin, MDMA, or ketamine is administered under medical and clinical supervision, embedded within a structured course of psychotherapy that includes preparation sessions before the dosing experience and integration sessions afterward. The substance is understood as a catalyst for a therapeutic process, not as a standalone treatment.
In plain terms: this isn’t someone handing you a substance and sending you home. In every legitimate research protocol, it’s a small number of carefully screened sessions, in a clinical setting, with trained staff present, wrapped in hours of talk therapy on either side.
Three substances come up most often in this conversation, and they’re not interchangeable, legally or clinically.
Ketamine is where the legal picture is most often misunderstood, because “ketamine” is actually two different things in this conversation. Esketamine, brand name Spravato, is the version with an FDA-approved indication in the United States. Its current FDA label approves it for adults with treatment-resistant depression, either as monotherapy or in conjunction with an oral antidepressant, and separately, always in conjunction with an oral antidepressant, for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior (FDA-approved prescribing information for Spravato). It’s administered as a nasal spray, and because of its risk of sedation and dissociation and its potential for misuse, it’s only available under direct supervision through a restricted distribution program, with monitoring at the time of dosing. Racemic ketamine, the older, generic form of the drug, is a different regulatory story: it doesn’t carry an FDA-approved psychiatric indication. Some psychiatric clinics use generic ketamine off-label for depression, typically as an infusion, under a prescriber’s care, but that use sits outside the FDA-approved pathway that applies specifically to esketamine. Both forms are controlled substances available only through a prescriber, not for self-administration.
MDMA remains a Schedule I controlled substance in the United States, meaning it has no approved medical use outside of a research protocol. It has moved through Phase 3 clinical trials for PTSD and received Breakthrough Therapy designation from the FDA, a status that speeds up the review process for promising treatments. Breakthrough Therapy designation isn’t approval. As of this review, MDMA-assisted therapy isn’t an approved treatment and is only legally available inside a registered clinical trial.
Psilocybin, the compound in certain mushroom species, is also Schedule I federally. Some jurisdictions have decriminalized or regulated adult use or supervised services locally, and that patchwork is changing quickly, but at the federal level psilocybin has no approved medical use and remains illegal to possess or use outside of research settings in most of the country. Research on psilocybin for depression and anxiety, much of it out of Johns Hopkins, has been promising enough that the FDA granted it Breakthrough Therapy status for treatment-resistant depression, again a designation that accelerates review, not an approval.
I want to be direct about why I’m listing legal status this plainly. A driven woman doing her own research can read six months of promising headlines and lose track of where the actual regulatory line sits. The line matters. It’s the difference between a legal, monitored path and one that carries real legal and physical risk.
A designation the FDA grants to speed the development and review of a drug intended to treat a serious condition, when preliminary evidence suggests it may show substantial improvement over existing therapies. According to the FDA’s own current guidance on psychedelic drug development, allowing a clinical investigation to proceed, or granting an expedited designation, does not mean the agency has determined the drug is safe or effective.
In plain terms: a headline that says a psychedelic got a fast-track designation isn’t the same as a headline that says it got approved. Those are two different sentences, and the marketing around this field frequently blurs them on purpose.
The FDA has published clinical guidance specifically for researchers designing psychedelic drug trials, addressing everything from how to manage the fact that participants can usually tell whether they received the active drug or a placebo, to safety monitoring requirements during and after dosing sessions (FDA, Psychedelic Drugs: Considerations for Clinical Investigations). The agency’s own resource page on psychedelic drugs is explicit that these substances are still in drug development and clinical investigation, not approved treatments, with the specific exception of esketamine’s approved indications described above (FDA, Psychedelic Drugs). I’m citing the agency directly here because I think the accurate, unglamorous version of this story serves you better than the version optimized for a landing page.
3. What the Research Actually Studied, and What It Didn’t
Here’s where I think the conversation about psychedelics and midlife women goes sideways most often: the studies that get cited in wellness marketing were not studying midlife women, and they were not studying perimenopause.
Roland Griffiths, PhD, the late founding director of the Johns Hopkins Center for Psychedelic and Consciousness Research, led a randomized, double-blind trial published in the Journal of Psychopharmacology in 2016 showing that a single high-dose psilocybin session produced substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer diagnoses (Griffiths et al., 2016, DOI: 10.1177/0269881116675513). That is a real and important finding. It’s a finding about existential distress in people facing terminal illness, not a finding about hormonal mood symptoms in midlife women.
Michael Mithoefer, MD, and colleagues published the study design and rationale for Phase 3 trials of MDMA-assisted psychotherapy for PTSD in Psychopharmacology in 2019, built on a pooled analysis of six earlier Phase 2 randomized controlled trials (Mithoefer et al., 2019, DOI: 10.1007/s00213-019-05249-5). That research program is specifically about chronic PTSD, evaluated with structured trauma symptom measures, in participants who met diagnostic criteria and were carefully screened for the trial. It’s not a study of perimenopausal mood change.
Calvin Ly and colleagues published foundational lab research in Cell Reports in 2018 showing that several classic psychedelics promote structural and functional neural plasticity, the kind of measurable change in neurons and their connections that’s associated with the brain’s capacity to form new patterns (Ly et al., 2018, DOI: 10.1016/j.celrep.2018.05.022). That’s cellular and animal-model research. It tells us something about a plausible mechanism. It doesn’t tell us how that mechanism behaves in a fluctuating perimenopausal hormonal environment, because that question hasn’t been directly studied yet.
I want to name what I actually see when I read this literature closely, because I think the honest version is more useful than the exciting version. In each of these studies, psilocybin or MDMA produced measurable improvement on standardized clinical outcome measures within a specific, carefully selected population: patients with life-threatening cancer diagnoses and existential distress, or patients meeting full diagnostic criteria for chronic PTSD, treated inside a structured, multi-session protocol with trained clinical staff. Those are real findings, and they also come with the ordinary limits of early-stage clinical research: relatively small samples, participants screened to exclude many of the conditions common in general midlife populations, and open questions about how the results generalize beyond the specific group studied. This review didn’t identify any peer-reviewed clinical trials testing psychedelics as a treatment for perimenopause itself; the trials cited above concern other diagnoses and other populations. What exists is a plausible hypothesis, built from research on adjacent conditions, that a woman in perimenopause who also has treatment-resistant depression or PTSD might be a candidate for the same interventions being studied for those diagnoses. That is a very different claim than “psychedelics help with perimenopause,” and it’s the claim I actually see wellness marketing making.
4. The Perimenopausal Brain: What We Know and What We’re Guessing
What therapists and researchers understand about the perimenopausal brain is that estrogen does more than regulate reproduction. Estrogen receptors are dense in brain regions involved in mood regulation, memory, and stress reactivity, and estrogen interacts directly with serotonin signaling, the same neurotransmitter system that classic psychedelics like psilocybin act on through the 5-HT2A receptor.
A subtype of serotonin receptor in the brain that classic psychedelics such as psilocybin and LSD bind to directly, producing the characteristic perceptual and cognitive effects of the psychedelic experience. Estrogen is known to modulate serotonin receptor density and sensitivity, which is one reason researchers hypothesize that hormonal status could affect how a person responds to these substances, though this hasn’t been directly tested in perimenopausal populations.
In plain terms: the same chemical system that psychedelics act on is a system your fluctuating hormones are also acting on. Nobody has run the study that tells us exactly what happens when both are true at once, which is precisely why “we don’t fully know yet” is the honest clinical answer here, not a hedge.
What this means in practice is that a woman going through perimenopausal trauma reactivation, where old material she thought she’d processed resurfaces with new intensity, is dealing with a nervous system that is already more reactive, more easily flooded, and less predictably regulated than it was in her thirties. Layering an intense psychedelic experience onto that same nervous system isn’t necessarily contraindicated, but it’s not neutral, and anyone suggesting it’s a simple addition to a stable system is oversimplifying the neurobiology.
Hormone therapy adds another layer of complexity to this picture. Some women on hormone therapy for perimenopause are also, separately, taking psychiatric medications such as an SSRI or SNRI for mood symptoms. I’m not aware of direct research evaluating how hormone therapy itself interacts with psychedelics, so I won’t assert a specific interaction here. What I can say is that any combination of hormone therapy, psychiatric medication, and a psychedelic substance is exactly the kind of full-picture review that belongs with a prescribing physician who knows a woman’s complete medical history, not something to sort out independently or leave to a retreat intake form.
5. How This Shows Up in Driven Women
Markesha is 44, runs a nine-person consulting firm, and came to see me eight months after starting an SSRI that had, in her words, “turned the volume down on everything, including the good stuff.” She’d read about ketamine-assisted therapy for treatment-resistant depression and asked her psychiatrist directly whether she was a candidate.
“She didn’t say no,” Markesha told me. “She said we’d need to look at my cardiovascular history first, and my anxiety pattern, because ketamine can spike blood pressure and heart rate, and she wanted to rule out a few things before we even had the conversation seriously. I think some part of me wanted her to just say yes immediately. I had already decided this was going to be the answer.”
What I said to Markesha, and what I’ve said to several driven women in a similar position, is that her psychiatrist’s caution was the sign of a good psychiatrist, not an obstacle. The screening process that a careful clinician runs before considering ketamine, or before referring someone toward a legitimate MDMA or psilocybin research protocol, exists because these aren’t low-stakes interventions. A thorough screen typically considers psychiatric history including any personal or family history of psychosis or bipolar disorder, cardiovascular status, current medications and their interaction profile, and whether the person has adequate support and integration resources in place for after the session, and not only during it.
Markesha’s consulting firm ran on her ability to solve problems by working harder and researching more. Sitting with her, I watched the same pattern show up in how she was approaching this decision: research it exhaustively, build the strongest case, present it to the gatekeeper, expect a yes. What her psychiatrist’s screening process was actually offering her was something different from a yes or a no. It was a real clinical evaluation of whether her body and her history made this an appropriate path at all, evaluated by someone qualified to make that call, which is exactly how this decision should be made.
6. What Can Go Wrong: Risks, Contraindications, and Why Screening Matters
I think it does a disservice to pretend the risks here are minor or purely theoretical. A few of the most clinically significant ones, drawn from the research literature and from what physicians who work in this space describe as standard screening concerns:
Cardiovascular risk. Ketamine can cause acute increases in blood pressure and heart rate, which is why cardiovascular screening is a standard part of any legitimate ketamine protocol, and why it isn’t a fit for someone with uncontrolled hypertension or certain cardiac conditions.
Psychiatric contraindications. A personal or family history of psychosis or bipolar I disorder is treated as a significant caution flag, and often an exclusion criterion, in psilocybin and MDMA research protocols, because classic psychedelics can potentially trigger or worsen psychotic symptoms in vulnerable individuals.
Medication interactions. SSRIs can blunt the subjective effects of psilocybin, which matters both for research validity and for a person’s actual experience. MAOIs combined with MDMA carry a risk of serotonin syndrome, a potentially serious medical emergency. Anyone on psychiatric medication needs this evaluated by a prescriber before considering any psychedelic-assisted approach, not decided independently.
Inadequate integration. A dosing session without skilled preparation beforehand and integration support afterward is, in my clinical view, one of the more common ways this goes wrong outside of research settings. An intense psychedelic experience can surface material, memories, grief, insight, that a person then has no structured support to process. Judith Herman, MD, the Harvard Medical School psychiatrist whose work on complex trauma shaped a generation of trauma treatment, wrote a line I return to constantly in exactly this context.
“Recovery can take place only within the context of relationships; it cannot occur in isolation.”
JUDITH HERMAN, MD, psychiatrist, Harvard Medical School, from Trauma and Recovery (1992)
An intense altered-state experience isn’t, on its own, a relationship. It can be the occasion for real insight, and I’ve had clients describe real, lasting shifts after supervised ketamine-assisted therapy for treatment-resistant depression. But the insight becomes durable change through the relational work that comes after it: a skilled integration therapist, a support system, time, and the ordinary slow work of translating a peak experience into changed patterns in an actual Tuesday-afternoon life. Without that container, what a person is often left with is a vivid memory and no map for what to do with it.
Retraumatization risk. For a woman with a significant trauma history, an unsupervised or poorly held altered-state experience carries real risk of re-exposure to traumatic material without adequate safety scaffolding, which can worsen rather than resolve symptoms. This is precisely why legitimate protocols include extensive preparation sessions before any dosing occurs.
7. Both/And: Real Signal, Serious Infrastructure
Both of these things are true at once, and I want to resist the pull toward resolving the tension between them.
The trials on psilocybin for treatment-resistant depression and MDMA for chronic PTSD were conducted by serious researchers, published in peer-reviewed journals, and showed measurable improvement on standardized outcome measures within their specific study populations. The FDA has granted both compounds Breakthrough Therapy designation, which reflects the agency’s judgment that preliminary evidence and a serious unmet medical need warrant an accelerated review pathway. That designation is a signal worth taking seriously. It’s not itself a finding of safety or effectiveness, and it doesn’t substitute for the full trial record. Dismissing this body of research as fringe or dangerous across the board would be its own kind of inaccuracy.
And the infrastructure required to make these interventions safe, specifically medical screening, psychiatric history review, trained clinical supervision, and structured integration support, isn’t optional scaffolding around the “real” treatment. It’s the treatment. A psilocybin session without that infrastructure isn’t a lighter version of the research protocol. It’s a different, much riskier thing wearing the same name.
For a woman in perimenopause specifically, both things are also true: the neurobiological changes she’s experiencing may make her more sensitive to both the potential benefit and the potential destabilization of an intense psychedelic experience, and nobody has published the study that tells us which effect predominates in her specific hormonal context. Holding “this research is promising” and “this hasn’t been studied in people like me” in the same breath isn’t indecision. It’s accuracy.
8. The Systemic Lens: A Regulated Frontier Being Marketed Like a Luxury Good
Here’s the terrain-level force I think doesn’t get named enough in this conversation: a still-developing area of federal drug policy and clinical research has become, in the span of a few years, a wellness-industry marketing category aimed squarely at affluent, driven women in midlife.
Retreat businesses, some operating in jurisdictions with looser regulatory frameworks, market directly to the exact demographic reading this post: successful, self-aware, financially resourced, and exhausted enough to want a shortcut through years of accumulated stress and unprocessed history. The marketing language borrows heavily from legitimate research, the citations to Johns Hopkins and MAPS studies are often technically accurate, while quietly skipping the screening rigor, the medical supervision, and the integration infrastructure that made those research results hold up in the first place.
This is a familiar pattern to anyone who has watched the wellness industry absorb a legitimately interesting scientific development before the science has caught up to the marketing. It happened with hormone therapy in its own complicated way, and it’s part of why the conversation about the longevity industry targeting perimenopausal women has become its own necessary topic. The pattern isn’t unique to psychedelics. It’s what happens whenever an underserved population with money and desperation meets an industry willing to sell hope faster than the evidence can support it.
Which means, in practice, that the burden of discernment falls on individual women doing exhausting independent research at midnight, trying to distinguish a legitimate clinical trial from a beautifully photographed retreat website, at exactly the point in their lives when they have the least bandwidth to do that kind of vetting alone. That’s not a personal failing. It’s a structural gap that a regulated healthcare system hasn’t yet closed, and a for-profit wellness industry has rushed in to fill.
9. What a Legal, Regulated Path Actually Looks Like
If, after a serious conversation with your physician or psychiatrist, this feels like something worth pursuing, the responsible paths are narrower than the marketing suggests.
Esketamine (Spravato) through a licensed medical provider. This is the FDA-approved route, specifically for treatment-resistant depression, either as monotherapy or alongside an oral antidepressant, or for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, always alongside an oral antidepressant, and it’s administered only under direct supervision through a restricted distribution program, with a prescribing physician who screens for cardiovascular and psychiatric contraindications before treatment begins.
Generic ketamine through a psychiatric provider, understood as off-label care. Some psychiatrists and psychiatric clinics offer generic ketamine, usually by infusion, for depression that hasn’t responded to other treatment. This is legal when prescribed and supervised by a licensed provider, but it doesn’t carry an FDA-approved psychiatric indication the way esketamine does, and it should be discussed with a prescriber as an off-label option, not assumed to carry the same regulatory footing.
Enrollment in a registered clinical trial. For MDMA or psilocybin, the only legal access in most of the United States is through a clinical trial registered with the FDA, typically listed on ClinicalTrials.gov, run through an academic medical center or research institution with an institutional review board overseeing participant safety. Trials have specific inclusion and exclusion criteria, and being turned down for a trial isn’t a personal rejection. It’s the screening process working as designed.
A conversation with your existing prescriber first. Before any of the above, the actual first step is telling your psychiatrist or primary care physician what you’re considering and asking them to help you evaluate candidacy, given your specific psychiatric history, cardiovascular status, and current medications. That conversation, not a retreat brochure, is where an honest answer about whether this is right for you actually begins.
What I’d ask you not to do is treat a blog post, mine included, as capable of determining whether you’re a candidate for any of this. I can’t assess your cardiovascular history. I can’t review your medication list for interaction risk. I can’t evaluate whether your specific trauma history makes an intense altered-state experience more or less advisable right now. A licensed physician who has your full chart can, and that evaluation isn’t a formality to rush past on the way to the experience you’ve already decided you want.
10. Where This Fits Next to the Foundation
Joy and I spent most of our subsequent sessions not talking about psilocybin at all. We talked about the folder. About what it meant that she’d built six subfolders and a research process instead of calling her psychiatrist first. About the specific 4 a.m. thought loop that had started three months before any of this research began, and what that loop was actually about.
What we found, working through it together, was that the appetite for a dramatic intervention was real, and it was also doing some work that had nothing to do with psilocybin. It was a way of not sitting with a much less exciting, much more effective next step: an actual conversation with her prescriber about a medication that had stopped working, and a hard look at a caregiving load at home that had quietly tripled over the past year without anyone renegotiating it.
This is the pattern I want to name plainly, because I think it matters more than any single substance discussed in this post. The identity disruption that perimenopause brings can create a real hunger for something that feels like a fast, decisive answer. Sometimes that hunger points toward something worth investigating with proper medical guidance. And sometimes it’s pointing at the exhaustion of an unexamined foundation, the family-of-origin patterns and adult-life load that no hormone or substance was ever going to resolve, because it was never a chemistry problem to begin with.
I’m not telling Joy, or you, that psychedelic-assisted therapy is off the table. I’m telling you that it belongs in its proper place in the sequence: after a real medical evaluation, after an honest look at whether the foundational work of therapy has actually been done, and never as a substitute for either.
If you’re in perimenopause, feeling like the ground has shifted under you, and you’ve found yourself curious about whether psychedelic therapy might help, I want to meet that curiosity with both honesty and care. It makes complete sense to go looking for something when the old strategies stop working and your body feels unfamiliar. You can hold genuine hope about emerging approaches and also stay clear-eyed about how much is still unknown, unregulated, and marketed with more certainty than the evidence supports, both at once. Neither cancels the other. Nothing in this piece is medical advice or a recommendation to pursue any specific treatment. What I hope it offers is a more grounded set of questions to bring to your own doctor or a qualified provider who knows your history. You deserve support that takes your whole context seriously, your hormones, your nervous system, your story, rather than a single dramatic fix. Please make any decision about your care in partnership with licensed professionals who can look after your safety directly. When you’re ready for that kind of support, I’m here.
Warmly,
Annie
Warmly, Annie
Q: Does psychedelic-assisted therapy treat perimenopause?
A: No. Perimenopause is a hormonal transition, not a psychiatric diagnosis. This review didn’t identify any peer-reviewed clinical trials testing psychedelics as a treatment for perimenopause itself. The existing trials cited in this article concern other diagnoses and other populations: treatment-resistant depression, existential distress in terminal illness, and chronic PTSD, not perimenopausal hormonal symptoms. A perimenopausal woman with one of those diagnosed conditions might be a research candidate for the studied intervention; that is a different claim than “this treats perimenopause.”
Q: Is ketamine-assisted therapy legal and FDA-approved?
A: Esketamine (Spravato) is FDA-approved specifically for treatment-resistant depression and for depression with acute suicidal ideation, delivered under direct medical supervision. It requires a prescribing physician and standard psychiatric and cardiovascular screening. It’s legal only through a licensed medical provider, not for self-administration.
Q: What about MDMA-assisted therapy for trauma?
A: MDMA remains a Schedule I controlled substance in the United States. It has completed Phase 3 clinical trials for PTSD and holds FDA Breakthrough Therapy designation, but that designation isn’t the same as approval. As of this review, the only legal access to MDMA-assisted therapy is through enrollment in a registered clinical trial.
Q: How do FDA guidance documents describe the current status of these treatments?
A: The FDA’s own guidance for researchers frames psychedelic compounds as substances still under clinical investigation, with detailed requirements for safety monitoring and trial design. The agency has been explicit that allowing a study to proceed, or granting an expedited designation, doesn’t mean a drug has been determined safe or effective. Current FDA resources on this topic are available directly from the agency.
Q: Who should not consider psychedelic-assisted therapy?
A: A personal or family history of psychosis or bipolar I disorder, certain cardiovascular conditions, and specific medication interactions (including MAOIs and, for research contexts, sometimes SSRIs) are treated as significant screening concerns or exclusion criteria in legitimate protocols. Only a licensed physician who knows your full psychiatric, cardiovascular, and medication history can make this determination. This post can’t and doesn’t make that determination for you.
Q: What does “integration” mean, and why does it matter so much?
A: Integration is the structured therapeutic work that happens after a psychedelic-assisted session, helping a person process and make lasting sense of what surfaced. Without skilled integration support, an intense experience can leave someone with vivid material and no framework for translating it into changed patterns. Legitimate research protocols build multiple integration sessions into the treatment course; this isn’t an optional add-on.
Q: How do I access this legally if I want to explore it further?
A: Start with your prescribing psychiatrist or primary care physician, not an independent search. For ketamine or esketamine, ask your psychiatrist about a licensed medical provider. For MDMA or psilocybin, the only legal path in most of the country is enrollment in a registered clinical trial through an academic medical center, typically listed on ClinicalTrials.gov, with a formal screening and consent process.
Related Reading
- Griffiths, Roland R., Matthew W. Johnson, Michael A. Carducci, Annie Umbricht, William A. Richards, Brian D. Richards, Mary P. Cosimano, and Margaret A. Klinedinst. “Psilocybin Produces Substantial and Sustained Decreases in Depression and Anxiety in Patients with Life-Threatening Cancer: A Randomized Double-Blind Trial.” Journal of Psychopharmacology 30, no. 12 (2016): 1181-1197. https://doi.org/10.1177/0269881116675513.
- Mithoefer, Michael C., Marcela Ot’alora G., Bessel van der Kolk, Anne Wells, Bruce Fischer, Lisa Jerome, Berra Yazar-Klosinski, Amy Emerson, and Rick Doblin. “MDMA-Assisted Psychotherapy for Treatment of PTSD: Study Design and Rationale for Phase 3 Trials Based on Pooled Analysis of Six Phase 2 Randomized Controlled Trials.” Psychopharmacology 236, no. 9 (2019): 2735-2745. https://doi.org/10.1007/s00213-019-05249-5.
- Ly, Calvin, Alexandra C. Greb, Lindsay P. Cameron, Jonathan M. Wong, Eden V. Barragan, Paige C. Wilson, Kyle F. Burbach, et al. “Psychedelics Promote Structural and Functional Neural Plasticity.” Cell Reports 23, no. 11 (2018): 3170-3182. https://doi.org/10.1016/j.celrep.2018.05.022.
- Herman, Judith L. Trauma and Recovery: The Aftermath of Violence, from Domestic Abuse to Political Terror. New York: Basic Books, 1992.
- van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking, 2014.
U.S. Food and Drug Administration. “Psychedelic Drugs: Considerations for Clinical Investigations.” Guidance document. Accessed July 2026. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/psychedelic-drugs-considerations-clinical-investigations.
U.S. Food and Drug Administration. “Psychedelic Drugs.” Accessed July 2026. https://www.fda.gov/drugs/resources-drugs/psychedelic-drugs.
If you’re moving through perimenopause alongside a trauma history, a few related pieces may help: why old trauma resurfaces during perimenopause, the identity crisis so many driven women feel in this decade, a therapist’s lens on hormone therapy, perimenopause and ADHD-like symptoms, perimenopause and changing alcohol tolerance, body image and weight-loss medication in perimenopause, how the longevity industry markets to perimenopausal women, why divorce rates climb during this decade, childhood emotional neglect and its adult echoes, and how to find the right therapist for this season.
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Annie Wright, LMFT
LMFT · Relational Trauma Specialist · Author, W.W. Norton 2027
Helping driven women finally feel as good as their résumé looks.
Annie Wright is a licensed psychotherapist (LMFT #95719) and trauma-informed executive coach with over 15,000 clinical hours. She works with driven women, including Silicon Valley leaders, physicians, and entrepreneurs, in repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, NBC News, and The Information. She is currently writing her first book with W.W. Norton.
