Psychiatry in 2026: Emerging Therapies and Why Sleep Is Moving Up the Priority List

Primary care clinicians are often the first point of contact for patients with depression, anxiety, and related concerns, and they increasingly face questions about emerging or experimental treatment approaches.¹ In this segment, Gus Alva, MD, emphasizes that while interest in novel therapies continues to grow, most psychedelic-assisted treatments remain confined to investigational research settings and are not appropriate for routine clinical use.^2,3 He explains that current studies rely on highly structured protocols that combine careful patient selection, supervised dosing, and psychological support—elements that are not replicable in unsupervised or nonmedical settings.^3,4 For primary care physicians, this distinction is central to patient counseling, particularly as some individuals may misinterpret media coverage or early trial results as evidence of established safety or effectiveness.⁵ Alva underscores the importance of setting clear expectations, screening for psychiatric risk factors such as bipolar or psychotic disorders, and discouraging self-directed experimentation that may exacerbate symptoms or lead to adverse outcomes.^4,6 He also highlights the role of primary care in harm reduction by anchoring discussions in evidence-based care while acknowledging unmet needs among patients with treatment-resistant conditions.^1,7 As research evolves, clinicians should be prepared to explain what is currently known, what remains uncertain, and why participation in regulated clinical trials differs fundamentally from nonmedical use. This approach allows primary care teams to maintain trust, reinforce clinical boundaries, and support patient safety while monitoring developments that may shape future practice.

References:

1. Reiff CM, Richman EE, Nemeroff CB, et al. Psychedelics and psychedelic-assisted psychotherapy. Am J Psychiatry. 2020;177(5):391–410.
2. Carhart-Harris RL, Bolstridge M, Rucker J, et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry. 2016;3(7):619–627.
3. Davis AK, Barrett FS, May DG, et al. Effects of psilocybin-assisted therapy on major depressive disorder. JAMA Psychiatry. 2021;78(5):481–489.
4. Johnson MW, Richards WA, Griffiths RR. Human hallucinogen research: guidelines for safety. J Psychopharmacol. 2008;22(6):603–620.
5. Yaden DB, Griffiths RR. The subjective effects of psychedelics are necessary for their enduring therapeutic effects. ACS Pharmacol Transl Sci. 2021;4(2):568–572.
6. Andersen KAA, Carhart-Harris R, Nutt DJ, Erritzoe D. Therapeutic effects of classic serotonergic psychedelics: a systematic review. Ther Adv Psychopharmacol. 2021;11:20451253211003414.
7. American Psychiatric Association. Position statement on the use of psychedelics in clinical practice. Updated 2023.