Dr. Mahjoubi’s Response to a Los Angeles Times Article About Psychedelics

By David Mahjoubi, MD — Founder, NutraBrain Clinic

On June 30, 2026, the Los Angeles Times published a guest essay titled “Mental health care isn’t ready for psychedelic side effects.” In it, writer Laura Zam describes the devastating breakdown her husband suffered after the couple enrolled in an MDMA-assisted therapy trial. It is a heartbreaking account, and her central plea — that clinicians be better trained before these substances are fast-tracked — is one I share.

But the piece rests on a category error, and because that error is common, I want to address it directly. The problem starts with the headline: it says psychedelics, as though they were a single class of interchangeable drugs. They are not.

“Psychedelics” is not one thing

The substances lumped under that word differ profoundly — in their chemistry, in their mechanism of action, and in the parts of the brain they affect. Classic psychedelics such as psilocybin and LSD (“acid”) act primarily on serotonin 2A receptors and produce powerful alterations in perception and consciousness. MDMA is an entactogen that floods the brain with serotonin, dopamine, and norepinephrine. Ketamine is a dissociative anesthetic that works on an entirely different system — the NMDA/glutamate pathway.

Grouping these together is like grouping aspirin, insulin, and general anesthesia under one heading and drawing conclusions about all three from a bad outcome with one. It’s comparing apples to oranges. And Ms. Zam’s story, when you read it closely, is about MDMA — not about ketamine, not about psilocybin, and not about “psychedelics” as a whole.

That distinction is not academic. MDMA currently has no standardized therapeutic protocol. Dosing, patient selection, and how to safely integrate the experience afterward all remain unsettled. When a substance has no established standard, the risk of harm from the wrong dose in the wrong patient rises sharply — which may bear directly on what this family endured.

It’s also why, when patients ask whether I would offer MDMA at my clinic if it were legalized, my answer is no. I was not trained in it. I was trained in ketamine, during my anesthesiology residency, where it has been used safely for decades. Declining to practice outside one’s training is exactly the caution Ms. Zam is asking for. Her essay would be stronger, not weaker, for naming MDMA specifically rather than indicting an entire field.

Why the drug — and the setting — matters

Here is a point the article never makes, and it is the most important one for anyone considering this kind of treatment.

Psychedelics like MDMA and LSD can carry real, lasting mental-health consequences — particularly when taken in unknown or unregulated doses. What surfaces during these experiences can overwhelm a nervous system that isn’t prepared for it, and the aftermath can extend for months or years, as Ms. Zam’s husband’s ordeal so painfully illustrates.

Ketamine, by contrast, has a very different safety profile when it is administered properly. In the hands of an experienced provider, in a medically supervised setting, serious side effects are rarely seen — at most, some patients experience transient nausea or a mild headache. The keys are the setting and the source:

• A controlled, medically supervised environment, with the treatment given by intravenous (IV), intramuscular (IM), nasal spray, or oral route under clinical oversight.
• Ketamine from a trusted source — a licensed compounding pharmacy or an established pharmaceutical manufacturer that has been producing ketamine reliably for years — rather than an unknown or unregulated product of uncertain dose and purity.

This is the difference between medicine and a gamble. Dose, purity, route, and supervision are not footnotes; they are the entire margin of safety.

Correcting the record on ketamine

Ms. Zam also includes an aside worth correcting. She notes that her husband’s integration provider switched to ketamine patients, and adds in parentheses that ketamine “has limited FDA approval and can be very lucrative.”

Ketamine’s FDA approval is limited for a simple reason: it went off patent decades ago. Neither pharmaceutical companies nor universities will fund large, expensive trials on a generic drug that offers no financial return. When a molecule did offer that return, the research followed — Johnson & Johnson studied esketamine, a single mirror-image enantiomer of the ketamine molecule, and won FDA approval for it under the brand name Spravato for treatment-resistant depression. The science follows the money, not the merit of the medicine.

As for “lucrative” — anyone who has actually run a ketamine clinic knows better. Payroll, rent, medical supplies, and malpractice coverage are all steep. Even getting ketamine delivered is a hurdle, because many medical suppliers won’t sell it to ketamine clinics at all. It is a demanding, tightly regulated practice, not a windfall.

The takeaway

None of this diminishes what the Zam family went through, or the genuine need for better clinician training that Ms. Zam identifies. If anything, it sharpens her point. Precision — which drug, at what dose, in whose hands, from what source, in what setting — is the whole game. We should demand that precision in our medicine, and in how we write and talk about it.

At NutraBrain Clinic, that precision is the standard we hold ourselves to every day.

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David Mahjoubi, MD, is a board-certified anesthesiologist and the founder of NutraBrain Clinic. The views expressed here are his own.

David Mahjoubi, MD
www.NutraBrainClinic.com