For as long as there has been medicine, the goal has been to manage a condition: lower the blood pressure, quiet the tremor, dull the pain. A new group of drugs is aiming at something different. Their purpose is to change how the brain itself is wired, quickly, and in a way that lasts.
That’s a big claim, and it’s worth slowing down on. Nothing like it has existed at scale before.
What do these drugs actually do?
The brain can reorganize itself. It forms new connections and prunes old ones, especially early in life. Scientists call this plasticity. Some compounds seem to reopen that window, and the researcher who coined the term for them, David Olson at UC Davis, called them psychoplastogens. You’ll also see them called neuroplastogens.
The best-known examples are psychedelics like psilocybin, the active ingredient in magic mushrooms. The newest twist is a version with no trip at all. One company’s experimental drug, zalsupindole, is described by its maker as a non-hallucinogenic neuroplastogen. A 2026 peer-reviewed review reports that in early tests in healthy volunteers it caused no psychosis-like effects, such as hallucinations, at the doses tested. In a small follow-up study, the company reported clinically meaningful reductions in depression scores among 18 adults with major depressive disorder, about 50% by day 8 and sustained through day 36. That’s promising, but it was a small study with no placebo group, so it can’t prove the drug caused the improvement. The company says the FDA has cleared the design of a larger, placebo-controlled study, and researchers say these drugs will be the first real test of whether the trip is necessary.
Is any of this already here?
Partly. The nearest precedent is ketamine, and its nasal-spray form, esketamine (Spravato), is the only psychedelic-adjacent drug the FDA has approved for a psychiatric condition. Ordinary antidepressants are thought to build plasticity too, but slowly, after weeks of daily pills.
The classic psychedelics aren’t approved yet. As of this fall, the FDA has fast-tracked psilocybin and a related drug for review. Nothing is guaranteed.
What about addiction?
Alcohol is one of the conditions researchers are studying. In one trial, two psilocybin sessions combined with therapy led to fewer heavy-drinking days over 32 weeks than a comparison drug with the same therapy. The FDA has also allowed an early study of an ibogaine-based drug for alcohol use disorder. None of these are approved for alcohol use disorder, and none of this is medical advice.
The question underneath
Say these drugs work. Then what?
Who decides whether to take one? Will insurers cover them? Will they cost so much that only some people get rewired? If addiction becomes something a pill can fix, what happens to the idea of willpower, and to the blame that comes with it? I wrote about the free-will side of this in Conflicting messages.
AI is speeding this up. Researchers have trained machine-learning models to predict whether a molecule will cause hallucinations, which could shorten the search for the trip-free ones.
Why I wrote a novel about it
These questions are the heart of my novel, Syncope. Tom Glass uses an AI platform and a field kit for analyzing plants to identify medicines at a startling speed, and he stumbles onto a molecule that slows time perception. The story follows the fight over drug pricing, the pace AI has put on discovery, and what all of it does to a man who is himself a recovering alcoholic, the perfect test case.
The question the book asks is the one I keep coming back to: if we can rewire a brain, who gets to decide what it should be rewired into?