Can psychedelics meet their potential as mental health treatments?

Researchers at Johns Hopkins have determined that, on the basis of psilocybin’s pharmacological characteristics, including its low abuse liability, it would be most appropriate for a Schedule 4 designation, which would place it in the same category as commonly used benzodiazepines [24]. Similar conversations about the appropriate scheduling level for MDMA are unfolding as research progresses. Therapeutic alliance is considered a strong predictor of treatment success in conventional psychotherapy [107].

Psychedelic medicine

What many people don’t understand about psychedelics, Woolley said, is the impact can last for days, weeks or longer after the substance is no longer detectable in the body. These results suggest that the 5-HT2ARs inside and outside of neurons activate different cell-signaling pathways. When the researchers used an electrical current to allow compounds like serotonin to enter neurons, the compounds promoted dendritic spine growth. An NIH-funded research team led by Dr. David Olson from the University of California, Davis previously developed a sensor that could distinguish which drugs that bind to 5-HT2AR have hallucinogenic properties and which don’t.

Ocasio-Cortez wants to make it easier to study magic mushrooms, other psychedelic drugs

• Motivated by the high burden of mental illness and the urgent need for accessible treatments, Oregon decided to allow psychedelics to be administered by facilitators without mental health training, and for people to use psilocybin without a prescription.
• With rigorous psychotherapeutic integration, patients begin to consider new perspectives and are able to restructure their habitual ways of approaching the world.
• In particular, some people may have psychotic episodes or other mental health issues triggered by taking psychedelics, especially if they have a history of psychosis or pre-existing risk for serious psychiatric disorders like schizophrenia or bipolar disorder.
• To see whether a similar phenomenon could be detected in living brains, the team used mice engineered to make a protein that can bring serotonin into neurons.

Whether people from diverse socioeconomic, racial, and ethnic backgrounds respond to and benefit from psychedelic therapies in the same way as the participants in clinical trials so far remains a crucial open question. Moreover, the comparative risks and benefits of MDMA and psilocybin versus other novel psychiatric treatments, such as ketamine and various neuromodulation techniques, remain unknown. Psilocybin, for example, has demonstrated rapid and sustained antidepressant effects without tolerance or dependence in trials so far.

Psychedelics And Mental Health: What Does The Science Say?

• O’Donnell says this type of support, including preparing the patient for what will happen when taking the medication, is vital for successful treatment.
• Remarkably, decreased drug, alcohol, and medication use were also reported in studies with MDMA, ayahuasca and psilocybin that did not deal directly with substance use [53, 80, 87].
• While some qualitative research efforts have been directed at exploring the role of the subjective psychedelic experience in the treatment of mental disorders, to date no systematic review exists.
• In two of the studies that provided a single psilocybin session, several patients expressed the wish for additional sessions [82], and one study reported that several patients actively sought out extramedical psilocybin sessions for this reason [53].
• A slowed (or completely absent) perception of time and unusual bodily sensations were specifically mentioned by participants taking ketamine [84], while auditory effects, such as zapping or buzzing sounds, were only mentioned for ibogaine experiences [79, 86].

“For clinical indications, psychotherapy appears to be necessary to support and facilitate change,” says Danovitch. Nevertheless, the mTORC1 signaling pathway is downregulated in the hippocampus and PFC of MDD in postmortem tissue (Jernigan et al., 2011), consistent with this signaling pathway being relevant for the treatment of MDD. Other signaling systems, for example, opioid receptors (Williams et al., 2018), may also play a role, which is perhaps unsurprising in light of the diversity of ketamine’s pharmacological targets. Shifting our perspective from receptor-based mechanisms to a neural-systems level analysis may provide new directions for optimizing ketamine therapy and developing novel treatments based on ketamine’s mechanism. In addition to accepting challenging emotional states, accepting one’s situation (or more specifically, one’s body and illness), particularly in the face of one’s impending demise, appeared to play an important role for patients with a terminal diagnosis [81, 82, 85].

Psychedelic effects can be long lasting

At this point, only some research has been devoted to determining patient-specific factors that predict psychedelic outcomes [42, 43]. Our experience in clinical trials suggests it is important to carefully screen patients for co-morbid personality disorders when they are pursuing psychedelic treatments for primary affective disorders. Given the intensity of the psychedelic experience, patients with a poorly integrated sense of self, and those with difficulties in emotional regulation and distress tolerance, may find the psychedelic experience destabilizing. We also suspect that patients who are high in avoidance — independent of the presence of personality disorders — may also have more challenges tolerating the psychedelic state. As research progresses, clinicians will gain a better sense for which patients are most likely to benefit from psychedelic treatments.

Listen to a sample from How to Change Your Mind

Achieving this goal will require more-inclusive clinical trials and unbiased regulatory review of psychedelics by the FDA. The social, economic, and public health impacts of untreated mental disorders demand solutions. If psychedelic therapies do prove to have enduring effects after just a single or a few administrations in the context of a few sessions for preparation and integration, they have the potential to offer not just a new approach to mental health care, but an entirely new paradigm of care.

Psychedelic-assisted psychotherapy has garnered large amounts of attention in recent years as the next potential breakthrough treatment for psychiatric illnesses. Despite unprecedented levels of psychopathology worldwide, the field of psychiatry has produced relatively few novel interventions in recent decades. Globally, depression is a top five cause of disability, are psychedelics addictive affecting about 5% of the world’s population [1], while PTSD has a global prevalence of 3.9%, with high-income countries having a higher burden of PTSD compared to low-income countries [2]. Psychedelic-assisted psychotherapy offers the hope of a new treatment whose rapid onset and enduring efficacy could outpace that of other psychiatric treatments.

These studies found strong reductions in both depression and anxiety symptoms, as well as improvements in quality of life and spiritual well-being, from psilocybin-assisted psychotherapy. That same year, another pilot trial found success with psilocybin for treatment-resistant depression [30•]. Moreover, the studies helped establish the safety of psilocybin, which was well-tolerated and did not cause any serious negative physiological or psychological consequences. Other research has supported psilocybin’s capacity to treat tobacco use disorder [31], alcohol use disorder [32], and obsessive compulsive disorder [33].