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Turn On, Tune In, and…. Heal Your Brain? Psychedelics Return as Potential Therapy for Mental Health Disorders

Sonja was twelve years old when the car accident happened. She survived, but her family didn’t. For years, she could not escape the horrible reality that she called life. She suffered from debilitating dreams, where she vividly relived “flashbacks” of the event. She ended up finding a career where she could work from home because getting into a vehicle of any kind was simply out of the question.

She tried to get help and was diagnosed with PTSD (Post-traumatic stress disorder). She went from therapist to therapist and tried medication after medication. 

No relief.

She felt so ALONE. So isolated.

As she sank deeper and deeper, she turned to alcohol and cigarettes to numb the pain. It didn’t solve the problem, but at least took the edge off.

Finally, after watching a documentary about something called 'psychedelic therapy,' she had new hope. She ran the idea past her aunt, who expressed concern. “Honey, I knew people who tried that in my day. It was bad news. Some of them had what we called “a bad trip” and were never the same.” She valued her aunt’s opinion but decided to trust her gut and enrolled in this new therapy.

Thanks to new developments in brain imagining technology, the understanding of the human brain have come a long way in the last 20 years. Discovery of an area known as the default mode network, involved in brain processes such as daydreaming, thinking of the future, and recalling memories has sparked a renewed interest in psychedelics as potential drug therapies. 

Psychedelic Use in The Past

In the 1950s, researchers began to conduct studies focused on the therapeutic effects of psychedelics. Psilocybin and LSD, which work on similar receptors, were widely studied in more than 40,000 people for their use in substance use disorders. Some were in controlled therapeutic settings, but some were also used unethically. 

The counterculture movement and fear of increased drug use led to the ban of LSD in 1968. The Controlled Substances Act in 1970 soon followed, and all research on psychedelic use in humans came to a halt. It wasn’t until the turn of the century, in 2000, that things began to turn around.

Johns Hopkins Center for Psychedelic & Consciousness Research

In 2000, a research group at Johns Hopkins University was the first to secure regulatory approval in the United States to reinstitute research with psychedelics In healthy volunteers. In 2006, they published a monumental study showing a single dose was safe and had lasting positive effects. This study was followed ten years later with another study showing that psilocybin significantly decreased depression and anxiety in patients with terminal cancer. 

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How do Psychedelics Work?

The exact mechanism of how psychedelics work in the brain is not well understood. Researchers have theorized that the agents work on the area known as the default mode network, enabling patients to experience “loss of self” or “ego dissolution.

What is known is that the use of the drug is only part of the equation. Effective psychedelic therapy requires intense therapy with a trained therapist to allow integration of the experience.

In November 2019, officials in Oregon approved a 2020 ballot measure that would allow medical professionals to conduct psilocybin-assisted therapy. If it passes, Oregon will be the first state to let licensed therapists administer psilocybin. Other states like California are likely to follow suit. 

Which Individuals Should NOT Use Psychedelics?

There is a population of individuals, such as those who have schizophrenia, who should not be given psychedelic therapy. Also, these types of drugs can increase blood pressure, so those suffering from uncontrolled hypertension should not partake in psychedelic therapy.

Risk can also be minimized by carefully selecting the patient and giving it in a controlled environment where the patient feels safe.

Breakthrough Therapy Designation by FDA

Several other institutions, such as the Multidisciplinary Association for Psychedelic Studies (MAPS), the Usona Institute, and Compass Pathways, are each working towards acquiring U.S. Food and Drug Administration (FDA) approval of investigational psychedelic medicine. 

Presently, both MDMA (another psychedelic) and psilocybin have been granted Breakthrough Therapy Designation by the FDA. Breakthrough status is granted when early clinical evidence suggests that the agent being studied may offer substantial benefits over existing therapies for serious conditions. So, the FDA commits to expediting the development and review of these agents as a result. 

Another leader in experimental psychedelic clinical research, COMPASS Pathways, is testing the safety and efficacy of psilocybin-assisted therapy for treatment-resistant depression. They also have a similar study for psychedelic use in obsessive-compulsive disorder. 

The Future of Psychedelic Drug Therapy

Research continues in areas such as smoking cessation, anorexia nervosa, Alzheimer’s Disease, and individuals who have PTSD (Post-traumatic stress disorder). You can read more about the research and trials here. The most significant barrier to future research is the availability of funding. Due to the uncertainty of the drug's legal status, it is challenging to conduct costly research. In the interim, some gain tremendous benefit from therapy.  

References:

Anderson A, LSD May Chip Away at the Brain’s “Sense of Self” Network. Scientific American website. Published April 16, 2013. https://www.scientificamerican.com/article/lsd-may-chip-away-at-the-brain-s-sense-of-self-network/. Accessed 1 July 2020. 

Cooper A. Psilocybin Sessions: Psychedelics could help people with addiction and anxiety. CBS News website. December 29, 2019. https://www.cbsnews.com/news/psychedelic-drugs-lsd-active-agent-in-magic-mushrooms-to-treat-addiction-depression-anxiety-60-minutes-2019-12-29/. Accessed 1 July 2020.

Food and Drug Administration. Breakthrough Therapy. FDA Available from: https://www.fda.gov/patients/fast-track-breakthrough-therapy-accelerated-approval-priority-review/breakthrough-therapy. Accessed 12 July 2020. 

Griffiths RR, Richards WA, McCann U, Jesse R. Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology (Berl). 2006;187(3):268-292. doi:10.1007/s00213-006-0457-5

Griffiths RR, Johnson MW, Carducci MA, et al. psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513

Hale, V. The FDA and Psychedelic Drug Development: Working Together to Make Medicines. MAPS Bulletin Spring 2020: Vol 30, No. 1. MAPS website. Published Spring 2020. https://maps.org/news/bulletin/articles/439-bulletin-spring-2020/8129-the-fda-and-psychedelic-drug-development-working-together-to-make-medicines. Accessed 1 July 2020.

Illing, S. The extraordinary therapeutic potential of psychedelic drugs, explained.Vox website. Published March 8, 2019. https://www.vox.com/science-and-health/2019/1/10/18007558/denver-psilocybin-psychedelic-mushrooms-ayahuasca-depression-mental-health. Accessed 30 June 2020. 

Johns Hopkins Center for Psychedelic and Consciousness Research Homepage. https://hopkinspsychedelic.org/. Accessed 1 July 2020.   

Lewis, T. Johns Hopkins Scientists Give Psychedelics the Serious Treatment. Scientific American website. Published January 16, 2020. Accessed 29 June 2020. https://www.scientificamerican.com/article/johns-hopkins-scientists-give-psychedelics-the-serious-treatment/

Nutt D. Psychedelic drugs-a new era in psychiatry? Dialogues Clin Neurosci. 2019;21(2):139-147. doi:10.31887/DCNS.2019.21.2/dnutt

Nutt, D et al., Psychedelic Psychiatry’s Brave New World, Cell (2020). DOI: 10.1016/j.cell.2020.03.020

Revisiting the potential of using psychedelic drugs in psychiatry. Medical Xpress website. Published April 2, 2020. https://medicalxpress.com/news/2020-04-revisiting-potential-psychedelic-drugs-psychiatry.html. Accessed 30 June 2020.

Published July 17th, 2020 by Dr. Betsy Hoida, PharmD, BCPS
Fact Checked by Chris Riley

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