PSYCHEDELICS IN TODAY’S MEDICINE
Psychedelic therapies
PSYCHEDELICS
What are psychedelics
“LSD gave me an inner joy an open mindedness, a gratefulness, open eyes and an internal sensitivity for the miracles of creation.” (Albert Hofmann)
“[It’s difficult] trying to find words to describe it… You really need to be a poet!” (Study participant)
These quotes are from LSD discoverer Albert Hofmann and from a person who took the classic psychedelic psilocybin in an Imperial College study (1). They both describe some of the extraordinary effects of psychedelic experiences. Patients who had used psychedelic substances often describe a fundamental positive change of their attitudes after one or two guided therapy sessions. Therapies involving these substances are said to be a real disruption in the psychiatric field as potentially effective treatments for several mental disorders.
DEFINITION
Classic psychedelics
“Classic” psychedelics are substances that target the same serotonin receptors in the brain. The most known psychedelics are: psilocybin – a psychoactive compound found in ‘magic mushrooms’ and more than 200 other mushroom species, lysergic acid diethylamide [LSD] – the first psychedelic to be approved as medicine in 1949 , mescaline and dimethyltryptamine [DMT], which is also an active compound in ayahuasca – a plant-based brew used in traditional healing ceremonies in some Amazonian tribes.
Psychedelic is a neologism coined in 1953 by psychiatrist Humphrey Osmond from the Greek psyche (mind) and delos (reveal/manifest). Back then, it has primarily referred to the effects of lysergic acid diethylamide (LSD), but today the term is used to describe a range of pharmacologically diverse substances.
(Photo: Albert Hofmann, discoverer of LSD)
MODE OF ACTION
What do psychedelics do in the brain?
Psilocybin and other psychedelics operate by modifying human consciousness in the sense of altered perception of the self and the world. They stimulate neuronal growth, leading to increased psychological flexibility, openness, and the rise of new perspectives. A psychedelic-activated brain becomes more interconnected. Under psychedelics, communication between different neural regions was shown to be intensified (2). In addition, they also inhibit the activity of the Default Mode Network (DMN) a neural network that is activated during rest and passive/mind-wondering activity, and implicated in the perception of the self and the ego. A brain under psychedelic substances tends to be more playful and imaginative, thus readier to face challenging experiences or memories, reacting with more resilience and creativity.
PSYCHEDELICS-ASSISTED THERAPY
Treatment of mental disorders
Multiple types of scientific studies report psychedelics-augmented (or assisted) psychotherapy to be a promising treatment for several mental disorders. Yet only psilocybin and MDMA are currently (in 2021) being investigated in ongoing so-called phase III studies which means that the evidence for the following indications is still to be seen as preliminary. Phase III studies lead to an approval of the substances in the health systems if they succeed.
For instance, psychedelic-assisted psychotherapy was found to be effective in phase II studies for anxiety and depression secondary to a life-threatening illness (5), treatment-resistant depression (6, 7, 8) and substance use disorders (SUDs) (9), including alcohol (10) and tobacco (11).
PSYCHEDEDLIC PSYCHOTHERAPY
What is psychedelic-augmented psychotherapy like?
“You will come back/ and relate your journey/ and we shall know together/ of where you have gone/ and how you have returned/ taking this journey.” – Phil Wolfson (28)
Psychedelic-assisted psychotherapy includes preparatory psychological screening and motivational preparation with a trained therapist, the dosing session(s), and post-dosing integrative psychotherapy. During the dosing sessions, participants usually lie comfortably on a couch, wearing eyeshades, listening to preselected music, and directing their thoughts toward their internal experience. Given the growing evidence for the unity of body and mind, these substances’ neuro-biological effects are closely interrelated with the psychotherapeutic work and with setting preparation.
STUDIES
What is the current research situation?
Psychedelics are being investigated in several universities in the world in the treatment of mental disorders. If finally successful in phase III studies, psychedelic-assisted therapy could offer a cost-effective alternative to the treatments with mainstream antidepressants for many patients. Several world-renowned institutions like John Hopkins University Baltimore, Imperial College London, University of Zürich and the Central Institute of Mental Health Mannheim are now participating in the struggle to increase the understanding of psychedelics’ action. The legal status of these substances however often creates an obstacle in manufacturing and administering them to patients.
Nonetheless, the interest in clinical research on psilocybin for the treatment of depression keeps growing. Research on ClinicalTrials.gov (on March 21) revealed that more than 30 psychedelic drug trials for depression with psychedelics are registered (mostly with psilocybin, although a few are with LSD, ayahuasca, DMT and ketamine).
CURRENT SITUATION
Do such therapies exist today?
Outside of clinical studies, therapies with the mentioned substances, such as psilocybin, are not possible today. Abridging the current state of psychedelic-assisted psychotherapy evolution, it’s evident that the interest is growing both in renowned academic institutions (university and hospitals) and private institutions or companies. Undoubtedly, the argument is getting into mainstream discourse, which is also based on the growing number of informative articles and books.
Today, it is not possible to provide broader access to psychedelic therapies outside of clinical studies. One exception is off-label with the atypical psychedelic ketamine. Ketamine can create valuable altered states of consciousness that are used in psychotherapy. In the OVID clinic, we integrate ketamine infusions into a holistic and evidence-based therapeutical concept to augment psychotherapy.
Published on 21. April 2021
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