What is psychedelic therapy and how can it benefit our mental health?

What is psychedelic therapy? 

Psychedelic therapy, sometimes known as psychedelic-assisted psychotherapy (PAP), is a type of psychotherapy using plants and compounds that can induce hallucinations to treat certain mental health conditions, such as depression and post-traumatic stress disorder (PTSD). 

Though hallucinogenic substances have been used in Indigenous communities in spiritual and therapeutic settings for thousands of years, their introduction and use in Western medicine is relatively new.  

In this type of therapy, psychedelics are usually combined with talk therapy. 

How does psychedelic therapy work?

The study of psychedelics and their therapeutic potential has its roots in the 1950s and 60s, before hallucinogenic substances were banned in the United States with the Controlled Substances Act of 1971. During this period, researchers produced evidence pointing towards the benefit of psychedelic therapy in treating addiction, PTSD, and mental health disorders like anxiety and depression.

In recent years, renewed interest and investment in research into psychedelic therapy has allowed scientists to conduct trials on the use of these hallucinogenic substances to better understand their effects and possible applications in both clinical and nonclinical settings.

While traditional, pharmaceutical medications for mental health conditions take several weeks to take effect or only work as long as the patient takes them, researchers have found that psychedelics can often bring immediate improvement, even with a single dose.

Scientists are still working to understand how psychedelics work and these drugs are not effective on everyone. Nevertheless, researchers have proposed the following hypotheses:

• Changes to neurotransmitters: As we have learned in our previous article (Depression: Is it linked to brain dysfunction?) neurotransmitters are chemical messengers in the brain. Many medications for mental health conditions act on these neurotransmitters to change the brain's behavior and therefor our mood. It is thought that certain psychedelic drugs may do the same.
• Increased suggestibility: Using psychedelic drugs may make a person more suggestible, meaning that they are more responsive to a therapist's positive suggestions or to the positive effects of the hallucinations.
• Spiritual or psychedelic experiences: The hallucinations the person experiences while on psychedelic drugs can be deeply meaningful, shifting his or her mindset or beliefs. This shift can cause the person to change their thinking patterns or behaviors.

What are the different types of psychedelic therapy?

As research into psychedelic therapy and psychedelic drugs is still ongoing, there is no one drug that is used universally by therapists. 

Typical psychedelic treatment options include: 

• Psilocybin: The focus of many recent research studies, psilocybin is the main compound in “magic” mushrooms. It alters perceptions, mood, and consciousness and has shown itself to be effective in studies treating depression and anxiety in people with terminal illnesses. It may also help with addiction, obsessive-compulsive disorder (OCD) and treatment-resistant depression. 
• Ketamine: The most-studied psychedelic for mental health therapy, in low doses ketamine has proven in trials to be beneficial in treating depression. However, its effects are not long-lasting. Study of this drug have led to the development of Spravato®, a ketamine-based nasal spray for treatment-resistant depression. 
• Ayahuasca: A plant-based psychoactive brew originating in South America, ayahuasca is thought to help with anxiety, depression, and addiction. Caution must be taken with this substance as it can cause serotonin syndrome and interactions with certain medications. 
• MDMA (Ecstasy/Molly): Though it is not a traditional psychedelic substance, MDMA is a drug that provokes “psychedelic effects” such as altered perceptions, euphoria, increased sociability and arousal. Multiple phase 2, as well as a phase 3 clinical trial have shown that MDMA can treat PTSD symptoms in the long term. In the phase 3 trial, sponsored by the Multidisciplinary Association for Psychedelic Studies, 67% of participants with severe PTSD no longer qualified for a PTSD diagnosis after three treatments, and 88% had fewer PTSD symptoms. These positive results may pave the way for FDA approval of MDMA-assisted therapy by 2023. 
• Lysergic acid diethylamide (LSD): LSD is a potent and long-lasting psychedelic that has served as an example for therapeutic psychedelics. It has been found to help with anxiety and alcohol-use disorder in people with terminal illnesses. 

There is as yet no standardized method of administration, so individual practitioners have their own techniques and methods of psychedelic therapy. However, in clinical settings psychedelic therapy tends to occur in three stages: 

• Consultation, to discuss the patient’s personal background, any goals or concerns about psychedelic therapy, and to ensure that there are no contraindications to it. 
• Ingestion, in which a low to moderate dose is administered either orally or by injection, under the supervision of a trained professional. 
• Integration, a period after ingestion where the patient and therapist work together to process the psychedelic experience, make sense of it, and integrate its meaning. 

There are usually multiple sessions of psychedelic therapy, depending on the drug used and the personalized treatment plan. For example, psilocybin- and LSD-assisted therapy usually require at least two sessions, MDMA-assisted therapy typically involves at least three sessions, and ketamine-assisted therapy requires between one and twelve sessions. 

How can psychedelic therapy benefit mental health?

Psychedelics are powerful substances that can provoke intense, mind-altering effects. They are thought to function by affecting the neural circuits that utilize the neurotransmitter serotonin. Some of the potential benefits include: 

• Introspection 
• Feelings of relaxation 
• Increased feelings of social connection 
• Improved feeling of well-being 
• Spiritual experiences 

When used in a safe, therapeutic environment with a trained professional to administer the drugs, supervise the situation, and aid the patient to interpret and integrate the experience, psychedelic therapy can be beneficial in easing the symptoms of many mental health conditions, such as: 

Post-traumatic stress disorder (PTSD) 

The psychedelic effects of hallucinogens are thought to relieve some of the effects of trauma, though recent research has returned mixed results. 

A 2020 review examining five studies of ketamine and four studied of MDMA in the treatment of PTSD found that evidence supporting the effectiveness of ketamine alone was low while evidence supporting MDMA was moderate. A second 2020 study following survivors of the AIDS pandemic, however, found clinically significant reductions in certain PTSD symptoms after treatment with psilocybin. 

Anxiety and other mood disorders

As mentioned earlier, psychedelics can have positive affect on stress and mood, which could benefit chronic mental illnesses like anxiety and depression. 

Research has backed up this belief: a randomized double-blind controlled trial in 2016 found that psilocybin-assisted therapy contributed to significant reductions in depression and anxiety in patients in treatment for cancer and a 2017 study on people with treatment-resistant depression found that psilocybin-based treatment resulted in significant symptom reduction over time. 

Alcohol and substance abuse disorders 

Early research into psychedelics showed strong evidence that they could help with substance abuse disorders. Addictions and other mental health disorders such as depression or anxiety often occur together, which could explain their effectiveness. It is posited that by reducing the symptoms of other mental health conditions, psychedelic drugs make it easier to break addictions. 

Two studies – in 2015 and 2016 – using psilocybin in combination with psychotherapy techniques produced high success rates in curbing addictive alcohol and tobacco use. 

What are the risks of psychedelic therapy? 

While psychedelic substances can bring great benefits to certain patients, it’s important to know that they are not for everyone and can also cause effects such as: 

• Paranoia 
• Altered sense of time 
• Distortion of reality and perceptual experiences 
• Intense emotions or perceptions 
• Hearing, seeing, or sensing things that one would normally not experience 

According to the National Institute on Drug Abuse (NIDA), these side effects can be considered a type of drug-induced psychosis, causing “distortion or disorganization of a person’s capacity to recognize reality, think rationally, or communicate with others.”  

Psychedelic therapy is still in its experimental stages, so there is still a lot for the medical community to learn. Existing and ongoing research is full of promise, especially for patients with severe anxiety, depression, and PTSD. 

It is important to note that psychedelic therapy is not yet widely available everywhere - with the exception of ketamine, psychedelic-assisted therapies are still illegal under federal law. However, both psilocybin and MDMA have been given breakthrough therapy status by the FDA, meaning they have been given a fast-tracked process for potential approval for use in legal therapeutic and medical instances. Between 2019 and 2021, psilocybin has also been legalized for medical use in the state of Oregon and decriminalized in Denver, Colorado; Oakland and Santa Cruz, California; Washington, D.C.; Ann Arbor, Michigan; and Somerville, Northampton, and Cambridge, Massachusetts.

If you are interested in trying psychedelic therapy, joining a clinical trial is a viable option. You can find trials that are recruiting participants on the NIH Clinical Trials database, or via the Multidisciplinary Association for Psychedelic Studies (MAPS) and the John Hopkins Center for Psychedelic and Consciousness Research.

Patient advocates and lobbyists are taking strides to decriminalize certain psychedelic substances so as to advance research and improve access for patients. Perhaps in the coming years we will see psychedelic therapy as a commonplace alternative to conventional pharmaceutical treatment options for mental health conditions! 

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