I’ve blogged previously about antidepressant medications which, while helpful for some with severe depression, are not as effective as we would like. One physician/author compared them to non-drug therapies that were equally effective but take longer to kick in. His well-referenced article was published in the Canadian journal, Pharmacy Practice. Here’s a link to that blog, in case you missed it.
But I’ve been reading about new research into some old medications that were being studied for use in those with mental illness in the 50s and 60s but set aside due to concerns about recreational misuse of the drugs. I’m talking about LSD (lysergic acid diethylamide) and psilocybin (also known as magic mushrooms). I was so surprised to learn these Psychedelic drugs had been studied in the past and were being studied again for treating mental health issues that I had to read more about them. In pharmacy school, these drugs were only discussed as drugs of abuse. I had no idea they might be useful medications. As in many other professions, the history of psychedelic medication studies for therapeutic uses had been erased, never to be mentioned.
“How to Change Your Mind” is a newly published book by investigative reporter, Michael Pollan, that shares information gathered from many interviews with researchers, therapists and people who have used the psychedelic drugs: LSD, psilocybin, mescaline, peyote and others. The word, “Psychedelic”, by the way is Latin for “mind manifesting”. Some of these drugs have a long history of ceremonial or religious use in many different cultures.
LSD is a synthetic drug, originally created in 1938 by researcher, Albert Hofmann, who was working for the Sandoz pharmaceutical company, but he only began testing its effects in 1943. The drug’s structure and actions were so unusual he didn’t know what to do with it. So, the company provided it for free to anyone who was able and willing to perform research with it from the date it was released under the brand name, Delysid, in 1947 until they stopped production in 1965. The withdrawal occurred in response to the drug being declared illegal by the US government due to its widespread recreational use – the “hippie” culture.
Although a small amount of research continued underground, it began again slowly after 2010, mainly as small quiet projects and efforts to recover information from past studies. In 2016 and 2017, larger studies in US and UK were officially sanctioned. Old research results were unearthed from archives and added to the knowledge bases that were being developed. Because of the baggage attached to LSD from its history of past abuse, the new studies mostly used psilocybin, the active ingredient in magic mushrooms.
Treatment with psychedelic drugs has been found to have positive effects on depression, anxiety, PTSD (post-traumatic stress disorder), palliative care (fear of dying), alcoholism and compulsive behaviours. However, it is not the effect of the drug itself, but the experience the person has while on the “trip” the drug produces that changes their behaviour. The same results can be achieved by any of the psychedelic drugs (in sufficient dose), by deep meditation (by an experienced meditator) or by the experience of profound awe (for example, as described by an early astronaut, when he first saw the earth from space). Experiments were also performed on healthy people – artists, musicians, writers – to see if it would enhance their creativity or improve their outlook on life.
Treatments results are described as being highly influenced by what is suggested before the drug is given, the mindset of the person and the setting in which is it given. A trained guide prepares the patient beforehand, stays with them during the time the drug is active in their system, and meets with them afterward to help interpret what they experienced. As such, the treatment is really a combination of medication and counselling, not just a drug treatment alone. This is different from standard drug treatments. Some refer to the therapy as drug-assisted psychotherapy.
So, the challenge in testing these drugs is that it’s not simply the drug effect, but the experience the person has while under its influence that makes the treatment effective. This makes it much more difficult to perform the standard studies used in Western medicine, where a drug is compared with a placebo (sugar pill) to determine how well it works.
The dosing is also much different: when the drug is successfully given once, the effect may last 6 months, a year or longer. Occasionally, only needed a single treatment is needed. People will often describe the “trip” experienced while the drug in active in their system as the most profound experience of their lives. One woman, when asked what she experienced, said she learned that “love was everything”. When the guide then asked what else she learned, she said “no you don’t understand; love is EVERYthing”. That sounds so much like the hippie movement of the 60s – “love is all you need” – when LSD was popular with the counterculture. It seems this is a common sentiment after a successful “trip” on a psychedelic drug.
Two common themes described by volunteers for the treatment were reconnecting with their feelings, core beliefs, values and with others and nature; and a new access to difficult emotions that depression blunts or shuts down completely.
Depression currently affects almost 1 in 10 in North America and is a leading cause of disability worldwide. There are over 42,000 suicides in US every year, more than deaths from either breast cancer or car accidents. Half of these have never received mental health treatment. Experts are describing the mental health treatment system as “broken”. (see reference, below)
Studies are currently being conducted at Johns Hopkins, New York University, Heffter Research Institute and others in US as well as centers in other countries. Research includes addiction treatment, benefits to patients with cancer, treatment-resistant depression. There is also some research in healthy volunteers to learn how the drug works in the brain and how it affects attention, perception and cognition. While it may be years until this therapy is proven safe and effective and becomes an accepted treatment for medical use, it is exciting to watch the development of what may be a significant break-through in treatment for mental illnesses.
References:
How to Change Your Mind, Michael Pollan
