The future of psychedelics in psychiatry: a neurologist explains

He was a 38-year veteran officer in the New York Police Department who was responding to a call one morning when the building he had just exited suddenly exploded, injuring him, civilians, other officers and a The first responder died. The devoted husband and father was diagnosed with a traumatic brain injury and suffered from anxiety, depression and post-traumatic stress disorder, which drastically changed his life. I recently met him through a co-worker and his story resonated with me, it felt like I was sharing many of the patients I have cared for over the years.

He was given medicines one after another but there was no apparent benefit but a lot of side effects. Ultimately in 2020, four years after his accident, he came off all his medications and decided to try something different. He joined more than 7 million Americans who used psychedelics and other hallucinogens that year.

Psychedelics have the potential to treat post-traumatic stress disorder, anxiety, substance use disorders, depression, and other mental conditions. “In our newly established interventional psychiatry program, where we aim to treat depression, post-traumatic stress and other disorders that do not respond to conventional treatments, we hope to use ketamine, psilocybin, MDMA and other drugs There is much to be gained from the use of psychiatry—our patients need options,” said my colleague Dr. Stephen Ferrando, professor and chair of psychiatry at New York Medical College as well as director of psychiatry at WMCHealth.

There have been hundreds of clinical trials evaluating psilocybin, LSD, ibogaine, as well as other hallucinogens such as MDMA and ketamine. This includes a Phase 3 clinical trial at the University of California San Francisco, which showed that psychedelic-assisted therapy reduced PTSD symptoms and functional impairment in diverse populations with moderate to severe PTSD. Such results have increased excitement about psychedelics and have led researchers to predict that positive clinical trial results could lead to FDA approval within a year. This is a big deal. This is why we should care about it.

It is estimated that 22% of adults in the US are living with a mental illness, including one third of young adults ages 18 to 25. Unfortunately, a large portion of them suffer from anxiety, depression, and other symptoms despite available treatments and treatments. medicinal treatment, and many may go as far as attempting suicide or even committing suicide.

Psychedelics may provide hope for these patients. They have been around for centuries and have been used in the past for spiritual, religious, and recreational uses, as well as to explore consciousness. They have also been used as a therapeutic tool for healing purposes by the indigenous people of South and Central America.

Many war veterans have found that the treatments offered for PTSD are not adequate, so they have sought treatment with psychedelics such as ayahuasca and psilocybin. The Veterans Administration has indicated that it is willing to safely explore the potential of psychedelics in the treatment of PTSD, and the FDA has provided guidance to sponsors developing psychedelic medications for the treatment of psychiatric conditions.

Modern era of psychedelics

Dr. Albert Hofmann first synthesized lysergic acid diethylamide, commonly known as LSD, in 1938. Five years later, in 1943, he became the first person to try it. Classic psychedelics like psilocybin (or magic mushrooms), mescaline, LSD, and DMT have been classified as Schedule 1 substances by the US Drug Enforcement Agency since the 1970s, meaning they have no therapeutic benefits. MDMA, synthetic psychedelic also known as ecstasy. Was added to the list in 1987. In the 1980s and 1990s, psychedelics were popular among teenagers because they looked like stickers and candy, increasing their appeal to this age group.

In 2019, researchers at Johns Hopkins received $17 million in funding to launch a center for psychedelic and consciousness research, and last month Harvard University received a $17 million grant from Harvard University to use an interdisciplinary approach to study psychedelics in society and culture. The grant was awarded by the Chicago-based Gracious Family Foundation. , Other institutions studying psychedelics include Yale University, Stanford University, and the University of Washington, among many others.

effects of psychedelics

Word psychedelic It is derived from the Greek word meaning “to reveal the mind.” Psychedelics result in alterations in perception, including altered states of awareness or focused consciousness, altered thought patterns, trance, mystical and hypnotic states. This may be related to effects on the brain’s sensory relay station, known as the thalamus, and its connection to the cerebral cortex, which mediates higher-order intellectual functioning. People who use psychedelics may also have hallucinations or synesthesia as a result of these changes, a phenomenon in which you experience more than one sense simultaneously.

Some people experience a different level of self-perception and can gain a better understanding of themselves, others, and the world, as the NYPD officer experienced.

“Before I tried psilocybin, the door was closed to all emotions, but now I can experience good and bad emotions, and I don’t have a problem with them.” Six hours after taking his first dose of psilocybin, he wanted to go home to be with his family.

He has received additional doses of psilocybin since the first trial in 2020, but he has identified people close to him who can guide him through the therapy, so he no longer has to travel thousands of miles to get his treatment . He hopes that through legalization and FDA approval, psychedelics can become more widely available to other people suffering from PTSD and other psychiatric disorders, especially his fellow first responders. While waiting for FDA approval, there are several organizations, such as the Casey Skudin 343 Fund, that provide financial assistance to help first responders access these treatments.

Despite the potential benefits of psychedelics, it is important to note that the independent and personal use of these agents is illegal in all 50 states. However, Oregon and Colorado have fully legalized supervised adult use of psilocybin, and the VISION Act of 2023 is a Congressional bill intended to prevent any state from enacting its own laws regarding psilocybin. There is a ban on the use of money. This could pave the way for more research on the safety and efficacy of psilocybin and other psychedelics in treating mental health conditions.

Despite all the discussion about psychedelics, it is important to keep in mind that these drugs have limitations and potential side effects. Patients who have experienced psychosis and severe dissociation are generally not considered suitable for these treatments. “While the potentially pleasurable effects of upliftment, feelings of oceanic unity, and reduced defensiveness can all be facilitated by psychotherapy, the medications themselves can cause unpleasant side effects,” says Dr. Ferrando. These can include intense dysphoria, the so-called “bad trip”, feelings of isolation or alienation, as well as physical symptoms, such as changes in heartbeat and blood pressure. All of these require close monitoring according to FDA guidelines, including the presence of a physician and monitors in the room with the patient during the drug experience, as well as regular checking of vital signs.

Dr. Ferrando points out, “However, despite these limitations, when used appropriately and under appropriate clinical conditions, we are hopeful that these medications will be safe and provide a much-needed option for those Those who have not responded to other treatments.”

With so many academic centers researching these agents, increased funding, and positive clinical trial results, the evidence is gradually becoming more solid, and many scientists now believe that the FDA The approval cannot go away. However, it is important that we continue to approach these substances responsibly and with scientific rigor. It will take a lot of thought to regulate these substances, especially given that they are already in widespread use despite still being illegal in the U.S. Many physicians and scientists now have concerns about psychedelics in the future. There is good reason to be cautiously optimistic about the role.