Could Psychedelics be Used to Treat Mental Illness?


There has been increased interest and research in psychedelics as a treatment for mental illness in recent years. A new review study concludes that while research is still preliminary, psychedelics, such as lysergic acid diethylamide (LSD), show promise for treating conditions including treatment-resistant depression, anxiety and posttraumatic stress disorder (PTSD).  However, researchers also concluded that these drugs are not ready for use as treatment at this time. (1)


Collin M. Reiff, M.D., led the research team which included the APA Work Group on Biomarkers and Novel treatments, a division of the APA Council on Research. The research was published in February in the American Journal of Psychiatry.


The group examined use of LSD, 3.4-methylenedioxymethamphetamine (MDMA), psilocybin and ayahuasca for treatment of psychiatric disorders. All four drugs are currently classified by the U.S. Drug Enforcement Administration (DEA) as Schedule 1 substances—controlled substances with no currently accepted medical use in the United States and a high potential for abuse.


Two of the drugs, MDMA and psilocybin, have been designated by the U.S. Food and Drug Administration (FDA) as “breakthrough therapies,” meaning they receive priority in the regulatory process.


Psilocybin is found in a variety of mushroom species (and produced synthetically). It can cause sensory perception changes including auditory and visual hallucinations. Clinical trials are under way for its use with depression and other mental health disorders.

LSD is best known for its ability to produce “powerful psychedelic, spiritual, and mystical experiences.” Recent studies have looked at the use of LSD in treating mood disorders, anxiety, migraine headaches and pain, and included the use of LSD-assisted psychotherapy.


When psychedelics are used to assist psychotherapy, it typically involves preparatory sessions, medication sessions (one to three) and integration sessions. During the integration session the “therapists work with the patient to interpret the content of the psychedelic experience into meaningful on-term change through identifying insights or interpreting thoughts or ideas that arose during the psychedelic sessions,” the study authors explained.

MDMA (distributed illicitly under the street name “Ecstasy”) is associated with feelings of emotional well-being and reduced response to threat. Some early research has shown promising results for using MDMA to assist in psychotherapy for the treatment of PTSD. Other research has examined the use of MDMA to treat social anxiety disorder in adults with autism and for anxiety associated with life-threatening illness.


Ayahuasca is made from a combination of two plants native to the Amazon basin and it has been used in traditional practices by indigenous groups in the region. It can have a range of sensory effects including auditory and visual hallucinations and euphoria. Researchers in Brazil have looked at the use of ayahuasca for treatment-resistant depression.

The review study concludes that overall, the research “is insufficient for FDA approval of any psychedelic compound for routine clinical use in psychiatric disorders at this time, but continued research on the efficacy of psychedelics for the treatment of psychiatric disorders is warranted.”


In a commentary on the study, Joel Yager, M. D., notes the considerable work yet to be done in assessing the use of these “intriguing agents,” and their potential for abuse, but suggests that “we should closely follow and rigorously analyze findings from future studies.”(2)


References


(1) Reiff, CM, et al. Psychedelics and Psychedelic-Assisted Psychotherapy. American Journal of Psychiatry. Published online Feb. 2020.

(2) Yager, J. Psychedelics for Psychiatry? NEJM Journal Watch Psychiatry. March 2, 2020.


©American Psychiatric Association

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