New research is examining whether psychedelics taken under close medical supervision can help treat PTSD, chronic pain, depression and obsessive-compulsive disorder.
SciLine interviewed dr Jennifer Mitchell — a professor in the Departments of Neurology and Psychiatry and Behavioral Sciences at the School of Medicine at the University of California, San Francisco — to discuss what scientists have found so far about the effectiveness of these drugs in treating these conditions and how they might be safely administered become.
The Conversation has partnered with SciLine to bring you highlights from the discussion, edited for brevity and clarity.
What are Psychedelics and How Do They Work?
Jennifer Mitchell: Psychedelic basically means “manifest mind”.‘ suggesting that the connection helps one uncover issues that might otherwise remain deeply hidden from consciousness.
It’s a slightly different term from hallucinogen, sometimes used almost interchangeably with the term psychedelic.
A hallucinogen, by definition, is something that makes you see, hear, smell something that isn’t otherwise there, so you can imagine that there’s a lot of overlap between psychedelics and hallucinogens.
What types of psychedelics are being studied by researchers for potential therapeutic uses?
Jennifer Mitchell: The two most studied drugs at this point are MDMA And psilocybin.
MDMA is being evaluated primarily for the treatment of post-traumatic stress disorder treatments, and psilocybin mainly used to treat resistant depression and major depressive disorder.
MDMA is the furthest along because there is Phase 3 data (late-stage research data) and the possibility of a new drug application being submitted to the FDA sometime later this year.
LSD is also being evaluated for a number of different indications, most notably OCD.
And then a few heavy hitters are now being tested in mostly healthy control populations, including drugs like mescaline And Ayahuasca.
What have scientists found out about whether these drugs are effective in treating health conditions like PTSD or chronic pain?
Jennifer Mitchell: The drugs so far seem to be quite effective. I think a key thing, however, is that they are typically administered in conjunction with some form of psychotherapy.
So it’s important to keep that in mind as we look at this Findings from some of these recent studies that these are not drugs that are administered in isolation.
You don’t take home a bottle of pills and take them twice a day like you would with an antidepressant, for example. These are managed in a very special way.
What does therapeutic treatment with these drugs involve?
Jennifer Mitchell: Typically, prior to taking the drug, subjects attend a series of prep sessions so that they understand a little about what will happen on an experimental session day.
And then the subjects come into a room that looks a lot like a cozy living room and spend the whole day there. The drug is typically given in the morning. For psilocybin, expect a six-hour ingestion and for MDMA, an eight-hour ingestion.
You are in the company of a group of trained providers: therapists, psychedelic brokers, psychiatrists, and clinical research coordinators.
What are the potential risks of using psychedelics for therapeutic purposes?
Jennifer Mitchell: One concern we had is cardiovascular risk and as such we are very cautious on some clinical trials currently to assess cardiovascular stress, including heart attack risk, during and after the experiment. This evaluation includes the recording of the heart rate and blood pressure of the participants.
Additionally, researchers are concerned about suicidality, in part because these are treatment-resistant populations we’re starting with, and so there’s concern that they might be destabilized — either by the psychedelic or simply by tapering off their other medications to take on a psychedelic participate in the study – that we might be taking the risk of suicide.
Finally, I think the FDA was concerned about the possibility that psychedelics could be addictive, so we followed up the study participants to make sure they weren’t seeking or using drugs outside of the study.
What do we know about the safety of taking psychedelics outside of the clinical context?
Jennifer Mitchell: I think we all heard stories from the 60’s and 70’s of people taking psychedelics and had very bad experiences. What we now know is that the environment in which you take the psychedelic is of paramount importance. It is not appropriate at this point to attempt to ingest some of these substances or to repeat some of these protocols yourself without supervision.
Watch them full interview to learn more about psychedelic medicine.
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Jennifer Mitchellprofessor of neurology, University of California, San Francisco
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