Updated: Jul 21, 2020
The role of psychedelics in mental and emotional healing is a relatively novel target of hot debate in the neuroscience and clinical psychology communities. Psychedelic-assisted therapy usually refers to treatments that incorporate the sensory and perceptual alterations induced by psychedelics in patients to enhance the psychotherapeutic treatment of depression, trauma, schizophrenia and other forms of psychopathology. It’s also been shown to help with alcoholism. People who are psychologically healthy but strive for higher levels of consciousness also use psychedelics to better understand and expand their own minds.
Most plant medicines are considered controlled substances in many parts of the world, and receiving approval for their use in research is made more complicated by this fact. Prohibition of LSD and other psychoactive substances in 1970 by the Nixon Administration halted many of the ongoing experiments looking at their benefits. While many of these controlled substances are still classified as dangerous, their continued use in research has shown that they hold much promise in treating a multitude of psychiatric conditions. Psychedelics have been researched their role in:
Mitigating treatment-resistant depression
Treating trauma and post-traumatic stress disorder
Expanding consciousness and heightening awareness
Through a vast catalogue of plant medicines, varying effects, dosages, and roles in treating illness, they're becoming promising tools for improving patients’ quality of life.
What are psychedelic substances?
Psychedelic is an umbrella term that encompasses a wide range of psychoactive substances that produce sensations of altered mood, consciousness, and sensation. There are other terms used to describe these substances, but for the purpose of this article, the term psychedelic will be used. They are often derived from indigenous traditional plant medicines and have long been associated with spirituality and religious rituals. Many of the psychedelic substances we know today were once commonly used by ancient civilizations in healing practices and are still used ceremonially by indigenous peoples all around the world. It is probable that psychedelics have been used in ancient civilizations in shamanic ceremonies and healing rites for thousands of years
Common psychedelics throughout the world include:
Lysergic acid diethylamide:
Also known as LSD, produces altered sensations and visual perceptions (i.e. hallucinations) at relatively low doses in individuals. It’s pharmacological properties and mechanisms of action are still not well understood, serotonin seems to be the main neurochemical system implicated its psychoactive effects.
A naturally occurring drug found in many species of mushrooms -- where the nickname, “shrooms,” comes from -- that produces mind-altering effects in patients very similar to LSD. It’s neuropharmacology is better-understood. When ingested, psilocybin is metabolized into psilocin, where its effects are thought to be the result of its structural similarity and partial activation of serotonin receptors in the brain.
The chemical name for MDMA is commonly referred to as ecstasy, chemically similar to amphetamines, but with a slight chemical addition it looks more like the hallucinogen, mescaline. MDMA is a synthetic structure. It has strong psychedelic properties, though it is technically an “empathogen,” meaning that it heightens feelings of empathy and connectedness with other people. It may help improve their focus on positive emotions while reducing the focus upon negative emotions. It seems to activate the ventral striatum on MRI while decreasing the activity of the amygdala, our threat response center. It primarily acts upon serotonin, preventing its reuptake in the synapse, but it also affects noradrenaline and dopamine release. Unlike LSD and psilocybin, MDMA was once used in psychotherapy in the 1970s prior to its scheduling as a Schedule I controlled substance in the United States. MDMA has shown a great deal of promise in healing PTSD and other sequelae of trauma. Clinical trials are underway with MDMA and complex PTSD with promising results.
Also known as DMT, this particular molecule is one of the strongest hallucinogens in the psychedelic family, and consumers often report a complete alteration in consciousness and detachment from reality. It has a history of use throughout South American spiritual groups, more specifically in a brew known as ayahuasca. Ayahuasca is a tea made from the leaves of the Psychotria Viridis shrub along with the stalks of the Banisteriopsis caapi vine, traditionally made in the amazon rainforest in South America. Other plants and ingredients can be added as well, but it typically is the combination of leaf and vine. While DMT is a powerful hallucinogenic chemical, it gets rapidly broken down by enzymes called monoamine oxidases (MAOs) in your liver and gastrointestinal tract (2 Trusted Source).
For this reason, DMT is often combined with something containing MAO inhibitors, which allow DMT to take effect. Banisteriopsis caapi contains potent MAOIs called β-carbolines, which also have psychoactive effects of their own. When combined, these two plants form a powerful psychedelic brew that affects the central nervous system, leading to an altered state of consciousness that can include hallucinations, out-of-body experiences, and euphoria.
These summaries capture only a part of the broad class of drugs and molecules that produce psychedelic effects.
The early LSD-assisted therapy for children with schizophrenia found that some of the patients were then able to re-assess some of their thoughts, feelings, and perceptions and make meaning out of them. Many recovered with this intervention. Psychedelics have most recently been investigated for its ability to reduce avoidance behaviors in patients and promote acceptance in a cognitive-behavioral therapy model. Mechanistically, while the exact mechanism of action for psilocybin is not well-understood, functional magnetic resonance imaging (fMRI) reveals significant effects of psilocybin on treatment-resistant depression. This is shown by decreased cerebral blood flow in the temporal areas of the brain, specifically around the amygdala, a brain area implicated in mood disorders. Speculations are that psychedelics can loosen ego defenses, help patients integrate traumatic memories, and revamp old negative experiences into meaningful ones.
More recently, MDMA’s role as a viable intervention for PTSD has been compelling enough to designate it as a breakthrough treatment. This means that if the drug proves effective, FDA approval may happen sooner. LSD, as one of the most common hallucinogens, has been shown to alleviate symptoms of alcoholism, a strangely specific but overall encouraging result.
Low-dose psychedelics used to treat psychiatric illness
Low dose treatments of these substances are particularly interesting. The cutting edge conversation more recently has been geared towards the purported benefits of microdosing. This refers to the practice of taking extremely low doses of psychedelic substances over repeated periods of time, and early studies are promising:
Evidence for microdosing of LSD and its effects on the functional connectivity (white matter connections) within the amygdala at rest.
Self-reported improvements in mood, attention, and stress levels in people who microdose LSD and psilocybin.
Reduction in depressive neuropathology in mice given microdoses of DMT.
Recently, one of the first placebo-controlled trials of microdose LSD was reported. The study concluded that “microdoses of LSD appreciably altered subjects’ sense of time, allowing them to more accurately reproduce lapsed spans of time. While it doesn’t prove that microdoses act as a novel cognitive enhancer, the study starts to piece together a compelling story on how LSD alters the brain’s perceptive and cognitive systems in a way that could lead to more creativity and focus”.
Of increasing importance, psychedelics have been investigated for their role in improving coping among hospice patients, mitigating anxiety, and depression. High-quality palliative care plays an important part in reducing suffering among patients near death, and the need for better strategies is clear. Palliative care clinicians, then, are faced with the challenge of improving the quality of care for their terminally ill patients, while also ensuring their treatments do not harm.
Thus, psychedelic drugs as a palliative care treatment are being studied within a framework that prioritizes safety, supervision, and setting. Clinicians who are considering psychedelic drugs (such as psilocybin, LSD, MDMA, or ketamine) for their potential therapeutic role for their hospice patients are cautioned to supervise and administer proper dosing, as harmful effects can arise from too high a dose. As the medical community examines psychedelic substances with warranted scrutiny, their role as a palliative care agent may become more solidified.
These cases highlight the importance of varying doses as part of the research model, as too high a dose can cause irreversible harm, similar to many pharmaceutical agents. For example, MDMA overuse can often induce permanent damage to serotonin receptors, greatly increasing their risk for severe depression. High doses of LSD can result in respiratory arrest and coma. There is also increasing evidence that using plant medicines and psychedelics before the brain is completely developed, increases the risk for psychopathology in vulnerable young people.
While the dangers of these drugs are clear, researchers emphasize the importance of research into their safety for therapeutic use.
What does the future of psychedelic research look like?
Ever since the passage of the Controlled Substances Act in 1970, the United States has pushed psychedelic-assisted therapy research aside. While social attitudes surrounding them are changing, their legality is not, and this is a problem when attempting to research their role in treating mental and physical illnesses. This was the case for clinical trials investigating cannabis, for example, as it’s strict scheduling prevented multiple sites from studying it.
The future of psychedelic research is being spearheaded by groups such as the Multidisciplinary Association for Psychedelic Studies (MAPS) who sponsor and coordinate multi-site clinical trials across the United States. Academic research in this field is sparse but progressing and psychological trauma has been a promising target of treatment.
When assessing a treatment’s effectiveness, researchers and clinicians need to take safety and dosing into consideration; this is especially true with psychedelics. Plant medicines in psychedelics are particularly risky for teens and young adults whose brains and nervous system‘s are not yet fully developed. The risk for inducing psychopathology in this group is high.
The importance of an accurate diagnosis cannot be overemphasized. Clinical psychotherapy has always championed novel treatments for psychological illness, and the data now show another promising approach in combining psychedelics or plant medicines with psychotherapy. This may be the newest frontier in the mental health and brain health arenas. Indiginous peoples all over the world will continue to use their native plant medicines in traditional rituals to expand consciousness and heal in ceremony. There is a great deal to learn about these kind of ceremonies where people integrate altered perceptual and sensory states and heal in community.
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