At first, it may be difficult to imagine illicit psychedelic drugs such as, “magic mushrooms”, being used in clinical settings. But following recent research, this may well be where the future of psychiatry and psychotherapy lies. Spanning the last two decades, this new wave of research is paving the way for the integration of psychedelic-assisted psychotherapy into the Canadian health-care system. This would involve psychedelic-assisted therapy as a treatment for mental illnesses such as post-traumatic stress disorder (PTSD), anxiety, depression and addiction.

Developments in this research offer new ways of understanding, and treating, otherwise intractable psychiatric conditions, and carry with them important implications for nurses in the clinical setting. Currently, a number of prominent academic research institutions around the world are investigating the therapeutic potential of these medicines. They have made remarkable progress and mark the dawning of what is likely to become a new and powerful method to traditional therapy.

What are psychedelics?

So, what are psychedelics, and how might they revolutionize psychiatry? Psychedelic, a term coined by Canadian psychiatrist Humphry Osmond in the mid-1950s, means “mind-manifesting” and refers to a type of psychotropic drug in a class entirely of its own. Examples of psychedelic compounds are mescaline, psilocybin, lysergic acid diethylamide (LSD), ibogaine and ayahuasca. Historically, many psychedelics have been used by Indigenous cultures across the globe as part of sacred healing rituals.

Each compound contains unique properties, but all share the pharmacological effect of profoundly altering consciousness. It is this central feature that may be a major component in its remarkable ability to treat an ever-growing set of psychiatric conditions.

Decades of research

World-class institutions such as Imperial College London, Johns Hopkins University School of Medicine, and New York University are among the many involved in psychedelic research. Researchers have been focusing on the therapeutic applications of psychedelics for intractable psychiatric conditions such as treatment-resistant depression (TRD) and post-traumatic stress disorder (PTSD). The outcomes of phase I and phase II clinical trials, though preliminary, have thus far been promising, especially at a time when there has been little advancement in therapies and drugs for treating mental disorders in over 30 years.

Psychedelics exert their effect by inducing powerfully altered psychological states of varying duration (minutes to hours), where perception and awareness are transformed and a “reset” of the mind takes place. The revival of research into these once-taboo drugs began nearly two decades ago, after a long prohibition was enacted in the United States in response to the hippie-counterculture of the 1960s. This revival builds on an already large body of research from the 1950s and 1960s. Today’s researchers are reopening the gateway for therapeutic indications of these drugs and bringing hope to people suffering from debilitating mental health disorders.

A remission of depression

The research on psilocybin has been drawing attention around the world. Disbelief is common when learning that a one-time dose of psilocybin — the active component of “magic mushrooms” — can produce a sustained remission of depression that lasts from months to years. Though many of the results are still preliminary and some of the studies involve small sample sizes, the studies consistently demonstrate the remarkable potential of psilocybin-assisted psychotherapy. The research has garnered favorable attention from the U.S. Food and Drug Administration (FDA), which has given the go-ahead for much larger-scale studies on how psilocybin could be used to treat TRD, and major depressive disorder.

The power of psilocybin lies in its ability to transform the mind and produce a psychologically transformative state where the sense of self is altered and barriers to exploring past traumas are temporarily lifted. The drug affects the serotonergic system, and functional MRI scans show it significantly increases neuronal crosstalk between regions of the brain that don’t normally communicate. 

Psilocybin-assisted psychotherapy

Administered in a comfortable setting with two trained therapists, the sessions involve the patient lying on a couch with eye shades on and music playing. This setting facilitates the emotional breakthrough and experience that often leads to mood improvement, antidepressant effects, and stress relief — with clinically significant improvements lasting more than six months. Emotions of love and joy, a feeling of oneness, and a sense of transcending time and space are but a few of the effects commonly elicited during the six to eight-hour sessions. This research builds on the more established body of later-stage research surrounding psilocybin as a treatment for anxiety and depression in patients with end-of-life and life-threatening diseases.

For example, in a randomized double-blind study, 92% of the cancer patients who received the high-dose psilocybin showed a clinically significant (greater than 50%) decrease in depression scores after the first session. These effects showed a sustained symptom remission rate of 65% at the six-month follow-up assessment.

Safety and risks

Though the research is both exciting and promising, researchers have approached psychedelics with a great deal of care, and a strong emphasis on safety. Strict exclusion criteria, filter out patients with any personal or family history of bipolar, schizophrenia, and psychotic disorder as there is speculation that psychedelics may accelerate early-onset or acute episodes. The safety risk is low — psychedelics show no addictive properties, and there is no known lethal dose. Perhaps the greatest risk for patients may be the intense nature of the experience.

Much of this risk, however, can be managed through the presence of two trained therapists providing comfort and support throughout the entire session. This support — along with pre-session relationship-building and a strong emphasis on “letting the experience take them where it will” — has been effective at minimizing negative experiences. The FDA has recently granted psilocybin with “breakthrough” status and Health Canada has approved research trials, but high safety standards are in place and patient well-being is of the utmost importance.

A cultural shift

The acceptance of previously illegal drugs for medical purposes has helped pave the way for the embrace of psychedelics for therapeutic purposes. This cultural shift is highlighted by recent events such as marijuana legalization and the FDA’s recent rescheduling of ketamine (the first legal psychedelic) for the treatment of TRD. With an accelerating pace of research and a rapidly growing body of knowledge, these mind-altering substances may soon change the way we offer care and approach mental illnesses.

The renewed interest in psychedelics is opening the doors to research on a plethora of disorders. Studies are planned or underway for the application of psychedelics in the treatment of Alzheimer’s disease, anorexia nervosa, obsessive-compulsive disorder (OCD), and addictions (alcohol, tobacco, crack cocaine and heroin).

A beacon of hope

Psychedelic medications, when judiciously used in well-regulated settings, serve as a beacon of hope to suffering patients across the globe. Given these far-reaching implications, health-care professionals should stay informed of the rapidly advancing research and clinical developments. Understanding these advances will help nurses to adapt and inform their patients accordingly.

During a time when there has been little improvement in the effectiveness of medication targeting anxiety and depression — despite the billions invested in research — psychedelics could be the answer psychiatry has been looking for. Can-Am Interventions can answer any questions regarding mental health treatments, as well as accommodate those in need of immediate assistance for their family, friends or themselves.

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