By: Leah Fattor
Our face-paced society loves the idea of quick-fixes and miracle cures. When it comes to treating mental illness, time is definitely of the essence. Researchers over the last half century have proven time and time again that there is an efficient, successful medical treatment that tackles a wide range of mental illnesses: psychedelic drugs.
Psychedelics are undeniably having a moment in the spotlight. In 2019, Denver became the first city in the United States to decriminalize psilocybin, the key compound in psychedelic mushrooms. This move was shortly followed by the city of Oakland (Wingerter). In November 2020, Oregon legalized psilocybin mushrooms for use in therapy as well as decriminalized the possession of small amounts of all drugs, including psychedelics (Roberts). Michael Pollan’s 2018 book How to Change Your Mind, a book about the history of psychedelics and its promising research, reached #1 on New York Times bestseller list. This mere fact attests to a cultural destigmatization of psychedelic drugs.
However, are psychedelics really a cure-all for mental illness? Of course not. But, there is some very promising data supporting their use in treating mental illness in certain settings.
How Psychedelics Got A Bad Reputation
Psychedelics are actually not a new treatment for mental illness. There were many studies conducted in the 1950s and 1960s that dealt with psychedelic drugs. However, when Nixon took office in the 1970s, his administration ignited the hypothetical "war on drugs" as a form of social control, in part against the counterculture movement and anti-war hippies who were known for doing drugs, especially psychedelics. This led to the classification of psychedelics as Schedule 1 substances: drugs that are highly addictive and have no medical value (Chatterjee).
Based on more modern evidence, we now know that many psychedelics are not actually addictive and do have medical value, but their status has yet to be changed nationally. As such, it wasn’t until the 1990’s and 2000s that researchers reignited the fascination with psychedelic as potential mental illness treatments (Belser).
Here’s What We Know
What are the conclusions of such studies, you may ask? According to Collin M. Reiff, MD, clinical assistant professor in the department of psychiatry at New York University Grossman School of Medicine, “Randomized clinical trials support the efficacy of MDMA in the treatment of PTSD and psilocybin in the treatment of depression and cancer-related anxiety, and there is emerging preliminary evidence on the efficacy of LSD and ayahuasca in depression and other psychiatric disorders” (Gramigna). In all cases, the psychedelic is professionally administered in a controlled setting as part of an elaborated psychotherapy program (Schenberg).
Ketamine has been the most studied and has been/is currently involved in over 70 Phase 2 trials as treatment for a variety of psychiatric disorders, and two Phase 3 trials for treating depression. In the depression treatment trials, there was a low frequency of adverse events in the short term, and short-term positive effects reported in a significant portion of patients (Schenberg).
MDMA has been/currently is involved in 17 Phase 2 trials and was declared a breakthrough therapy for PTSD by the FDA (Schenberg). The Breakthrough Therapy designation “is a process designed to expedite the development and review of drugs that are intended to treat a serious condition and preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over available therapy” (FDA.gov).
Psilocybin is the third most studied psychedelic substance for treating psychiatric disorders. It has a very low risk profile even in unsupervised settings and has a very high safety ratio (the ratio of the dose that produces toxicity to the dose needed to produce the desired therapeutic response) (Schenberg). It has also been classified by the FDA as a breakthrough therapy, but in this case for treatment-resistant depression (Gramigna).
LSD, ibogaine, ayahuasca are the least studied psychedelics, but each of still show promise. LSD is currently in two Phase 2 trials for existential anxiety for terminally ill patients. Ibogaine has had considerable success in treating opioid addictions; however, unlike the other psychedelics mentioned, ibogaine is much less safe in that it could lead to patients having fatal cardiac arrhythmias (Schenberg).
To sum it up, there is evidence based on reputable, clinical studies proving that psychedelics can be safely used to treat a wide variety of mental illnesses including depression, OCD, PTSD, suicide, alcohol addiction, cocaine addiction, social anxiety in autistic adults, existential anxiety, and cigarette dependence (Schenberg).It is important to note that psychedelic drug therapy is administered from a trained professional in a clinical setting, and it is a supplemental treatment in addition to psychotherapy.
Here’s What We Don’t Know
Since this is a relatively new field of study, there are many aspects of psychedelic drug treatments that have not yet been studied. Psychedelics have not been studied as an independent treatment for psychiatric disorders, but rather always incorporate some form of psychotherapy. Psychedelics have not yet been studied for use (in a professional setting or otherwise) by people without any preexisting mental disorders as means to generally increase mental health/quality of life (Belser). Psychedelic treatments have not yet been studied without professional administration. There is no evidence that psychedelics, even with psychotherapy, are a permanent cure for the mental disorders they treat, i.e., there is no evidence that they come close to a cure-all for mental illness (Chatterjee).
Finally, there is no evidence that if you drink mushroom tea in your dorm room or trip on LSD at a party that you’ll incidentally remedy your depression.
Here’s What’s Next
According to findings published in the American Journal of Psychiatry, “The current body of research regarding psychedelics has produced insufficient evidence to recommend FDA approval of any psychedelic compound for routine clinical use in psychiatric disorders,” (Gramigna). As such, the next step is to continue gathering evidence by conducting clinical trials in order to gain FDA approval (for anyone curious or confused about the steps to approval or the differences between Phases, check out this source). Despite being classified as Schedule 1 substances, the FDA will review psychedelics in the same manner as other investigational psychiatric drugs (Hale).
FDA approval of psychedelic drug treatments would lead to many benefits, beyond allowing for the large-scale use of psychedelics in psychiatric treatment. After the first approval (e.g. psilocybin for treatment-resistant depression), secondary indications (e.g. psilocybin for any depression) are thought to be a faster and less expensive treatment option. FDA approval also facilitates insurance coverage and would likely open up new research avenues and more opportunities for funding by the National Institutes of Health (Hale).
Rick Doblin, founder of the Multidisciplinary Association of Psychedelic Studies (MAPS) and a psychedelic research pioneer, predicts that MDMA and psilocybin will be approved by the FDA in 2021, for PTSD and treatment-resistant depression respectively. Approximately 8 million Americans suffer from PTSD, while over 500,000 Americans have treatment-resistant depression, so the approval of just these two drugs alone would be an incredible advancement in battle against mental illness.