Psychedelics: A comeback
Written by Adam Elsherbini
Albert Hoffman, the founding father of psychedelics, once said, "LSD is just a tool to turn us into what we are supposed to be." Hoffman, who worked to develop one of the most renowned drugs in the present day, would go on to live a life of ups and downs. From Timothy Leary to the reintroduction of psychedelics into medicine, the history of psychedelics is short yet deep.
Psychedelics is an umbrella term for a multitude of drugs that induce altered perception, transient states (unsteady mental state), and impacted cognitive abilities. The already short history of psychedelics was delayed as they were banned within the United States in the '60s. This is because following the development of the anti-war movement against the Vietnam war, many individuals began to consume psychedelics. To make matters worse, a famous Harvard psychologist, Timothy Leary, was an avid supporter of psychedelics who took his research to an extreme point by even recommending that kids take psychedelics. These cumulative factors resulted in the commencing of The Controlled Substance Act in 1970. This act made it impossible to study psychedelics, and the advancements were hindered.
The pathophysiology of psychedelics has never really been understood. Some believe neurotransmitters are altered, while other research proposes its increased suggestibility, a form of cognitive bias that allows individuals to accept the suggestions of other individuals. The most reputable belief is that psychedelics act as an agonist on the brain serotonin 5-hydroxytryptamine. That is, they typically block off the usual activation, leading to certain effects, such as hallucinations. Regardless, psychedelics have been a hazardous and intensive drug when taken under free use. Compared to allopathic medications that typically take weeks to work for the treatment of mental illness treatment, psychedelics have an immediate effect. In addition, the transient states claimed by psychedelics can allow individuals to touch into their memories and trauma. These are referred to as 'bad trips' and are arguably the most traumatic element of psychedelics. Other adverse effects include nausea, out-of-reality, and panic attacks.
So why even converse about psychedelics after all these negatives? Recent research has proposed that psychedelics can be used to treat mental illnesses. Following this announcement, regulations became more lenient, research output is at an all-time high, Wall Street spends billions on psychedelic companies, and Oregon has recently legalized mushrooms. However, before diving into the research, it's necessary to understand some of the most common psychedelics.
Lysergic Acid Diethylamide (LSD) is the most common psychedelic and was derived from ergot, a type of fungus that impacts the rye plant. Mescaline is another psychedelic that comes from the peyote cactus and has been used by religious ancient aztecs to achieve a sense of hallucinations. Dimethyltryptamine (DMT) is an alkaloid that is found in magic mushrooms. Another psychedelic that is very well studied is psilocybin (magic mushrooms) which is naturally derived from mushrooms. A final honourable mention would be DOM, which is regarded for its extended duration and high potency as a member of the DOX family. Some of the effects that are present throughout these drugs include agitation, increased blood pressure, chest pain, and dilated pupils. Interestingly, psychedelics are deemed safe concerning the mechanism of action and physiology while having an absence of addiction.
Clinical Trials: Depression
One study in 2016 observed 29 cancer patients that were clinically diagnosed with depression. In a double-blind, placebo-controlled, crossover trial, subjects were given a singular dose of psilocybin or niacin. Not only were the psilocybin effects almost immediate, but a 6.5-month follow-up showed a significant antidepressant effect, with 60-80% of participants having reduced anxiety or depression. Another study published in JAMA psychiatry in 2021 found that psilocybin therapy had significant antidepressant effects in 24 patients diagnosed with depression through a Randomized Control Trial (RCT). Another study published in the New England Journal of Medicine at roughly the same time found that patients with a varying degree of depression that were treated with psilocybin were far better than other antidepressant medication over six weeks.
Clinical Trials: Trauma
One of the most renowned studies in psychedelics relative to trauma was a recent 2021 study published in Nature. It provided a safe, tolerable, and efficacious MDMA therapy for patients suffering from PTSD through an RCT. Similarly, a previous systematic review in 2020 supported ketamine (type of psychedelic) in the treatment of trauma, especially ketamine and psychotherapy as a combination.
Although psychedelics pose many threats to the general community, they can serve a great purpose in the clinical practice of psychiatry and general mental illnesses. It can aid prisoners, veterans, and any individual who may be suffering from depression or anxiety. The Controlled Substance Act had done an exceptional job in regulating psychedelic use and its impact can still be of use. I propose an alternative act that attempts to regulate the use of unprescribed psychedelics while attempting to advance its scientific contribution and possibly introduce them into mainstream medicine.
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