Psychedelic Medicine: a Re-emerging Therapeutic Paradigm
Kenneth W. Tupper, Evan Wood, Richard Yensen and Matthew W. Johnson - CMAJ October 06, 2015 187 (14) 1054-1059; DOI: https://doi.org/10.1503/cmaj.141124
Link to journal article - https://www.cmaj.ca/content/cmaj/187/14/1054.full.pdf
The authors aim to discuss and synthesise emerging research, with regard to the potential benefits and harms of psychedelic compounds used in a therapeutic setting - with a focus on both clinical studies (human subjects) and when used in combination with mental health counselling.
- Until recently, the use of psychedelic compounds in a medicinal setting has been restricted. Research into their potential medical benefits and limitations was terminated in the 1950's.
- Recent clinical studies have since highlighted the potential benefits of certain psychedelic compounds when administered in conjunction to more traditional psychotherapeutic routes.
- Central to the psychedelic renaissance lies the paradigm of the clinician-patient relationship and the physical setting in which therapy is conducted. Both of these variables should be considered for facilitating positive outcomes.
- A small randomised controlled clinical trial (crossover design) was conducted in 2014 to determine whether LSD-assisted psychotherapy had the ability to meaningfully reduce anxiety associated with terminal illness.*
- After a 2 month follow-up period, it was determined that there was a non-significant reduction in trait-anxiety levels in the group receiving high dose LSD-assisted psychotherapy compared to the control group. However, state-anxiety was significantly reduced.
- A further 1 year follow-up period detected no adverse side effects, but rather a sustained therapeutic effect.
- Trait and state-anxiety levels were measured in accordance with the state-trait anxiety inventory.
- Meta-analyses of past research conducted in the 1950's suggests a beneficial effect of psychedelic-assisted psychotherapy in the treatment of various addictions - including alcohol dependence.
- In 2015, a small, early stage clinical trial was completed in New Mexico to analyse the effect of psilocybin-assisted therapy on the treatment of active alcohol dependence.**
- Self-reported average percentage of drinking days and heavy drinking days were reduced by over 50% when compared to baseline values.
- Nausea and mild headaches were reported as side-effects, however no chronic conditions or long-lasting negative effects were reported.
- A randomised controlled clinical trial was conducted to assess the effects of MDMA-assisted psychotherapy for the treatment of treatment-resistant PTSD.***
- Significant, long-lasting reductions in PTSD symptoms were measured in accordance with the clinician-administered PTSD scale. c.83% of patients in experimental group exhibited reduction in symptom severity by over 30%. As opposed to c.25% in the placebo group.
- No serious side effects were reported.
Concluding Remarks: Further determination of how psychedelic compounds work as therapeutics are needed in order to optimise dosing and delivery, as there is currently only fairly limited knowledge regarding the neuropharmacological mechanisms of these compounds. This may assist in the advancement of psychological, psychiatric and medicinal therapeutic avenues where psychedelics may offer potentially beneficial outcomes.
* Gasser P, Holstein D, Michel Y, et al. Safety and efficacy of LSD-assisted psychotherapy in subjects with anxiety associated with life-threatening diseases: a randomized active placebo- controlled phase 2 pilot study. J Nerv Ment Dis 2014;202:513-20
** Bogenschutz MP, Forcehimes AA, Pommy JA, et al. Psilocybin- assisted treatment for alcohol dependence: a proof-of-concept study. J Psychopharmacol 2015;29:289-99
*** Mithoefer MC, Wagner MT, Mithoefer AT, et al. The safety and efficacy of 3,4-methylenedioxymethamphetamine-assisted psy- chotherapy in subjects with chronic, treatment-resistant posttrau- matic stress disorder: the first randomized controlled pilot study. J Psychopharmacol 2011;25:439-52