Psychedelic Drugs for Treating Mental Illness?

Patient Expert

A headline to an article in yesterday's edition of the journal Science caught my eye: "Can Ecstasy Treat the Agony of PTSD?"

According to the article (paid access), the compound MDMA - first synthesized in 1914 and commonly known as the recreational drug Ecstasy - is showing promise in the treatment of PTSD. This is based on a small trial involving female assault victims. Ten of the 12 patients who received MDMA combined with psychotherapy no longer met the diagnostic criteria for PTSD compared with two of eight patients who received a placebo.

Another small study, however, showed no significant effect. Other studies are in progress.

PTSD is typically treated by "exposure therapy," where patients relive their traumas again and again in a safe clinically supervised atmosphere, to the point that their destructive memories lose their hold. According to an expert cited in the article, David Nutt of Imperial College London, "MDMA might make that easier because it reduces fear and fosters trust."

The research was carried out by the Multidisciplinary Association for Psychedelic Studies (MAPS), based in Santa Cruz, CA. The organization is also investigating the clinical uses of LSD, ayahuasca, ibogaine, and marijuana. In brief:

LSD was first synthesized in 1938. Through the 50s, 60s, and 70s, clinicians and researchers administered the drug to thousands of subjects to treat alcoholism, and anxiety and depression in cancer patients. A small MAPS study found that just two sessions of LSD-assisted psychotherapy reduced anxiety. MAPS also claims the substance can be administered safely.

Ayahuasca is a psychoactive brew derived from a mixture of Amazonian plants and used by certain peoples there to achieve transcendent states. According to MAPS: "Although preliminary, current research suggests that when administered in therapeutic settings, ayahuasca may help reduce problematic substance use by helping promote personal or spiritual insights or self-knowledge."

Ibogaine, derived from a shrub, is a mild stimulant in small doses, and a powerful psychedelic in larger doses. It has been used in healing ceremonies and initiations in various parts of West Africa. According to MAPS, ibogaine may "reduce withdrawal from opiates and temporarily eliminate substance-related cravings."

Other psychedelics under investigation elsewhere include the natural substances peyote, mescaline, and psilocybin, all closely associated with various Native American shamanic practices, plus synthetic compounds such as ketamine.

According to the article in Science, MAPS was started in 1986 by psychotherapist Rick Doblin, a year after the DEA made MDMA illegal. Earlier, Dr Doblin had a life-changing experience using MDMA and had looked forward to using it in clinical practice. Then the politics of recreational drug-use got in the way.

On its website, MAPS asserts that MDMA is not the same as Ecstasy, as street drugs frequently contain unknown and dangerous adulterants. Moreover, contends MAPS, unlike most psychiatric meds, MDMA is only administered a few times, and is safe "when taken a limited number of times in moderate doses."

MAPS completed its own phase I safety study in 1995. It is looking to achieve FDA approval for the drug by 2021.

According to a 1986 article  published in the Journal of Psychotherapy, it is a mistake  to consider psychedelic drug therapy a form of psychiatric drug therapy such as lithium.

Rather, psychedelic drug treatment is more of a one-time deal. While on the drug, the patient may experience the type of transcendent mental state conducive to prizing loose a life-changing realization or two. This sets the scene for new insights into one's destructive thoughts or behaviors or addictions, and hopefully breaking free.

The authors of the article note that this type of breakthrough accords with the goals of traditional psychotherapy. This raises the issue of whether using psychedelic drugs as part of psychotherapy can achieve a much quicker and more reliable result. There is also the major issue of safety.

So far, we have little to go on. Old research, the authors point out, is based largely on anecdotal case reports that wouldn't hold up to modern scrutiny. It is high time, they argue, that we find a way to ask better questions and to "give psychedelic research another chance."

That was nearly thirty years ago.