Psychedelics as Therapy: We're Not There Yet, But the Possibilities Are Fascinating
The last thing I expected to encounter at a mainstream psychiatric convention was a session on psychedelics as a possibility for treating psychiatric conditions. But not only did I encounter the session - the session was well-attended.
The occasion was the Psychiatric and Mental Health Congress held last week in San Diego. The speaker was Andrew Penn, a nurse practitioner associated with UCSF.
Mr Penn opened with a personal account of how taking an antibiotic for a strep infection had him feeling better in one day and feeling like himself in two. “If we only had psychiatric medications that work this fast,” he let us know.
His talk focussed on two compounds that have been the object of research scrutiny - MDMA and psilocybin, neither of which are for recreational use, he cautioned.
The two drugs are commonly referred to as hallucinogens, but the term is misleading, as not everyone under their influence experiences hallucinations.
Psychedelics came to the attention of clinicians and researchers in the 1950s as a possible means to help patients “stuck” in their psychoanalysis see beyond the constraints of their narrow ego identities. This, in turn, would help move their recoveries forward.
At Harvard, Timothy Leary and Richard Alpert did investigative work into LSD, but the sixties counter-culture and its attendant bad publicity resulted in the Controlled Substances Act of 1971 that placed psychedelics and other substances on Schedule 1. This status effectively shut down all research.
MDMA, commonly known as Ecstasy, was discovered in 1912 and rediscovered in the seventies. Psychotherapists noted the drug created feelings of warmth and empathy and began using it as a clinical tool. Abuse by the rave culture earned it Schedule 1 status in 1985. It wasn’t until 2001 that the first study was published.
Now studies are emerging from around the world, with focus on end-of-life anxiety (such as from terminal cancer), OCD, substance abuse, and PTSD. What these conditions have in common, Mr Penn observed, is that individuals appear “stuck” in their current unhealthy states.
In depression, Mr Penn noted, patients are “stuck” in a pathologically ruminative state. A little background: Neuroimaging is revealing two key functional neural networks - the default mode network and the task positive network.
The default mode network is a state of wakeful rest, when the brain is focussed inward.
The task positive network shifts into gear when the brain needs to engage with the outside world.
Perhaps you see the problem. Someone experiencing depression is stuck in default mode. Booting into task positive constitutes a Herculean labor. Can MDMA help out? Who knows? Is it worth further study?
Mr Penn was quick to remind us that psychedelics are power tools that are not to be toyed with. In treating PTSD (which involves the brain “stuck” in fight or flight) an MDMA session is typically an all-day affair preceded by preparation the day before and a sleep overnighter. The patient is free to bring up trauma at his or her own discretion.
The primary target of MDMA is serotonin. The drug also results in the release of oxctocin and prolactin, two hormones associated with pair-bonding and interpersonal trust. The net effect may be the release of fear and the promotion of a productive clinical relationship. A 2011 study of MDMA therapy found reduced PTSD scores in patients. The results held steady over three-and-a-half years.
Psilocybin occurs naturally from “magic” mushrooms. In the body, psilocybin turns into psilocin, a serotonin-like compound that binds to three different serotonin receptors.
The drug is believed to have an influence on the connecting hubs of the brain. The analogy Mr Penn gave is to the conductor of an orchestra - only the players who are supposed to be playing are playing while the rest stay silent. Life is predictable.
But psilocybin appears to take the brain out of its predictability. Ordinarily, the brain operates either in default or task positive mode, but not both at the same time. With psilocybin, however, both modes get turned down. The effect, according to those who have used the drug, is a profound sense of connection. In 1957, Aldous Huxley wrote:
To make biological survival possible, Mind at Large has to be funneled through the reducing valve of the brain and nervous system. What comes out at the other end is a measly trickle of the kind of consciousness which will help us to stay alive on the surface of this particular planet.
But can an occasional experience of Mind at Large shake us out of our pathological trickles? Perhaps direct us to more healthy trickles? These are questions we need to be asking.