Sunday, December 5

‘Psychedelic Renaissance’: A New Wave of Research Advances Hallucinogens to Treat Mental Health | Mental health


It was out of desperation that Michael Raymond found himself sitting in a remote retreat in the Peruvian Andes, drinking a cup of bitter tea.

Raymond had reached the breaking point. His 16-year career as an electrical engineer in high security situations for the Australian Air Force had seen him deal with near-death experiences, accidents, casualties and “the aftermath of human remains.”

Michael Raymond overlooking Machu Picchu in Peru
Michael Raymond, an Australian Air Force veteran, traveled to South America for psychedelic-assisted therapy.

“I was going to kill myself in a moment,” he says. “I couldn’t go on.”

After being discharged for post-traumatic stress disorder (PTSD), anxiety, and depression, Raymond was prescribed antidepressants and underwent psychotherapy, but to no avail.

Drinking ayahuasca tea, which contains the psychoactive compound N, N-dimethyltryptamine (DMT) and San Pedro cactus, had been his last resort.

After early psychiatric experimentation in the 1950s and 1960s, followed by decades of prohibition, sparked in part by the backlash against the hippie counterculture, psychedelics are experiencing a renaissance. A new wave of research has returned to hallucinogenic drugs as potential candidates for treating psychiatric conditions.

It has also meant that more people, frustrated by drugs that don’t work, have sought out illicit drugs. Experts are quick to warn of the risks of self-treating mental health conditions with psychedelics.

But the therapeutic uses of illegal substances, including MDMA, DMT, and psilocybin, the active ingredient in magic mushrooms, are now being explored in clinical trials.

Dr. Martin Williams, executive director of Psychedelic Research in Science and Medicine, says the tide has finally turned after decades of being associated with “occupational suicide.”

Magic mushroom cultivation
Therapeutic uses of illegal substances, such as the active ingredient in magic mushrooms, are being explored in clinical trials. Photograph: Westend61 GmbH / Alamy Stock Photo / Alamy Stock Photo

Williams, also a Monash University researcher, is co-leading a clinical trial at Melbourne’s St Vincent Hospital on psilocybin-assisted psychotherapy to treat anxiety and depression in terminally ill people.

The trial, which will run through 2023, involves 40 people with terminal conditions such as chronic obstructive pulmonary disease and motor neuron disease, who are receiving one or two 25-milligram doses of psilocybin along with therapy.

Follow successful US studies of the drug in patients with anxiety and depression associated with life-threatening cancer. In the follow-up four and a half years later, Participants “overwhelmingly attributed the positive life changes to the experience of psilocybin-assisted therapy and rated it among the most personally and spiritually significant experiences of their lives.” A similar LSD trial It also found beneficial effects.

For anxiety and depression at the end of life, evidence suggests that standard drug treatments with antidepressants like SSRIs (selective serotonin reuptake inhibitors) are not particularly effective, Williams says.

“Psychedelics … through whatever mechanism appear to represent a significant improvement over standard therapies.”

Meanwhile another psilocybin clinical trial, at St Vincent Hospital in Sydney, is investigating whether the compound can help treat methamphetamine addiction.

Brain chemistry

Classic psychedelic drugs (DMT, LSD, mescaline, psilocybin) act in the brain by binding strongly to specific serotonin receptors known as 5-HT2A receptors. Its action on these receptors is believed to result in the hallucinogenic effects of the drugs, as well as changes in perception and a sense of ego dissolution.

Psychedelics are also believed to dampen the ‘default mode network’, a system of interconnected brain regions that is active in unfocused and awake rest, such as daydreaming. The region is believed to be important in formulating our sense of identity and can become too rigid when people experience anxiety and depression.

Cultivated magic mushrooms.
Cultivated magic mushrooms. Photograph: Nigel Dodds / Alamy

By silencing the network by default, psychedelic drugs appear to allow for different interconnections in the brain, such as “crossover talk,” Williams says, resulting in an altered sense of perspective and greater psychological flexibility.

The potential of psychedelics is something of a “paradigm shift for traditional psychiatry,” says Professor Jerome Sarris, one of the directors of the recently established Psychae Institute in Melbourne. The research center is planning ayahuasca clinical trials in 2022 to treat depression and alcohol use disorder.

It is one of the few tests in the world: a Brazilian study showed promising results for treatment-resistant depression, while regulators approved a trial of DMT in the UK.

The co-director of the Sarris and Psychae Institute, Dr. Daniel Perkins, previously conducted a international survey of ayahuasca drinkers. Of those who reported anxiety or depression at the time, 70% and 78%, respectively, reported an improvement in symptoms. (The study was observational, so causality cannot be established.)

For Raymond, taking ayahuasca was the kind of ineffable experience, an encounter with the mystical, that many who have consumed the infusion describe. “I have to bring out these unadorned truths about myself,” he said.

“Wanting to be what I thought a manly man was, or whatever, a military man … I had no tools to express emotions in a healthy way,” he says. “Even with a psychologist it was hard for me to open up.”

Michael Raymond on a beach
Michael Raymond says that consuming ayahuasca raised some “unadorned truths about me.” Photography: Michael Raymond

One drug that has shown promise for treating PTSD is MDMA, when used in conjunction with therapy. In the USA phase III clinical trial – the last research barrier a drug must overcome before regulators consider approving it as a new drug – found it to be “highly effective” and safe in people with severe PTSD.

The mode of action of MDMA differs from psychedelics, but it also increases serotonin in the brain. Dr. Stephen Bright, a psychologist and senior lecturer at Edith Cowan University, says: “That release of serotonin seems to activate parts of the prefrontal cortex associated with language, and that could be why people can talk about experiences. that they have not been able to [before]. “

Bright will lead a small MDMA-assisted therapy trial in Perth later this year, the first in Australia, that will treat four people with PTSD.

Ecstasy pills
Ecstasy pills. MDMA increases serotonin in the brain and is being used in a Perth trial to treat people with PTSD. Photograph: Westmacott / Alamy

Regulatory requirements

Despite promising results to date, no psychedelics have yet accumulated the required level of clinical evidence to be listed as legally supplied drugs on the Australian Register of Therapeutic Products. But Dr. Daniel Perkins says regulators are recognizing its potential benefits. “It’s a question of how they provide access, not whether or not they would.”

Perkins, who was the director of the medical cannabis office at Victoria’s health department, emphasizes that psychedelics are only part of the treatment. The other is psychotherapy, and the approval of any drug would also be conditional on the treatment protocols that have been examined in clinical trials.

In February, the Therapeutic Goods Administration of Australia (TGA) made an interim decision rejecting a proposal to reclassify MDMA and psilocybin from prohibited drugs to controlled substances. It has postponed making a final decision, pending an independent report on the therapeutic risks and benefits of the drugs, to be published next week.

The regulator already grants permission for the use of these drugs on a case-by-case basis through its special access scheme, but it is not uncommon for access to be later barred at the state level.

Tania de Jong, founder of Mind Medicine Australia, the nonprofit that led the reclassification bid, says a change in regulations would not result in a “floodgate” but would better standardize federal and state approvals than doctors would have to obtain.

De Jong says she is regularly contacted by desperate people who have exhausted all other treatment options. “They just want the opportunity to lead a healthy, meaningful and functional life,” he says. “The longer these drugs take to become available in clinical settings, the more people will seek them clandestinely.”

TO World drug survey 2020 found that of 1,376 people who used psychedelics for self-treatment, 4.2% needed to seek emergency medical treatment, about five times more than people who used such drugs recreationally.

Psychedelic-assisted therapies are contraindicated for people at risk for drug-induced psychosis.

“I see an increasing number of people who are getting worse as a result of trying this on their own,” says Dr. Stephen Bright. He is wary of the growing public interest in psychedelics, because the venues for clinical trials are very limited and it may take five to ten years before the treatments are widely available in Australia.

Michael Raymond stands in front of an air force plane
Michael Raymond in his days in the air force. Photograph: Australian Defense / Michael Raymond

Raymond says his quality of life has improved dramatically since taking ayahuasca in South America, but acknowledges that the experience was not a panacea. “I still have things to figure out,” he says.

Now he is studying and working to mentor other people who are walking away from life in the military. “I have found more gratitude just for being alive.”


www.theguardian.com

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