The Pros and Cons of Psychedelics in Psychiatry

Psychedelics in Psychiatry

In recent times, there has been a lot of hype surrounding the use of psychedelic drugs as potential treatments for psychiatric issues. The excitement about the possibilities of these mind-altering substances to relieve symptoms associated with a variety of mental health conditions is reaching a fevered pitch. But does the reality live up to the hype? And just how safe are these substances? Although it’s true that some scientific research suggests potential mental health benefits from using psychedelics in a clinical setting, there are downsides too. Extreme caution is needed. Here’s what you need to know.

Although it’s true that some scientific research suggests potential mental health benefits from using psychedelics in a clinical setting, there are downsides too. Extreme caution is needed. Click To Tweet

WHAT ARE PSYCHEDELICS?

The term psychedelics refers to mind-altering drugs that can expand consciousness and impact sensory perceptions. There are many such substances—some that occur in nature while others are chemical compounds developed in laboratories. Four of the most commonly discussed drugs currently gaining traction in the field of psychiatry are psilocybin, MDMA, LSD, and ketamine.

Psilocybin

Have you heard of “magic mushrooms?” These natural substances contain a psychoactive compound called psilocybin that can alter thoughts and perceptions and can cause visual and auditory hallucinations at high doses. The psychedelic effects of psilocybin include feeling like time has slowed down, a sense of euphoria, seeing colors more vividly, thinking unusual thoughts, and seeing stationary objects appear to move.

MDMA

Commonly known as ecstasy or Molly, 3,4-methylenedioxymethamphetamine (MDMA) is a mood-altering chemical that produces enhanced sensory perception and feelings of closeness to others.

LSD

Discovered in the 1950s by Swiss chemist Albert Hofmann, lysergic acid diethylamide (LSD) was made available to the psychiatric research community. By the following decade, over 130 studies on the substance showed that it produced positive results in a range of mental health issues, such as anxiety, depression, and alcohol abuse. In the 1970s, however, following a surge in the recreational use of LSD and instances of “bad trips,” the drug was banned.

Ketamine

Developed more than half a century ago, ketamine is an anesthetic that dulls pain and makes people feel dissociated from their body. This substance can have hallucinogenic effects and has been used as a recreational drug with the nickname “Special K.”

PROS AND CONS OF MICRODOSING PSYCHEDELICS

Emerging research is investigating the use of psychedelics for the treatment of depression, anxiety, post-traumatic stress disorder (PTSD), addiction, and more. In the field of psychiatry, this typically involves microdosing or administering very small amounts of the psychedelic substance. This is intended to produce benefits without causing a “bad trip” or triggering intense hallucinatory effects. A very important caveat of microdosing psychedelics is that the drugs are administered by a trained mental health professional in a clinical setting. The substances are used as a way to enhance psychotherapy, which is why this practice is referred to as drug-assisted therapy. Be aware, however, that studies also point to potential downsides related to the use of mind-altering substances. This is why the use of these substances outside the clinical setting is not recommended.

Psilocybin: Research points to potential benefits for the administration of this substance in a clinical setting. A 2021 study in JAMA Psychiatry involving 24 people with major depressive disorder, found that psilocybin-assisted therapy produced “large, rapid, and sustained antidepressant effects.” Other research from 2021 in The New England Journal of Medicine on people with moderate to severe depression showed that treatment with psilocybin was equally effective as treatment with a common antidepressant (escitalopram, brand name Lexapro).

Downsides: Some people who ingest magic mushrooms experience negative reactions, such as anxiety, panic attacks, paranoia, feelings of fear and depression, nausea, and numbness.

MDMA: A 2021 randomized, double-blind, placebo-controlled phase 3 clinical trial appearing in Nature Medicine looked at the impact of MDMA-assisted therapy on individuals suffering from severe PTSD. Following the treatment, 67% of participants no longer met the diagnostic criteria for PTSD. The researchers concluded that “MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation.”

Downsides: Blurred vision, nausea, clenched teeth, nausea, sweating, and chills are some of the unwanted effects of taking MDMA.

LSD: In a 2020 study looking at LSD and other psychedelics as possible treatments for depression, the researchers suggested that “low doses of psychedelics could play a role in depression by inducing some kind of cognitive flexibility, which might lead to decreased rumination.”

Downsides: The effects of this mind-alerting drug are unpredictable and can vary from one person to another. In high doses, negative effects can include extreme mood changes, psychosis, hallucinations, and flashbacks.

Ketamine: Numerous studies point to ketamine’s positive effects on major depressive disorder. Findings in a 2013 study in the American Journal of Psychiatry showed that in people with treatment-resistant depression, ketamine quickly triggered antidepressant effects. Significant improvement in depressive symptoms among people taking ketamine was also noted in a 2017 review in Mental Health Clinician. In 2019, the Food and Drug Administration (FDA) approved esketamine nasal spray—a derivative of ketamine—as a treatment for depression and treatment-resistant depression.

Downsides: Ketamine may be addictive and may cause high blood pressure, dizziness, and nausea.

HOW PSYCHEDELICS WORK ON THE BRAIN

Clearly, any mind-altering substance also has an impact on brain function. Here’s what the science shows so far about how psychedelics affect the brain.

Psilocybin: A 2020 brain imaging study in the journal NeuroImage looked at brain scans of people before and after taking psilocybin and found that the drug lowers activity in an area called the claustrum. This brain region is believed to be involved with setting attention and shifting tasks, which may explain why people taking psilocybin experience feelings of connectedness and a lack of ego.

MDMA: MDMA triggers the release of neurotransmitters, including serotonin, dopamine, and norepinephrine. Experts point to the heightened levels of serotonin as the primary basis for the feelings of euphoria that recreational users tend to experience. After this surge of serotonin, however, levels of the neurotransmitter may become depleted, leading to negative psychological effects. Long-term heavy use of MDMA is also associated with changes in regions of the brain associated with impulse control and attention, working memory, visual information processing,

LSD: Research shows that this psychoactive drug works on a variety of receptors in the brain, including serotonin and dopamine.

Ketamine: Research shows that ketamine alters the way the brain’s neurons communicate. The substance binds to receptors that trigger the release of glutamate, an abundant neurotransmitter in the brain that is involved in memory and learning. A 2019 study in the journal Science suggests that ketamine promotes the growth of synapses in the brain.

Although this research is a good start, there isn’t enough information yet to know how microdosing psychedelics in a clinical setting will affect the brain on a long-term basis. More investigation on the use of psychedelics as a psychiatric treatment is needed to understand their lasting impacts on brain health and to establish how safe they really are.

Depression, anxiety, PTSD, and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.

23 Comments

  1. Are there units in SC and NC and what is cost, insurance coverage.

    Comment by Kathy Mangum — October 6, 2021 @ 4:48 AM

  2. Please review and edit these epistles which can be sooo helpful. Really helpful. But to repeat “nausea” as a side effect for MDMA in a scholar-lite article is to reduce its credibility. It may be nitpicking, but my clients who wish to abuse these drugs will use these kind of errors to negate any rational discourse on the subject of drugs of abuse. Amen Clinics is frequently used by me to refute “street science “ of which there is far too much today. Thank you for your work. It is massively helpful.

    Comment by Ed poage — October 6, 2021 @ 4:48 AM

  3. I tried Ayahuasca. I had an amazing experience. I connected to planet earth and all my senses were enhanced while I was under the effects of the drink. My husband is considering a psychedelic experience for himself. What is your scientific knowledge of Ayahuasca?

    Comment by Elizabeth — October 6, 2021 @ 5:34 AM

  4. Very interesting topic. We will see where this goes.

    Comment by Timothy Lee — October 6, 2021 @ 6:02 AM

  5. I would be very interested in learning the effects of ketamine on people with Alzheimer’s disease.
    I also wonder if MDMA might be useful in helping people with Dissociative Identity disorders reintegrate their fragments.
    Thanks for this very interesting article!

    Comment by Nancz — October 6, 2021 @ 6:15 AM

  6. Thank you for writing this much needed information!

    Comment by Janet DaPrato — October 6, 2021 @ 6:50 AM

  7. I’m for a more healthy natural approach myself but am finding it impossible as an option. My 19 yr had a mental breakdown on Aug 13th. I’ve never seen this happen,ever! Then against family request to hospitalize him where we wanted he was sent to another mental hospital, returned with a black eye and ptsd so bad I’m having issues helping him now. Depakote, invega, remeron, are what’s being given now as round two and 2 mental stays later..yes all since the 13th. It’s the only thing keeping him somewhat stable. Not my choice but it’s better than a return to a locked up facility. This world needs changes to.help ppl with brain traumas! Plz send us prayers.

    Comment by Janet — October 6, 2021 @ 7:27 AM

  8. I enjoyed reading this great overview

    Comment by Grant Schettler — October 6, 2021 @ 7:36 AM

  9. The article doesn’t mention that a single illegal pill of MDMA can sometimes cause death.

    Comment by Julia Lewis — October 6, 2021 @ 8:55 AM

  10. Hi, I have had chronic depression and anxiety most of my life. I’m a senior citizen , and I’d love to enjoy my later years with some relief.

    Comment by Debra Thompson — October 6, 2021 @ 10:45 AM

  11. You forgot to mention how MDMA has caused hart problems and death in people with pre existing conditions. Also, you left out Ayuaska, which is being successfully used to treat addictions.

    Comment by Vanessa — October 6, 2021 @ 11:49 AM

  12. Recently I had a slip and fall accident and broke my wrist . In the emergency room I was administered a sedative while they attemped to pull the fracture back in place. The dissociative state I experienced was far worse than the trauma of the accident and fracture. When I came to, I told them I thought I had died and come back to life . Ketamine was the culprit !! As a trained therapist I would not recommend this for my clients or anyone I care about .

    Comment by Kristin — October 6, 2021 @ 11:50 AM

  13. My 34 yo son has recently been diagnosed as being on the autism spectrum. Prior to that we tried many different treatments for his anxiety, depression, and OCD. Until he tried Ketamine therapy about two years ago, he had never really felt anything from any of the other treatments (TMS, ECT, and many medications). The Ketamine gives him energy to function and lifts his mood. The dosing and frequency are an ongoing trial but he benefits greatly from it. Psychotherapy will always be a part of his life, but we look forward to new advancements in mental health treatments as well.

    Comment by Jacquelyn Frank — October 6, 2021 @ 5:44 PM

  14. In the 1970s many psychiatrists did not know much about the brain, only Theories, thus it was a field that was taken full advantage of the ignorances. The drugs were used more out of testing the product/patient to diagnose symptomatically problems. As such being able to tell the people of events to happen in the future was deemed delusional/schizophrenia. Moods, depression, and way too many questions put a person into an introvertive state. Being allergic to some part of the drugs compound in the family of drugs made up of the same parts proved to cause psychosomatic events in various parts of my life that caused me to avoid any drugs. Thereby, with the questions of what is actually wrong and trying to prove what is not wrong has me in a dilemma with my doctors. Thereby bringing me to Dr. Amen’s Clinics to find out about his scans and trying to prove/disprove the theories of the past, find some solace in what is factual and being able to survive it all.

    Comment by Bruce R. Kuzma — October 6, 2021 @ 5:53 PM

  15. Ghey all sound like drugs to me. No mdntion of behavioral therapy being coupled with them for long-time maintenance without drugs. So, what are we doing? Trying to figure out what makes us feel better or just popping happy pills and not working on the fundamental problem causing our unhappiness. Sooo… just feeling good is now our ultimate goal even if we continue in patterns that shouldn’t feel good? Sounds like addiction over recovery wins. Shame. But, hey! Who isn’t game for feeling better with no effort? Who cares if we destroy our lives as long as we feel good! smh

    Comment by Lea Wright — October 6, 2021 @ 6:03 PM

  16. Hello Kathy, we currently have 9 locations nationwide: https://www.amenclinics.com/locations/. For more information about cost, insurance, and financing options, please contact our Care Coordinators: https://www.amenclinics.com/schedule-visit/.

    Comment by Amen Clinics — October 6, 2021 @ 7:01 PM

  17. K can sometimes lower inhibitions, i noticed [working in the O.R.] that patients preoperatively given K said some salacious things to the staff.

    Comment by bruce — October 7, 2021 @ 2:31 AM

  18. When I was 17 years old I did mushrooms and experienced anxiety for the following 10 years of my life. Biggest mistake of my life! Turns out I am allergic to psilocybin. Mushrooms completely ruined the trajectory of my life!

    Comment by Jacqueline — October 7, 2021 @ 6:36 AM

  19. I have a friend that has had much success on ketamine. It is something I would like to incorporate into my cognitive therapy. What locations are available in my area-Minnetonka, MN?

    Comment by Laurie Buell — October 7, 2021 @ 7:43 PM

  20. Hello Laurie, thank you for reaching out. Currently we have 9 locations nationwide: https://www.amenclinics.com/locations/.

    Comment by Amen Clinics — October 8, 2021 @ 7:38 PM

  21. LSD reuined my father. (Reference “Edgewood Arsenal human experiments — Wikipedia”) In the 1950’s my father participated in the U.S. Army Edgewood Arsenal Chemical Biological Center (currently Edgewood area of the Aberdeen Proving Ground, Maryland) LSD Research which used “LSD as a means of temporarily replicating the effects of mental illness. ” My father volunteered for the LSD research trials as being a U.S. Government civil service employee. His career was as Chief of Engineers of Tanks (GS-13 1956-1959) Aberdeen Proving Ground, Maryland — so very intelligent with Outstanding Performance Awards annually in his profession. (His career started prior to WWII, then in U.S. Navy for duration of WWII, then rehired post war.) He often complained about the side effects of coming down off the LSD “trips”. He became very beligerant and abusive physically and mentally to my mother and us 6 children. In 1959 he lost his job and a began life of immense poverty from unemployment . He had incestuously attacked and tormented the children repeatedly for years and one neighbor child. Often having hallucinations that the Communists were going to kidnap him and his children and wife. Mother legally separated from him in 1965 and court ordered he not allowed near the children without police escort. He was never charged with incest. He became homeless the rest of his life. Veterans hospital diagnosed him paranoid schizophrenic early 1980’s and tried treatments but he would discharge himself AMA and return to living on the streets the rest of his life. Finally approximately age 65 when he was drunk was hit by a truck causing frontal brain damage (with intelligence of 18 month old) and loss of right arm. Lived out remainder of his life in Intermediate Care nursing home till died of pneumonia at age 73. The point is… this man before LSD trials was a loving, caring, supporting husband, very successful professionally in the U.S. Government, very intelligent, but then life deteriorated drastically while on LSD research trials resulting in major personality disorders. A waste of a human being. (I have written my Memoir and go into detail about all this — AND MAY GOD BLESS by RUTH ANN COMER published Covenant Books 04/13/2021.)

    Comment by Ruth — October 10, 2021 @ 3:20 PM

  22. I have been getting Ketamine infusions for over a year and a half. Antidepressants no longer worked for me. Ketamine saved my sanity. . Do your research before choosing a clinic. Also insurance does not pay.

    Comment by Bonnie Durante — October 12, 2021 @ 1:53 PM

  23. Drugs are not the answer

    Comment by Kellie — October 17, 2021 @ 8:51 AM

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