The Pros and Cons of Psychedelics in Psychiatry

In recent times, there has been a lot of hype surrounding the use of psychedelic drugs as potential treatments for mental health 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 about psilocybin, ketamine, MDMA, and LSD. 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.

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WHAT ARE PSYCHEDELICS?

The term psychedelics refers to mind-altering drugs that can expand the 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. In the 1960s, people began investigating using psilocybin for depression and addiction. In the 1970s, it was classified as a Schedule 1 drug, meaning it currently has no accepted medical use, and it has a high potential for abuse.

MDMA

Commonly known as MDMA, ecstasy, or Molly, 3,4-methylenedioxymethamphetamine (is a mood-altering chemical that produces enhanced sensory perception and feelings of closeness to others. In the late 1970s, some psychiatrists began using MDMA because they believed it improved patient communications and gave patients greater insight into their mental health issues. The DEA issued an emergency ban on it in 1985, classifying it as a Schedule I drug.

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 a dissociative anesthetic. It 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.” In the 1960s, practitioners began using the ketamine as a human anesthetic in the clinical setting. Subsequently, it has been used as a potential treatment for treatment-resistant depression and chronic pain relief. Today, ketamine is a controlled drug and is classified as a Schedule 3 substance, which means there is a risk for abuse, but the risk is lower than with Schedule 1 drugs or Schedule 2 substances. Other Schedule 3 drugs include codeine and anabolic steroids. On October 10, 2023, the FDA issued a warning stating that it has not approved ketamine for the treatment of any mental health disorder. In this warning, the FDA clearly states that it has not determined that ketamine is safe and effective for the treatment of mental health conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD).

PROS AND CONS OF MICRODOSING PSYCHEDELICS

Emerging research is investigating the use of psychedelics for the treatment of depression, anxiety, 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

The research on psilocybin remains mixed. Some studies point to potential benefits for the administration of this substance in a clinical setting while others show negligible benefits. On the positive side, 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.” Another research paper 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). On the other side, scientific research in Scientific Reports shows that although psilocybin may work in the short-term, its effects are not long term. In fact, depression returns in a majority of people four to five months after a dose of the drug. When it comes to side effects, a 2023 study in JAMA found that participants receiving psilocybin was linked to a higher rate of adverse events and more serious adverse events compared with participants who received a dose of niacin.  Downsides: Some people who ingest magic mushrooms also experience negative reactions, such as anxiety, panic attacks, paranoia, feelings of fear and depression, nausea, and numbness.

MDMA

MDMA may have some benefits for people with PTSD. 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.” That’s the good news. The not-so-good-news comes from a 2024 review in Neuropsychopharmacology. This review found that in phase 3 clinical trials, people receiving MDMA were 3.5 times more likely to experience adverse events compared to controls. Downsides: Anxiety, jaw clenching, blurred vision, nausea, 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 depression treatments, 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.” Animal studies have found that side effects of microdosing LSD can last for weeks and include hyperactivity, heightened aggression, and difficulty feeling pleasure.

Ketamine

Downsides: The effects of this mind-alerting drug are unpredictable and can vary from one person to another. In high doses, 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.

MDMA

experience feelings of connectedness and a lack of ego. 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,

LSD

working memory, visual information processing, 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.

IS MICRODOSING SAFE?

Although some research is pointing to potential benefits of microdosing, 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.

PSYCHEDELICS IN PSYCHIATRY

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.