Psychedelics as a treament for depression
What if we had the tools to change people's lives - but we're just not using it? (Dr Rachael Sumner)
Magic Mushrooms and LSD for depression?
Last month, I released one of the most interesting discussions on the Sense of Hope Podcast. Dr Rachael Sumner, a researcher from the University of Auckland, and I discussed the use of psychedelic treatment for mental health disorders.
It’s an odd conundrum - when I first heard about psychedelics for mental health issues - I was not at all convinced. Are we simply going to have a whole lot of people walking around high? With their head in the clouds getting nothing done? Is it a form of escapism?
Then, as a strange twist in how the universe works - I ended up working as a research nurse at the University of Auckland in the same lab where the psychedelic research was being conducted. I helped with a few of the studies.
I also took it upon myself to do a bit of reading on the subject - which included Michael Pollan’s ‘How to Change Your Mind’ - which as promised - changed my mind.
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Before I go on - let me tell you I am incredibly drug-naive. Apart from a ‘party pill’ that I took once or twice and one time when I nibbled on some leftover crumbs of a ‘weed cake’ - I’ve really not indulged. I’ve never seen the point. I also am not a big drinker (although have had my times). So stepping into the realm of ‘magic mushrooms’, ketamine, LSD and MDMA* is quite a jump to the other side.
I’ve no idea what this mushroom is - so please don’t use it for identification purposes!
What conditions are being treated with psychedelics?
Worldwide, psychedelic treatment has been studied in:
Addiction (including methamphetamine and alcohol)
Chronic pain.
Mental health conditions like treatment-resistant depression and anxiety
Post-traumatic stress disorder (PTSD)
Treating depression and anxiety in people living with terminal illnesses (eg cancer)
Future research is looking into PMS (Pre-menstrual syndrome) and PMDD (pre-menstrual dysphoric disorder) as well as OCD (Obsessive compulsive disorder).
Currently, the University of Auckland has studied: Psilocybin (magic mushrooms), LSD, MDMA and ketamine.
What does treatment with psychedelics look like?
The only way you can currently engage in psychedelic therapy (legally) is through research studies like the ones being conducted at Auckland University. They (believe it or not) are always looking for participants as the criteria for the studies are quite strict - so if you are tempted - have a look at their Facebook page.
There are two main ways you can participate in psychedelic therapy - one is to receive a big dose of the substance, under the supervision of health professionals in a lab-like setting (there are some studies currently looking at large dose treatments for methamphetamine addiction in a marae setting). The other is to have ‘micro-dosing’ - which you do yourself at home. This involves taking very small doses of the appropriate substance often every few days (sometimes daily).
The big dose of psychedelic medicine
The large dose therapy is likely the most risky - both medically and psychologically if not done well. However, the risks are actually incredibly low. There is the potential for a ‘bad trip’ - hence very important to have qualified therapists to guide you through. Some people may continue to have hallucinations in the days or weeks following the treatment - therefore people with any history of psychosis or a strong family history of psychosis are not advised to trial psychedelics. There are some possible physical issues such as temporary high blood pressure during the process.
The micro-dose of psychedelic medicine
Micro-dosing is probably the more popular ‘everyday’ use of psychedelics. Micro-dosing is most often used with LSD or psilocybin. The user can take small doses of the substance and continue their day as usual. They are not ‘high’ and can function as they normally would. There are very few associated side effects with this type of therapy.
Probably not so ordinary if this was LSD or Psilocybin!
Benefits over psychiatric medications
Psychiatric medications for depression and anxiety are not without their issues. On average, antidepressants work around 30 - 60% of the time. Sometimes one needs to try several antidepressants before getting the ‘right’ one - a process that can take several months. Often - they don’t work at all and the person is labelled as having a ‘treatment-resistant depression”. Or they leave the person feeling overall ‘dull’. The depression has gone, but so is the joy in their life (known as emotional blunting).
There are withdrawal issues - coming off some antidepressants is proving to be a significant problem. Other side effects might include weight gain, and loss of libido and long-term they are associated with increased risks of CHD (coronary heart disease), CVD (cardiovascular disease) and all-cause mortality (death). Some studies also point to an increased risk of osteoporosis with SSRI (selective serotonin reuptake inhibitors) use.
Drugs used to treat anxiety and addiction are often addictive themselves - and people need higher amounts to get the same results.
Results of using Psychedelics for mental health conditions
In the case of a single dose of psychedelic, the psychotherapy that occurs as part of the treatment is a critical component of psychedelic-assisted therapy. As is what is termed ‘integration’ - the processing that happens after the event.
In the JAMA, (see reference below) they discuss that a single dose of psilocybin resulted in a rapid, robust, and sustained reduction in depressive symptoms which can last for months.
The ketamine response is more short-lived and will need to be given more regularly - but has very few side effects, is safe and is a cheap form of medicine.
People describe feeling much more connected with themselves and others. Long-held feelings of guilt or shame disappear. The mind stops ruminating and it’s compared to having new ‘tracks’ for the mind to experience - instead of repeating the same old thoughts. Others have described it as like a big warm hug. Some people have spiritual experiences that completely resolve feelings of depression, anxiety and fear and feel a new sense of purpose.
The psychedelic allows feelings such as self-compassion, forgiveness, understanding, and self-acceptance to surface that can be powerful antidotes to shame, guilt, anger, isolation, disconnection, or other negative emotions that patients find difficult to discuss in therapy and that do not seem to be mitigated by traditional antidepressants. (JAMA - Psychedelic Therapy—A New Paradigm of Care for Mental Health.)
Before we all get high (kidding)
Before we all go out venturing to paddocks to collect our magic mushrooms (don’t) - there are some very important points to ponder. As always - we should always address the root cause for the mood or anxiety issue.
I am always keen to understand what is going on - and the first things we should be considering are:
Does the person have a vitamin or mineral deficiency?
Is the person eating a whole-food healthy diet (which we know is associated with improved mental health)?
Is the person in an environment that is contributing to their mood state (relationship issues, domestic violence, terrible work environment)?
How is their gut? Do they have issues with their gut microbiome which may be contributing to depression or anxiety?
Have they experienced significant trauma in their life and has this been addressed (with therapy)?
Another tool in the toolbox
The idea that we have a tool in our toolbox that is relatively low risk, provides positive results and that we are not using it is, in my opinion, cruel.
Although we have a lot more research to do - I can quite comfortably suggest that some of the current medications on the market have not had as much research as many of the psychedelic drugs have had. They certainly haven’t been around as long.
Like high-dose micronutrients - psychedelics may be another tool in our toolbox to treat depression, anxiety, addiction and PTSD - and another tool that we are yet as a society to embrace.
There is a lot we aren't addressing regarding mental well-being in our current medical model. In my opinion the New Zealand government should be supporting these studies whole-heartedly - psychedelics, vitamins, EMDR - all treatment modalities which research has been very positive about with very few side effects.
You can listen to the interview here:
*Ketamine is actually an anesthetic and classed as a ‘dissociative’ drug - MDMA is classed as an empathogen not a psychedelic.
References:
Coupland, C., Hill, T., Morriss, R., Moore, M., Arthur, A., & Hippisley-Cox, J. (2018). Antidepressant use and risk of adverse outcomes in people aged 20-64 years: cohort study using a primary care database. BMC medicine, 16(1), 36. https://doi.org/10.1186/s12916-018-1022-x
Bansal, N., Hudda, M., Payne, R. A., Smith, D. J., Kessler, D., & Wiles, N. (2022). Antidepressant use and risk of adverse outcomes: population-based cohort study. BJPsych open, 8(5), e164. https://doi.org/10.1192/bjo.2022.563
https://www.auckland.ac.nz/en/news/2020/04/21/psychedelics-on-trip-from-fringe.html
https://www.facebook.com/profile.php?id=100063748411949
Yehuda R, Lehrner A. Psychedelic Therapy—A New Paradigm of Care for Mental Health. JAMA. 2023;330(9):813–814. doi:10.1001/jama.2023.12900