This is the first in a series of blogs exploring emerging research into psychedelic compounds, such as psilocybin (the active ingredient in “magic mushrooms”) and 3,4 methyelenedioxymethamphetamine (MDMA, commonly referred to as “ecstasy”) as a means of catalyzing psychotherapeutic change.
You and your patients have probably been reading studies in the popular press about research using MDMA as a means of accelerating the process of psychotherapy for posttraumatic stress (PTSD). These small but impressive studies have been documented in the Journal of Psychopharmacology (1,2).
A recent article in the New Yorker by Michael Pollan (3) highlighted work underway at NYU, Johns Hopkins, and Imperial College, London, investigating how psilocybin, the psychoactive component of “magic mushrooms,” may be used to help patients to come to terms with anxiety at the end of life or to help them stop using tobacco.
For those clinicians who have only encountered these substances in the context of patients who are abusing them for their intoxicating qualities, these inquiries into the therapeutic potential of these compounds may seem bewildering, even reckless. David Smith, MD, the founder of the Haight-Ashbury Free Clinic in San Francisco, famously quipped that being a psychiatrist (with regard to intoxicating drugs) is like being an orthopedist at a ski resort—the casualties we witness lead us to believe that these drugs can only result in harm.
But what if, in a controlled clinical setting, these drugs could be used as a means of accelerating the psychotherapy change process? What if there was something about these drugs, if used carefully, with appropriate screening and guidance, that could allow patients to shift out of rigid, fixed thinking patterns? What if this shift, even temporarily, allowed a change to persist, well after the drug had worn off?
If this model were proven, we would be looking at a potential game changer in the field of psychiatry. Rarely, in psychiatry, do we cure any of the chronic conditions within our bailiwick. In general, our pharmacologic treatments are palliative attempts to address symptoms.
Fortunately, some of the conditions we treat are episodic, and do heal, and the treatments we provide can certainly accelerate that healing. But what if we could have the same satisfaction that our colleagues in infectious disease often have, of curing an illness? Wouldn’t that be exciting?
It’s important to recognize that this is not a new idea. Lysergic acid diethylamide (LSD), first synthesized by Albert Hofmann while working for Sandoz in 1938 and recognized for its psychoactive properties in 1943, was initially given to psychiatrists for careful use with patients who were not progressing in psychotherapy and to other researchers who were using it as a model to better understand psychosis (4). Many patients were treated, and hundreds of papers were (https://www.erowid.org/references/hofmann_collection.shtml) written about these studies before the drug became discovered and abused by the youth culture of the 1960s. By 1970, as a result of this widespread use/abuse, psychedelic agents were placed under Schedule I of the Controlled Substance Act, which meant that they could not be readily studied for any purpose.
This prohibition (on LSD and a similar, naturally occurring indolealkylamine, psilocybin), along with later prohibitions on MDMA significantly impaired efforts to research these compounds for therapeutic benefit. The bureaucratic hurdles created by the need for Drug Enforcement Administration (DEA) approval process made research into these compounds all but impossible.
But this is beginning to change, and a renaissance of cautious, methodical psychedelic research is upon us. Several studies attempting to treat a curious collection of maladies, as different as obsessive compulsive disorder (5), PTSD (6,7,8), anxiety at the end of life (9), and substance dependence (10,11,12) have been attempted and published. The results are preliminary, but promising.
It is important to note that these studies are very different than unregulated substance use outside a clinical setting. The same power that makes these compounds potential agents for change also presents risks for the unprepared or unaware. It should go without saying, but is important to note, that this is not to be tried at home.
Over the next 3 blogs, I will first present a model of mental illnesses that reflects what I call “diseases of excessive psychic rigidity” and why psychedelic-assisted psychotherapy may be helpful in healing them. I will also discuss the pharmacology and potential uses of MDMA and psilocybin. I will attempt to convey what clinicians need to know to understand this research and, if patients are interested, to be able to explain what we know and what we don’t know about these compounds.
If this topic interests you, I hope you’ll join me in San Diego at the US Psychiatric Mental Health Congress where I’ll be presenting a talk entitled “Re-imagining a brave new world: Can psychedelics be catalysts for therapy?”
References
1. Mithoefer MC, et al. J Psychopharmacol. 2011;25(4):439-452.
2. Mithoefer MC, et al. J Psychopharmacol. 2013;27(1):28-39.)
3. Pollan M. The Trip Treatment. The New Yorker. February 9, 2015).
4. Sessa B. The Psychedelic Renaissance: Reassessing the Role of Psychedelic Drugs in 21st Century Psychiatry and Society. London, United Kingdom: Muswell Hill Press; 2012.)
5. Moreno FA, et al. J Clin Psychiatry. 2006;67(11):1735-1740.
6. Mithoefer MC, et al. J Psychopharmacol. 2011;25(4):439-452.
7. Mithoefer MC, et al. J Psychopharmacol. 2013;27(1):28-39. ClinicalTrials.gov Identifier: NCT01211405.
8. Oehen P, et al. J Psychopharmacol. 2013;27(1):40-52.
9. Grob CS, et al. Arch Gen Psychiatry. 2011;68(1):71-78. ClinicalTrials.gov Identifier: NCT0095735),
10. Bogenschutz MP, et al. J Psychopharmacol. 2015;29(3):289-299.
11. Johnson MW, et al. J Psychopharmacol. 2014;28(11):983-992.
12. Garcia-Romeu A, et al. Curr Drug Abuse Rev. 2014;7(3):157-164.
Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. Currently, he serves as an Assistant Clinical Professor at the University of California-San Francisco School of Nursing. Mr. Penn is a psychiatric nurse practitioner with Kaiser Permanente in Redwood City, CA, where he provides psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He is a former board member of the American Psychiatric Nurses Association, California Chapter, and has presented nationally on improving medication adherence, emerging drugs of abuse, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice.
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.
