In the last 50 years, psychiatry has made great strides in the development of therapeutic tools. New psychotherapy approaches, new medicines, and new medical device interventions have revolutionized the treatment of many disorders. A current area of research interest is the re-examination of psychedelic drugs and how they might be useful in the treatment of psychiatric disorders.
The “turn on, tune in, drop out” vibe of Timothy Leary and the recreational use of psychedelic drugs, particularly in the 1960’s, was often associated with “bad trips” and “burnouts.” The fledgling research, mostly with LSD (lysergic acid diethylamide), ceased in 1973 when the DEA reclassified these drugs as Schedule I, with “high potential for abuse and no currently accepted medical use.” These “club drugs,” used illegally at that time, included “acid” (LSD), “mushrooms” (psilocybin: O-phophoryl-4-hydroxy-N,N-dimethyltryptamine), “ecstasy” or “molly” (MDMA: 3,4-methylenedioxymethamphetamine), “blue caps,” or “buttons” (mescaline from peyote cactus), “angel dust” (phencyclidine), “special K” (ketamine), ayahuasca (a plant concoction containing DMT: dimethyltryptamine [“fantasia”]). Current research on the use of psychedelic drugs for various psychiatric disorders has been initiated in major institutions in the U.S. (Johns Hopkins, Yale, UC-Berkeley, and others) and abroad (Canada, Germany, France, Spain, Mexico, Brazil, Switzerland, etc.).
Recreational marijuana has been legalized in 19 states, Washington, D.C., and Guam, although standardized varieties and dosage forms have not been established. Cannabis for medical use is legal in most states. Medical indications include treatment for neuropathic pain, such as related to multiple sclerosis; tremors in Parkinson’s Disease; muscle relaxation; and glaucoma. It has also been studied in psychiatry for the treatment of anxiety, depression, and PTSD. Psilocybin is legalized for therapeutic use in Oregon. Ketamine is now FDA-approved for the treatment of refractory depression and suicidal impulses.
Although these psychedelic drugs have differing pharmacological effects on the brain, all have an impact on the serotonin receptor system which is implicated in symptoms of depression, anxiety, and psychosis. Typical positive psychedelic effects are increased sociability and feelings of openness, empathy, and trust. Dysphoric experiences include panic, fear, depression, paranoia, hallucinations, and feelings of unreality.
Psilocybin has exhibited positive effects in studies on obsessive-compulsive disorder, treatment-resistant depression, substance abuse (primarily alcohol and tobacco), and depression and anxiety in cancer patients. LSD has shown efficacy in depression and anxiety, especially when related to other medical illnesses. MDMA has shown improvement in anxiety associated with autism, and for PTSD. Studies are continuing to examine its utility in the treatment of headache and other pain syndromes and anorexia nervosa.
The clinical design involving these psychedelics includes close supportive psychotherapy. Critical introductory sessions prepare patients. Dosing is carefully monitored under supervision. Follow-up, integrative sessions are invoked. Although much work needs to be done, especially in the standardization of dosages, these drugs show great promise in the treatment of psychiatric illnesses. Some have quipped, “If you remember the ‘60’s, you weren’t there.” It now appears that remembering and restructuring some of the experimentation of that time will prove productive for future generations.