Psychedelics for depression and PTSD?
The Aztecs and Timothy Leary touted the psychological benefits of mind-altering psychedelic drugs. Now, science is finding out they may have been right.
Researchers are investigating the use of the mind-altering drugs psilocybin, for depression associated with advanced cancer, and MDMA, for post-traumatic stress disorder (PTSD). These drugs may also prove to be useful for other treatment-resistant psychiatric conditions. In fact, the entire December 2016 issue of the Journal of Psychopharmacology was devoted to the clinical utility of psychedelic drugs.
Psilocybin for cancer-related depression
Two small studies in this special issue of the Journal of Psychopharmacology looked at the effects of psilocybin, the active compound in what are commonly called magic mushrooms, on patients with advanced cancer who were experiencing depression and anxiety. The studies, from New York University (29 patients) and Johns Hopkins University (51 patients), found that treatment with a single dose of psilocybin, in combination with psychotherapy, led to an substantial reduction in depression and anxiety symptoms compared to a placebo. The benefit lasted up to eight months, with no serious side effects. These two studies were the most rigorous controlled trials of psychedelics in 50 years, according to the accompanying editorial.
Psilocybin was also shown to be safe and effective for treatment-resistant depression in a previous trial, published in The Lancet in 2015. But it included only 12 subjects.
Researchers are still not sure how psilocybin works. They speculate that a sub-type receptor for serotonin—the same neurotransmitter that many antidepressant drugs work on—is activated by the drug. But what would cause psilocybin to have the unusually long-lasting effect observed in the studies remains unclear.
MDMA for post-traumatic stress
The euphoric party drug 3,4-methylenedioxy-methamphetamine (MDMA), also known as Ecstasy or Molly, could be on its way to FDA approval for the treatment of PTSD. The FDA recently agreed to the start of a phase III clinical trial—the final step on a drug’s path to approval—for at least 230 patients. Researchers are so confident in the drug’s efficacy, they applied for “breakthrough therapy” status with the FDA, which could fast track its approval and availability to as early as 2021.
Eight million adults have PTSD in a given year, and 7 to 8 percent of people are likely to experience it sometime in their life, according to the Department of Veteran Affairs. In an unpublished study of MDMA-assisted psychotherapy, subjects diagnosed with PTSD were given either MDMA or a placebo during two eight-hour sessions, spaced drug three to five weeks apart. They continued with weekly psychotherapy in between. At a two-month follow-up, 83 percent of patients in the MDMA group no longer qualified as having PTSD, versus less than one-quarter of patients in the placebo (psychotherapy only) group. The benefits were maintained on average at a follow-up 4 years later, according to the nonprofit Multidisciplinary Association for Psychedelic Studies (MAPS), which funded the research.
Sexual assault victims, combat veterans, and police and firefighters were among the PTSD patients treated in two of six qualifying studies for the phase III trial. They had suffered from their PTSD symptoms for an average for 17 years, and none had responded to traditional prescription drugs or psychotherapy.
MDMA increases the release of the hormones oxytocin and prolactin, resulting in strong feelings of trust and compassion. This makes it particularly effective for a condition like PTSD. Trauma-based symptoms can manifest as nightmares, insomnia, and negative emotional memories and thinking, potentially leading to alcoholism, drug abuse, and suicidal ideation. Study participants reported that the drug not only helped them to face their painful memories, it helped them to kick other drugs and alcohol and put their lives back on track. The MAPS report notes that MDMA has been given to 780 clinical trial participants with only one serious adverse event.
Although some scientists worry that approving MDMA for medical use could increase recreational use, the potential benefit to PTSD patients might be worth that risk. PTSD is notoriously difficult to treat; experts estimate that some 30 to 40 percent of people suffering from PTSD don’t get sufficient relief from existing treatments, including cognitive behavior therapy, group therapies, and antidepressants.
Bottom line: While not ready for prime time, these psychedelic-turned-medical drugs—administered under medical supervision—show promise for people struggling with depression or PTSD for whom standard drug treatments and therapeutic modalities haven’t provided relief. If further studies confirm their benefits and safety, they could one day become a standard part of treatment for these and possibly other mental health conditions.
A final note: The conditions in these studies were strictly controlled and the patients meticulously monitored during treatment. These drugs should never be tried outside of medical monitoring. MDMA in particular has been linked to numerous adverse health effects, according to the NIH’s National Institute on Drug Abuse.