Psychedelic-assisted therapy in depression, addiction and death anxiety

This post reports on studies which have been recently carried out where psychedelic drugs (usually psilocybin, the active part of magic mushrooms) are given to willing and informed participants to try and reduce some of their suffering.

I summarise the main findings and implications of these studies, while also noting the limitations and caution needed around the use of psychedelic drugs.

Psychedelic-assisted therapy

Psychedelic-assisted therapy consists of a participant being fully informed and educated about what to expect during the psychedelic experience. While on the drug, they are accompanied by two therapists who are there to support them on their trip.

The setting is laid out in a particular way to encourage the person to have an inward experience and appropriate music is selected to help with the overall experience. All of this is done in a highly structured and thoughtful manner, attempting to maximise the benefits and minimise the harms.

Afterwards, people go through a debriefing process where essentially they are encouraged to extract out the meaning from the experience.

What do psychedelics do to the brain?

I have written about this here, but, in short, what psychedelics do is connect parts of your brain that usually operate separately.

For example, here is an image from a study of a brain operating under a placebo (top row) and a brain operating under LSD (second row):

When tripping, your senses interact, mingle, and connect in impossible ways in normal life. You see, hear, experience the world completely differently.

Psychedelics as entropy

Entropy is defined here as describing the uncertainty about the state of a system. Gas inside a container will have low entropy, we can measure and understand what is going on inside.

Release the lid from the container, the gas will escape and fly off in all directions. Entropy increases, and our ability to rationally predict where exactly that gas is becomes increasingly difficult.

Ingesting psychedelic drugs can be seen as introducing entropy to the brain systems.

A question arises: who could benefit from such a treatment?

Three candidates are considered here, which all fall under the umbrella term of "rigid thinking patterns"

Rigid thinking patterns and therapeutic value

The most compelling idea is that introducing entropy could be incredibly useful for people stuck in rigid thinking patters. The candidates are as follows:

1) Depression - is characterized by an overactive brain region called the Default Mode Network. This network is the home of the self, what we generally consider the feeling of "me" or "I". In depression, people overthink, ruminate, and evaluate themselves poorly across life. Life feels slow, like a shadow looms over them.

2) Addiction - describes the fact that some people develop an involuntary relationship to a certain behaviour or drug. They do this even when they know that it's bad for them. Because of this, addiction is much closer to a disease to be treated than a moral failing of the individual, since it is influenced massively by genetic endowment, brain structure, and social environment.

3) Death anxiety - simply, people have a terminal illness (they know they're going to die soon) and have anxiety about this

Psychedelics and depression

A 2015 surveyed 190,000 people in the USA about their psychedelic use and mental wellbeing. I'll let them speak for themselves:

"lifetime classic psychedelic use was associated with a significantly reduced odds of past month psychological distress, past year suicidal thinking, past year suicidal planning, and past year suicide attempt, whereas lifetime illicit use of other drugs was largely associated with an increased likelihood of these outcomes."

The studies using psilocybin to treat depression are going on right now in America and Europe.

3 months ago a study concluded using psilocybin to 20 people who on average have been living with depression for 18 years. They are classified as "treatment resistant" depression because they've tried antidepressants, talking therapies, and in general their feeling remains.

They state that:

"All patients showed some reductions in their depression scores at 1-week post-treatment and maximal effects were seen at 5 weeks, with results remaining positive at 3 and 6 months....The drug was also well tolerated by all participants, and no patients sought conventional antidepressant treatment within 5 weeks of the psilocybin intervention."

We'll find out the results of further studies in the next few years!

Psychedelics and alcohol use disorder (alcoholism)

Some researchers looked back at past studies where LSD was given to participants in the 1960s, and conducted a meta-analsis of these studies. The paper is attached below, but they concluded that the results obtained then (in the 1960s) were comparable to contemporary 21st century treatments.

These studies were not the best, and it's likely that their assessment is on the cautious side. We are now beginning to run better studies applying LSD and psilocybin to alcoholism, and again getting encouraging results!

A more recent paper concludes that the intensity of psilocybin's effects predicted decreases in craving and increases in less drinking, with no adverse effects. And that:

"These preliminary findings provide a strong rationale for controlled trials with larger samples to investigate efficacy and mechanisms."

Psychedelics and smoking

Psilocybin has also been studied to treat smokers. The smokers in the study are people who have been doing it a long time and have been unable to quit.

What the study found was that, after a high dosage of some psilocybin, 80% of participants had ceased smoking 6 months, and 60% cessation at 16 months.

For comparison, other interventions typically demonstrate less than 31% abstinence at 12 months, meaning that the effect psilocybin produced is the best anti-smoking treatment ever published.

Psychedelics and death anxiety

High doses of psychedelics seem to engender experiences people often describe as spiritual. The first research paper in around 35 years into psychedelics was done with terminally ill cancer patients who were generally struggling with their condition.

The researchers found:

1) the psilocybin session eased their anxiety and lifted their mood

2) 22 of the total group of 36 volunteers had a “complete” mystical experience after psilocybin"

Further research has shown there is relationship between spiritual experience on psychedelics and positive impact of the drug.

Specifically, the stronger the spiritual experience, the greater the benefit to the person.

Limitations and caution

1) Research into new drugs and treatments tend to produce overly positive results at the start because people are keen to publish the positive findings, while not publishing the negative

2) The studies so far generally use small sample sizes, which increases the likelihood of extreme results

3) The research recruits people in a highly systematic way, screening people out they deem to be at risk, so the findings are not simply generalisable to everyone

4) The conditions that the research is done is probably very different to how most people have taken psychedelics in real life. The biggest difference, perhaps, is the fact that the researchers have a therapist there listening to, monitoring, and supporting the person while they're tripping.

People are briefed for hours about what the trip will be like, what to expect, so they know what they're getting into. Afterwards, people go through a debriefing process where essentially they are encouraged to extract out the meaning from the experience.

5) Researchers are generally very cautious about their findings, because in the 1960s researchers were massively enthusiastic, and encouraged young people to take psychedelics with not much care or attention about how to use them.

Conclusions

Psychedelic-assisted therapy is growing a reliable body of evidence that suggests that, under appropriate conditions, these drugs can be therapeutically useful for people. In the case of reducing smoking addictions, it is the best result evert achieved.

New treatments tend to overexaggerate the effectiveness, and we need more time and research to demonstrate the true value of psychedelic drugs. For too long they were put into the category of illegal, but their positive impact for wellbeing - mental and spiritual - may be too big to ignore.

All drugs carry risks and trade-offs. Psychedelics are no different; risks can be managed and greatly reduced, but never fully eliminated. It's how we use them that matters.