Psychedelics show promise as anti-depressants
NEW HAVEN — Psychedelics as a treatment for depression, obsessive compulsive disorder and other mental health conditions look promising, but there are still many questions to answer, say researchers.
Psilocybin, the active compound in “magic mushrooms” that produces an altered state of consciousness, is “something that’s really taking the field by storm,” according to Dr. Christopher Pittenger, a professor of psychiatry at the Yale School of Medicine and director of the Yale OCD Research Clinic.
“Having come in agnostic, I’ve become convinced,” Pittenger said. He said the promise of psychedelics is that, unlike anti-depressant medication, which must be taken for long periods of time, one session taking a drug such as psilocybin, which may last six to eight hours, may produce dramatic effects that last months or more.
“We don’t know that much yet,” Pittenger said. While it’s unclear who the drugs can and cannot help, “the excitement is that they really are helping people. … It’s really quite impressive.”
“With these drugs, you take them once, the drug’s out of your body by the next day, but the changes that that triggers in your brain or in your mind … reverberate and persist and can lead in some people to improvement in symptoms,” he said.
Pittenger said while he specializes in OCD, others, both in the medical school and elsewhere in the university, are studying hallucinogens’ effects on depression and alcoholism.
“One interesting question is, are the psychological effects necessary for the treatment?” Pittenger asked. “Do you have to feel oneness with the universe or strong psychological effects to get better?”
Dr. Deepak Cyril D’Souza, who has studied psychedelics used ceremonially by indigenous peoples, such as the Mazatecs of Mexico, said there are complications to conducting clinical studies of psilocybin.
“It’s quite a challenge to do clinical trials with these drugs,” he said. “They produce such profound effects, it’s very difficult to do doubleblind studies.” He said many more such studies need to be conducted.
The other issue is what D’Souza called “expectancy.”
“There’s a certain amount of hype that’s built around these drugs,” he said. “If you heard about how lifetransforming these drugs could be … it’s very likely that you could have an extremely positive response.”
That may not matter
Psilocybin, the active chemical in “magic mushrooms,” may relieve symptoms of depression in one session, but questions remain.
much if the patient is feeling better — it’s similar to the placebo effect, in which a sugar pill may be effective if the patient thinks it’s a medication. But, D’Souza said, “I’m interested in how these drugs work from a biological perspective. It’s really important for us to differentiate the true pharmacological effects of the drug from expectancy.”
Pittenger agreed more studies are needed and said many people who enroll in clinical trials are “highly motivated” to be relieved of their depression or OCD.
“If and when these substances become more broadly available, suddenly we’re going to get people who are bipolar or have schizophrenia, people who are using [recreational] drugs,” he said. “There’s a lot of excitement, but we’re also at this point where we need to be careful.”
When studying a drug, it also matters how it is administered, D’Souza said. “If we are developing drugs, we have to evaluate everything that goes along with the drug, because the entire package may contribute to whether the drug is working or not working,” he said.
Giving psilocybin to a patient is a complex process. According to Pittenger, “You get to know the person quite well; they get very comfortable with the staff and they sit in a comfortable chair.”
The session lasts six to eight hours, attended by two people. “We believe that they be in a space that’s not only physically safe … but also psychologically safe,” Pittenger said. “Often the emotions are very strong and … they need to know that when these dislocating things happen that they’re going to be taken care of.”
During what’s called “the peak experience,” which can last from 90 minutes to 21⁄2 hours, “there’s a feeling of disassociation, a coming apart of the sense of self,” Pittenger said. It may feel like a religious experience and involve “vivid visual images. Often memories will come up very strongly,” as well as intense emotions, he said.
It’s important to have people stand by to take care of any physical needs. Also, if patients start to have negative emotions, “when they open their eyes and talk to people, they tend to feel more grounded and oriented.”
D’Souza, who serves on the state medical marijuana Board of Physicians, has been studying psychedelics for more than a decade. “About 10 years ago, we published one of the first papers about a very powerful drug,” salvinorin, used by the Mazatecs in religious ceremonies.
“At the time we did the study there wasn’t as much interest in psychedelic drugs” as there is now, D’Souza said. Also, “about three years ago, we published the first study from Yale about psilocybin for the treatment of headaches.”
He and his colleagues also have studied dimethyltryptamine, which is used in “a brew that certain indigenous tribes in the Amazon use in a communal setting.” He also has a paper “that is currently in review by a fairly prestigious journal” about psilocybin’s effect on depression.
“I think it’s very intriguing that there’s a lot of anecdotal evidence — and I want to emphasize that — and some clinical trials that suggest that these drugs can have long-lasting effects on psychiatric disorders after one or two doses,” D’Souza said.
However, since administering the drug is preceded and followed by six to eight weeks of therapy, that can be an issue for people who don’t have adequate health insurance.
Other issues to be investigated are how large a dose is needed and “what magnitude of psychological effects you need for someone to benefit from these drugs,” D’Souza said. Also, “how long does someone need to experience these psychedelic drug effects? Its it going to be five minutes, 10 minutes, or does it need to be six hours?” he said.