HealthThe 'psychedelic renaissance': science revives the therapeutic potential of psychoactive drugs |...

    The ‘psychedelic renaissance’: science revives the therapeutic potential of psychoactive drugs | Health & Wellness

    Psychedelic drugs are gaining ground in medicine. After decades in silence, cornered by prohibitive laws and the smear campaign of the Richard Nixon government in the 1970s, scientific research with MDMA, LSD, ketamine or psilocybin, present in hallucinogenic mushrooms, has flourished again to exploit its potential therapeutic mental health. There is already evidence on their side and the findings are now beginning to crystallize in clinical practice: the ketamine derivative esketamine is already being administered as a spray for people with resistant depression, and Australia has just become the first country in the world to allows prescribing MDMA for post-traumatic stress and psilocybin for depression. The experts consulted admit that the investigations with psychedelic drugs are “promising”, but the consistency of the benefits and the knowledge on how these therapies are to be implemented are still limited. And they ask for caution. They are not the panacea: they are not valid for everything or for everyone.

    They are ancient drugs. They have always been there. There are postpaleolithic cave paintings in Cuenca that suggest the presence of fungi with neurotropic effects (the Psilocybe hispnica); Mushroom petroglyphs resembling the fly agaric have also been found on large rocks in Siberia; and the use of almost 20 species of Psilocybe for shamanic rites in Mexico. Whether in leisure contexts or in healing rituals, psychedelic substances have never gone away, but now they are gaining more and more prominence thanks to science, says Joana Bauzà, a psychiatrist at the Sant Pau Hospital in Barcelona trained in MDMA-assisted therapy: “The latest investigations and the change in public opinion have led to the call psychedelic revival, where scientists recover these substances to treat diseases”, he points out. So much so, that the magazine Science recognized as one of the great discoveries of 2021 a work published in nature medicine that confirmed the efficacy of MDMA in reducing the symptoms of post-traumatic stress: two months after the therapy, 67% of those who received the psychedelic drug no longer met the diagnostic criteria for this disorder, compared to 32% in the group placebo.

    There is a list of candidates with therapeutic potential. Esketamine—a synthetic variant of ketamine, but without as many hallucinogenic and psychedelic effects—is already on the market for resistant depression. And the following ones that are postulated to be endorsed by regulators are those approved in Australia: MDMA in post-traumatic stress and psilocybin for patients with depression refractory to conventional therapies. But there are also studies to extend psilocybin to eating disorders or people at the end of life, and research with ayahuasca and DMT (derived from this plant) to prevent prolonged grief or depression. 5-MeO-DMT, which is extracted from the bufo toad, is also being tested for severe depression and the alkaloid ibogaine, found in the root of a Central African shrub, to treat opioid addiction. All of them, to a greater or lesser extent, alter the state of consciousness and act on various areas of the brain. “They act differently from classic antidepressants and have more immediate effects,” sums up Victor Perez, head of Psychiatry at the Hospital del Mar in Barcelona. His center recruited patients for an international psilocybin study that was published in the prestigious journal New England Journal Medicine: a single dose managed to reduce the effects of resistant depression.

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    In practice, psychedelic therapy is like a kind of trip. Patients live mystical experiences, there is an increase in the intensity of emotions, sensations of synesthesia, a dissolution of the ego, as if disconnected from the world, and they can revisit past experiences. “There is a higher capacity to connect ideas and memories,” adds Oscar Soto, a Vall d’Hebron psychiatrist and president of the Spanish Society of Psychedelic Medicine (Sempsi). With MDMA, for example, patients are able to revisit a traumatic situation without running away from it.

    They are not drugs with a high addictive potential, but Soto emphasizes that they must be accompanied by psychotherapy and support from professionals during the psychedelic experience. never alone “We know that the environment where it is taken and the preparation is essential. Music, for example, is important because it conditions a series of effects and in a psychedelic state in which the sensitivity to the environment is very high, it can be narrative, even cathartic”, he explains. You have to prepare a safe space and give the patient strategies to manage complex experiences on this psychological journey. The role of the therapist, who must have specific training to do all this, is to help navigate this experience: “The person is accompanied, so that they do not run away from what arises because it is very rich material to use later in psychotherapy” Soto adds.

    A vendor packages psilocybin mushrooms at a Los Angeles cannabis market.
    A vendor packages psilocybin mushrooms at a Los Angeles cannabis market. Richard Vogel (AP)

    What happens in the brain during these experiences is still being unraveled. There are changes in brain neuroplasticity and also neurocognitive. The same patient can live, with the same substance in two sessions, completely different experiences. “Classic psychedelics, such as LSD, psilocybin or ayahuasca, act on the 5-HT2A serotonin receptor. It causes a generalized depolarization of pyramidal neurons and causes various areas of the brain to be better connected, favors a greater flow of information, causes synesthesia, and mystical experiences may have to do with this dissolution of neurons. On the other hand, dissociative anesthetics, such as ketamine and esketamine, act on the NMDA receptor and cause somewhat different effects”, argues Soto.

    The investigation is still ongoing. Soto, for example, is recruiting patients for a study of psychotherapy-assisted ayahuasca for people in prolonged grief after loss. Rosa Duenas, psychiatrist and psychotherapist at the Parc Sanitari Sant Joan de Deu in Barcelona, ​​for her part, will also start a phase II trial in September with 5-MeO-DMT for resistant depressions: “This substance acts on serotonin reuptake receptors and, in Depending on the route of administration, they have a much faster effect: by inhalation, the effects appear in seconds and after 30 or 45 minutes, they already end. For it to be effective, it must be assisted by psychotherapy before and after [de la experiencia psicodelica]”, Explain. Preliminary trials with this substance, which originally comes from plants and a toad from the Sonoran desert, are “promising”, with up to 75% efficacy, says Duenas, but the studies are small and more research is needed to verify these success figures.

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    Controversial decision in Australia

    The experts consulted agree that the available evidence on the potential of these substances is “promising”, but there is still a long way to go. That is why Australia’s decision, which allows the prescription of MDMA and psilocybin from July 1, has been so controversial among the scientific community. In an open letter in the Australian & New Zealand Journal of Psychiatry, a group of researchers who study these substances rejected the decision. “Sufficient levels of evidence have not yet been generated to justify its large-scale implementation,” they argue. The scientists denounced that there are still questions to be resolved, such as which are the best models of psychotherapeutic care or how to differentiate the patients who would benefit the most: “Until these questions have been addressed in empirical research, the decision to increase public access outside of clinical trials is questionable, if not worrisome,” they warned.

    Bauzà, who is also a member of Sempsi, agrees that they should “have waited for more consistency and scientific evidence.” This therapy is not innocuous: “One of the biggest risks is that the potential of psychedelics is overestimated and that people read this and look outside to use it on their own and with untrained people. If it is taken in unsuitable environments and with unprepared people, the harmful effects can be very important, ”she warns. For example, they are not recommended for people with previous episodes or a family history of psychosis. “Another of the risks is re-traumatization if you live experiences that you cannot manage. You can also remember things that you did not remember and that can become traumatic and create a new problem. And another risk is that of worsening the disease if adequate control is not carried out ”, lists the psychiatrist from Sant Pau. Her center, which has an esketamine unit, will also participate in the study with 5-MeO-DMT.

    Not all substances have the same efficacy nor are they valid for everyone. Nor is anyone good to accompany on the psychedelic trip. “What happened in Australia could end in setback because if it is not implemented correctly, accompanied by good psychotherapy and infrastructure, it can lead to traumatic experiences,” Soto insists. Bauzà reinforces this message to the street: “It is not a panacea, it is a very important door that opens in psychiatry, but it must be explained that [las drogas psicodelicas] They are not the salvation for all ills”.

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    The psychiatrist sees Australia’s decision as “precipitated”: “When they were banned in 1971 it was for this: their use began to spread as a panacea and produced negative consequences and problems associated with consumption. And now we fear that the play will be repeated: we have been with a stigma and a huge lack of resources and now, by rushing, the same thing could happen again. The biggest challenge is not so much the efficacy of the substance itself, but how you are going to go about using it as a treatment.”

    unknowns to solve

    The investigations look good, but many doubts remain to be resolved, agree the scientists consulted. To begin with, it is necessary to corroborate the evidence on the efficacy of these substances in trials with more patients, clarify which profiles of patients will benefit the most and how the most beneficial psychotherapy should be. The appropriate therapeutic environment would also have to be set up, Soto maintains, with adequate infrastructures and training for professionals. And it is necessary to reinforce the ethical and deontological commitments to avoid abuses in the sessions, the psychiatrist refines: “The framework that guarantees patient safety must be very clear.” No violence, no sexual contact, and it is recommended that there are always two therapists, a man and a woman, and that the sessions be recorded. Risks must be minimized, Bauzà points out: “The code of conduct is super important, which differentiates the clinical part of the rituals. The patient has a part of consciousness, but decision-making is altered and whatever happens there has to be controlled. The person is very vulnerable and we have to protect them because we can do a lot of good, but also a lot of harm”.

    Perez also considers that, although the severe symptoms of dissociative symptoms caused by psychedelics were temporary in the trials and the drugs seem safe, “a long-term therapeutic model is lacking.” The psychiatrist knows that this substance will open a door for “patients who had no chance”, but calls for prudence. He himself has a patient on the waiting list who participated in the trials and “immediately improved”, but relapsed after a while. And he knows that these drugs can be an opportunity, but not before completing the research. “There’s not enough evidence to put that on the market,” he settles.

    With the hope of effectiveness on one hand and the deficiencies in the implementation on the other, the most “sensible” thing, agrees Bauzà, is to wait: “We are at stake a lot. We have been waiting for 30 years. It’s okay if we wait for something else.”

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    Source: EL PAIS

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