Introduction

What is psychedelic-assisted therapy?

Psychedelic-assisted therapy has, in recent times, become a thriving field as a potential new treatment for psychiatric illnesses. In the past several years, guided use of psychedelics such as 3, 4 methylenedioxymethamphetamine (MDMA) and psilocybin has been used to overcome multiple mental health hurdles.¹ This unconventional means of treatment provides an alternative method for individuals who have been unable to find relief through traditional psychiatric methods.

Brief history of psychedelic-assisted therapy

To fully understand psychedelic-assisted therapy, we must first understand its history. Psychedelics have been used in many cultures for centuries for spiritual and healing purposes. However, the first records of Western medicine applying psychedelics as a means of therapy were not noted until the mid-20^th century, specifically in 1950. Used most notably as aids to psychotherapy for the treatment of mood disorders and alcohol dependence, drugs such as lysergic acid diethylamide (LSD) showed initial therapeutic promise beginning in the 1960s.²

Importance of exploring psychedelic-assisted therapy

Today, with depression being one of the top five causes of disability, affecting about 5% of the population, and post-traumatic stress disorder (PTSD) having a global frequency of 3.9%, the importance of researching and exploring the potential of psychedelics cannot be overstated.¹ Psychedelic-assisted therapy offers medical professionals and individuals affected a fresh approach to their care, with studies already supporting its efficacy in dealing with depression, PTSD, and substance abuse.

It is also important to understand the ethical and regulatory issues that may arise while exploring the benefits of psychedelic-assisted therapy. By understanding both perspectives, this article aims to provide a comprehensive understanding of psychedelic-assisted therapy. This will allow you to make a more informed decision about the topic. It is important to note that a medical professional must be involved in the decision-making process, as well as the administration and oversight of anyone undergoing this type of therapy.

Understanding psychedelics

Definition and classification of psychedelics

Psychedelics, also known as hallucinogens, are a broad class of substances defined by their ability to induce altered states of consciousness, including changes in perception, thinking, and feelings.¹ While many compounds can be naturally found or made in labs, only a handful have been clinically studied and will be discussed in this article. Alongside LSD and psilocybin, dimethyltryptamine (DMT), is another common psychedelic.

Safety and risks associated with psychedelic use

While psychedelics show promise in terms of therapeutic benefits, we need to understand the risks associated with them, to allow safe use. While administering hallucinogens has certain psychological hazards, they are not thought to be drugs of dependence and are relatively harmless medically speaking.³ In terms of safety, classical psychedelics including psilocybin are considered well-tolerated and low-risk compared with standard treatments in psychiatry.¹ 

Potential side effects of psychedelics include anxiety and psychological distress. According to a large-scale study, no patients experienced serious adverse medical side effects.¹ Further studies have helped establish the safety of psilocybin by mentioning that it did not cause any serious negative physiological or psychological consequences.¹ However, these lack of risks come when psychedelics are used therapeutically, not recreationally. Under the guidance and monitoring of medical professionals, the risks are minimal.

Clinical applications

Now that the understanding of psychedelics is more clear, this section will discuss the clinical applications of psychedelics.

Treatment of mental health conditions

Depression

As mentioned previously, depression is a debilitating mood disorder and is one of the biggest disorders in the world that affects tens of millions of people. This makes it a clear target for psychedelic-assisted therapy research. Research studies have shown promising results, with psychedelic substances such as psilocybin. A study of patients with life-threatening cancer concluded that individuals showed a reduction in depression and anxiety symptoms, alongside improvements in their quality of life.¹ Research into heroin addiction used ketamine as a psychedelic of choice. The results showed improvements in anxiety and depression in both groups of people in the study using the psychedelic alongside psychotherapy. Furthermore, LSD and N, N-dipropyltryptamine (DPT) have also been administered alongside psychotherapy to help combat depression.⁴

Anxiety disorders

Anxiety disorders encompass all types of anxiety, whether they are social, generalised, or panic disorders. While managing depression, anxiety is often reduced alongside it, but in specific cases, psychedelics have been used to treat anxiety itself and have done so successfully. Studies state that psychedelics lead to significant improvements in anxious symptoms and increased emotional well-being.⁵ These improvements also increased with increased instances of psychedelic use, however, this showed a ceiling effect.⁵ Preferences for psychedelics were not observed, and one-off use also showed positive effects in individuals. Studies showed a lower mean of the general anxiety disorder scale (GAD-7) when comparing individuals' pre- and post-psychedelic use, and increased scores on the HERO wellness scale.

PTSD

PTSD is a disorder that occurs when a person has gone through a traumatic event. Psychedelics offer an alternative method for individuals where conventional methods, such as psychotherapy, may not be effective. Studies mostly use MDMA as their choice of psychedelic when treating PTSD and have reported a significant effect on PTSD symptoms.¹ A research paper combining multiple findings regarding the therapeutic benefits of psychedelics has pooled 4 studies regarding the use of MDMA to treat PTSD.⁴ All studies used a slightly varying dose of MDMA, but all reached the same conclusion, an improvement in symptoms. Two of the studies also found lower scores in analytical tests that can numerically portray the level of PTSD an individual is showing. This in turn has improved the quality of life and reduced the effects of trauma in individuals affected by PTSD.

Substance use disorder

Substance use disorders, including addiction to alcohol, opioids, and stimulants, represent another area of clinical application for psychedelic-assisted therapy. Research suggests that psychedelics like ibogaine and ayahuasca may help individuals break free from the cycle of addiction. In a study looking at opioid dependence and nicotine-dependent smoking, 50% of participants were reported as abstinent at 1-month follow-up in a study using ibogaine for opioid dependence and 92% of nicotine-dependent smokers were reported as abstinent at 1-month following the first psilocybin session.⁶ 20% of opioid users were abstinent after 6 months, while 80% of nicotine-dependent smokers remained abstinent in the same time frame.⁶ 

Lastly, a study that used psilocybin in combination with motivational enhancement therapy (MET) for alcohol dependence showed a decrease in drinking days from 42% to 12% during a one month period after the first session while days of heavy drinking decreased from 35% to 9%.⁶ Results showed roughly the same trends as prior studies after a 6 month period.

It is important to note that although the results in this section may seem extremely positive, not enough evidence has been acquired to suggest a strong relationship between the effectiveness of any of the psychedelics on any specific substance use disorder.⁶ Further research using better evaluation methods with larger sample sizes and longer-term follow-ups should be carried out for the best results and for more definitive conclusions to be drawn.

Future directions and implications

Psychedelic-assisted therapy remains in its early stages as a treatment in the healthcare industry. Therefore it is essential to discuss its future direction and any ethical implications it may present to individuals being treated and to society.

Potential integration into mainstream healthcare

While cultural and regulatory barriers remain, the slow acceptance and growing recognition of psychedelics as a healthcare method shows us a shift in the thinking around mental health and potential treatment options. As further evidence supporting the results and safety of psychedelics in a clinical environment is being brought to light, it is believed that further use of psychedelics as treatments will increase as time goes on. Further research and initiatives to decriminalise these substances will allow us to create a seamless integration of psychedelic-assisted therapy into healthcare.

Ongoing research and development

Ongoing and future research is the key to improving our understanding and improving the benefits that may be achieved from psychedelic-assisted therapy. One major area for future research is the generalisability of these clinical trials.¹ The large majority of participants in these trials are white individuals being treated in carefully controlled research settings.¹ This does not allow us to answer questions on whether people from all cultures will reap the same benefits. Moreover, the comparative risks and benefits of MDMA and psilocybin versus other novel psychiatric treatments, such as ketamine and various neuromodulation techniques, remain unknown. This raises new questions and possibilities for more research in the industry.¹ Additionally, as the mechanism of action of psychedelics is extremely complex, it is not fully understood yet. Therefore, research on how psychedelics work would help us gain a deeper understanding of them and disease processes.

Ethical and social implications

As psychedelic-assisted therapy increases in mainstream use and popularity, there will be questions raised about ethical and social implications. Guidelines, such as being transparent with patients, having their full and informed consent, and the duties of a doctor to do no harm and do only good will be key for the well-being of patients and the best possible outcomes. Ensuring that all psychedelics are administered professionally, and avoiding misuse, overuse/exploitation, and harm are key to public safety and responsible use guidelines. 

Summary

Psychedelic-assisted therapy, although an unconventional method, provides great potential for treating mental health disorders. An alternative, or a treatment used in conjunction with psychotherapy can be provided to individuals suffering from depression, anxiety, PTSD, and substance use disorders. It is important that you look at all of the information about psychedelic-assisted therapy and discuss things with your clinician before making any decisions about whether this is for you. 

While growing research continues to show promise in psychedelics as a method of treatment, to integrate psychedelic-assisted therapy into the mainstream, more clinical research with structure and ethical considerations must be considered to provide a better view of how psychedelics will perform on all types of people and be a potential transformative healing opportunity for many.