Psychedelics in Medicine
By Jessica Holbrook, MSN, RN
Reports of depression and anxiety have been climbing steadily in the United States since the early 2010s. The COVID pandemic, social media, political stress, and the economy are often thought to be the causes of this rapid increase in mental health disorders. According to the American Psychological Association, up to 60% of people battling these disorders do not respond to the first-line treatment of SSRIs and psychotherapies.
As mental health across the nation declines, healthcare teams and patients continue to look for alternatives to typical antidepressant and anti-anxiety medications. One solution that has been gaining traction is the use of psychedelics in medicine. This solution is somewhat controversial, and healthcare providers need to have a good understanding of the risks and benefits of psychedelic use.
Psychedelic Substances
Psychedelics in medicine have the potential to relieve patient symptoms of depression, anxiety, and PTSD more quickly than traditional therapies. However, these therapies are not without risk. In most cases, more research is needed to validate the safety and efficacy of these substances.
Psychedelic substances used for the treatment of mental health disorders frequently include:
Ketamine
Ketamine is an anesthetic medication that is approved for surgical procedures. It both sedates patients and gives them pain relief during invasive procedures.
More recently, providers have started using low-dose ketamine for patients suffering from treatment-resistant depression. Patients typically receive 2-3 doses per week for several weeks, and then slowly taper off of the medication. Studies have shown that up to 70% of patients respond favorably to this treatment method.
MDMA - 3,4-Methylenedioxymethamphetamin
MDMA, also referred to as “ecstasy” or “molly”, is a stimulant that is similar to methamphetamine. It is a synthetic drug that causes feelings of happiness, alertness, and closeness to others. Current studies show that MDMA has the potential to be a good treatment for post-traumatic stress disorder.
Research into the effectiveness of MDMA is ongoing. In August of 2024, the FDA declined to approve the drug, stating that further research needed to be conducted. Patients interested in trying MDMA can enroll in research studies through many Universities and hospital systems.
Psilocybin - “Magic Mushrooms
Magic mushrooms contain psilocybin, a substance that can cause hallucinations, altered emotions and senses, and changes in perception of time. Research published in the Journal of Psychopharmacology has found that patients suffering from depression had relief for up to 12 months after using psilocybin and participating in psychotherapy to manage their symptoms. Psilocybin is not FDA-approved for use in the United States. However, studies examining these drugs' safety and efficacy are ongoing.
LSD
Lysergic acid diethylamide (LSD) is known for causing altered consciousness, mood, and sense of time and space. Many users claim that “microdosing”, or taking a small amount of the drug each day, improves their mood and cognition. While this is becoming a more popular practice, researchers at the University of Colorado found that LSD use was not beneficial for patients' mood, focus, or functioning.
Risks Associated with Psychedelic
Most research shows that treatment of mental health disorders with psychedelic medication is relatively safe when it is done in a controlled environment, under the supervision of an expert in the field. Dangers associated with these substances are often temporary and non-life-threatening.
Many providers agree that the greatest risk is that patients will self-administer these medications without any guidance about dosing, frequency, drug combinations, or aftercare. Negative consequences associated with the use of psychedelics include:
- Increased Suggestibility
- Affective Instability
- Altered Ego Structure
- Altered Social Behavior
- Altered Worldview
- Headache
- Nausea
The greatest risk to patients is that they suffer what is often referred to as a “bad trip”, where their alterations in consciousness lead to feelings of intense distress or fear. These usually resolve as the drugs wear off.
Most of these conditions seem to be well-managed when treatment is guided by a medical professional or psychotherapist with a good understanding of psychedelic medicine.
Dependence
Unlike other Schedule I substances such as methamphetamines and cocaine, psychedelics like ketamine, LSD, and MDMA have a low risk of addiction and dependence. Studies show that these drugs are “weakly reinforcing”, meaning that patients do not often crave more of the drug after it wears off, and are able to stop using the substance if it has a negative impact on their life. Patients using psychedelic medications do not report symptoms of withdrawal when they stop.
Drug Interaction
Research regarding psychedelic medications and drug-drug reactions is limited. Because of this, providers need to use caution when recommending the use of psychedelic medication to patients who are taking other prescription medications.
A meta-analysis published in the Journal of Psychopharmacology showed that psychedelics may increase or decrease the psychiatric effects of antidepressant medications, depending on the drug combination. No life-threatening or severe side effects were noted in the study.
The Future of Psychedelics in Medicin
Alternative therapies continue to gain popularity across the United States, and many of these new treatments offer hope to patients struggling with mental health disorders. While the FDA is often slow to approve new medications and laws are unlikely to change overnight, patients, providers, and their families continue to advocate for more effective therapies.
Interested in learning more? Explore our courses related to psychedelic medicine and psychopharmacology at NetCE.com:
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