Psychedelics refer to a specific class of hallucinogenic drugs that temporarily distort someone’s thoughts, perceptions, and overall mood. Psychedelics have been used recreationally and medicinally for thousands of years. However, research shows that usage has gone up significantly over the past decade, with an estimated 5.5+ million people reporting annual use(1).
The FDA has recently approved ketamine for treating severe depression, and it has also granted ‘breakthrough therapy’ status for psilocybin. The National Institute on Drug Abuse (NIDA) endorses that it ‘supports and conducts’ research to further advance a global understanding of such treatment(2).
Understanding Psychedelics
It’s believed that psychedelics work by changing how different parts of the brain communicate together. These interactions are composed of the default mode network (DMN), and this brain is most connected to internal self-awareness.
This may explain why psychedelics seemingly impact how people perceive themselves and others. Many people report that, after taking psychedelics, they feel more connected to the world around them, and this may result from this kind of interaction occurring within the brain.
When using psychedelics, it’s common for people to report:
- Heightened state of relaxation and calmness
- Sensory hallucinations, particularly with sight, sound, and touch
- Distorted sense of sensations (tasting sounds or hearing feelings)
- Dilated pupils
- Nausea and vomiting
- Loss of appetite
- Distorted sense of time, space, and individual awareness
- Dissociation and depersonalization
Bad trips may come with more significant symptoms of psychosis, paranoia, muscle spasms, and even unconsciousness. While rare, it is possible to overdose on psychedelics, especially if they consume too much, have a previous history of substance abuse, or have an underlying medical condition.
Below are the most common psychedelics:
Psilocybin: Known as ‘mushrooms’ or ‘magic mushrooms,’ psilocybin is organically found within specific species of the mushroom plant. Psilocybin causes hallucinogenic effects, and it can be ingested, cooked with other foods, or brewed into tea. The full duration of a trip lasts between about 4-6 hours. Psilocybin has gained significant popularity in recent years, as it has been used as a breakthrough treatment model for symptoms of treatment-resistant depression.
Also Read: Mushrooms and Depression
LSD: LSD is a hallucinogen, and LSD-assisted therapy refers to using controlled doses of the substance within a therapeutic environment. Sessions are conducted under trained providers with the focus structured on exploring thoughts, memories, and sensations associated with the current trip.
MDMA: Often known as ecstasy, MDMA is a synthetic hallucinogen that was primarily used as a party drug to keep people feeling alert and connected. In recent years, this substance has gained significant traction as a potential treatment option for severe PTSD. Recent studies have found that MDMA may reduce or eliminate PTSD symptoms for up to 4 years. In fact, researchers recently conducted a phase 3 trial (the first phase 3 trial of any psychedelic treatment), indicating MDMA’s effectiveness for PTSD. Over two-thirds of participants in a 90-person trial no longer met the criteria for PTSD(3).
Ketamine: Ketamine is an anesthetic that triggers a dissociative-like trance. Controlled microdosing on ketamine is done via IV infusions or through a nasal spray. Research shows that the effects tend to be immediate. People with treatment-resistant depression may notice a significant symptom reduction just hours after receiving the dose. However, there is no current research on the long-term effects of this treatment. To date, ketamine has been the most researched psychedelic therapy option. In small doses, ketamine shows efficacy in treating severe depression, with results lasting anywhere from 1-2 months(4).
DMT: DMT is also a naturally occurring compound in certain animals and plants. It’s also manufactured as a synthetic to produce hallucinogenic experiences. In recent years, DMT has been studied in smaller sample sizes. It has shown positive effects in reducing symptoms of treatment-resistant depression, although further research is needed(5).
Legal Considerations of Psychedelic Therapy
The U.S. Drug Enforcement Agency (DEA) primarily lists all major psychedelics as Schedule I substances, and they are currently illegal at the federal level. However, in recent years, certain states have made exemptions and decriminalization efforts.
For example, Oregon has legalized psilocybin therapy and California, Connecticut, and New Jersey have legislation supporting legalizing psilocybin as well. Today, many people, especially younger ones, support psychedelic therapy. It’s likely that legislation will continue to evolve over the next few decades.
All current psychedelic-assisted therapy is conducted within various clinical trials. Independent mental health professionals cannot legally administer these drugs or interact with them with their clients. However, they may engage in integrative or processing work if their clients choose to take these drugs independently.
An Overview of the Process of Psychedelic Therapy
Although research is continuing to emerge, psychedelic therapy may be beneficial in treating numerous mental health issues, including:
- Depression
- Anxiety disorders
- Substance abuse and substance use addictions
- End-of-life stressors
- PTSD and acute trauma
- Eating disorders
Psychedelics are not considered to be addictive. However, research shows psychedelics are generally not advised if any of the following conditions apply(6):
- Pregnancy or breastfeeding
- Uncontrolled blood pressure
- Cardiovascular problems or previous heart attack
- History of psychotic symptoms or significant dissociation
- Those with significant trauma histories without adequate resourcing and coping
While psychedelic-assisted therapy (PAP) has gained traction in recent years, it is still not a mainstream option. There are currently no federal programs allowing average healthcare providers to directly facilitate these services.
As mentioned, individuals interested in supervised psychedelic treatment need to consider participating in clinical trials. These trials are funded and tracked by private donors instead of the government, and acceptance rates tend to be low.
Currently, MAPS (Multidisciplinary Association for Psychedelic Studies) is the leading nonprofit organization connecting public resources, leadership, and individual providers toward legalized psychedelic use. MAPS focuses directly on promoting accessible psychedelic-assisted treatment options throughout the U.S.
The typical psychedelic therapy process will adhere to the following roadmap:
Consultation
Consultation entails obtaining a detailed overview of each individual’s present mental and former mental health symptoms. It’s equally important to establish a working baseline for the person’s current state of mind. This information helps professionals discern whether the individual is suitable for psychedelic treatment. Consultation can last one or several sessions. Throughout this time, individuals will be thoroughly screened, particularly to assess their physical and emotional well-being.
Safety Review
Both physical and emotional safety are critical in all phases of psychedelic therapy. As part of the informed consent process, individuals must be thoroughly debriefed about the risks and benefits of using psychedelics. If they decide
Drug Administration
Drugs may be administered in different forms, depending on the specific substance and the clinical trial itself. Ingestion can be done through tablets or capsules, although ketamine is given through infusions or nasal sprays. Specific dosages vary and are contingent on each individual’s symptoms and the type of drug itself.
Clinical Observations
During clinical trials, participants receive controlled doses of the designated substance under monitoring. Because psychedelic use is risky, this supervision fosters a sense of safety, and that safety is integral for increasing the likelihood of having a positive experience.
Integration
Experiencing psychedelics is one phase of treatment. Reflection and integration are key parts of connecting the treatment together. After the substance has worn off, a trained provider will unpack and further explore what occurred during the psychedelic experience. They may ask the individual what they hope to take away, what they want to spend more time focusing on in the future, or how they intend to integrate what they experienced into their daily life.
Aftercare and Continued Treatment
While psychedelic therapy can offer promising results, it isn’t intended to be a complete treatment. Many people benefit from having long-term aftercare, including therapy, psychiatric or supplemental medication, and implementing healthy lifestyle changes. Repeated psychedelic use may be discussed during this time.
Final Thoughts
Psychedelic therapy shows promising results, and it will likely evolve in dramatic ways over the next few decades. That said, in its preliminary phases, it’s important for providers and patients to be aware of its risks, benefits, and limitations. As with any treatment option, consult with your healthcare provider to discuss your specific symptoms and goals.
Sources
- https://www.publichealth.columbia.edu/news/new-study-estimates-over-5-5-million-u-s-adults-use-hallucinogens
- https://www.publichealth.columbia.edu/news/new-study-estimates-over-5-5-million-u-s-adults-use-hallucinogens
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10781106/
- https://www.yalemedicine.org/news/ketamine-depression
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10206108/
- https://psychedelics.ucsf.edu/blog/medical-contraindications-to-classic-psychedelic-use#:~:text=As%20a%20result%2C%20psychedelics%20are,attack%20or%20stroke%20%5B3%5D.
