Could psychedelics be the future of mental health?

A resurgence in clinical trials and a new Netflix series are stoking interest in using psychedelics to treat mental health disorders. All Things Considered host Tom Crann talked to a researcher at the U of M about her work.

Jessica Nielson is assistant professor at the University of Minnesota's Department of Psychiatry and Behavioral Sciences, and she studies trauma and the use of psychedelics to treat it.

When talking about psychedelics, what are we talking about?

Psychedelics refer to a broad range of drugs that induce altered states of consciousness. Currently, the only legal psychedelic therapy that's available is ketamine. But there are other drugs that are currently Schedule I drugs — meaning that they're illegal and don't have any therapeutic potential — also being explored. This includes things like magic mushrooms, LSD, MDMA and ayahuasca.

What are people using psychedelics to treat?

There's currently research looking at MDMA to treat post-traumatic stress disorder. There are also clinical trials looking at psilocybin — which is the compound in magic mushrooms — to treat depression. And both of those are very well advanced into the clinical trial process and probably close to getting approved in the next couple of years.

There are some other smaller studies that are looking at different psychedelics to treat substance use disorders, obsessive-compulsive disorder, bipolar disorder, depression, anorexia, chronic Lyme disease, cognitive decline from Alzheimer's, cluster headaches, end of life and anxiety. And there's new studies popping up all the time. So there's quite a broad range of things that these could potentially be helpful for.

Is it like microdosing?

Not necessarily. The science of microdosing — I have my doubts about it, given that we haven't seen anything beyond what we would call a placebo effect where people don't know whether they're getting the drug or not. But mainly, what we're talking about in psychedelic-assisted therapy is really a higher dose, a psychedelic experience,

What's the most promising evidence?

Currently the most promising evidence is looking at MDMA for post-traumatic stress disorder. So this has recently, I think, completed a phase three clinical trial. A phase three clinical trial is what is needed as the final step, according to the FDA, for a drug to be approved as a treatment for a condition. And so that's important because once the FDA approves it, then the Drug Enforcement Administration (DEA) has to reschedule it so that it's no longer a Schedule I drug and providers are able to prescribe it to their patients. So that's the closest one we have to being approved, which will likely come through next year.

What's going on in the brain and the body with trauma that psychedelics help with?

Trauma is typically a deeply distressing or disturbing experience. And the traumas that lead to post-traumatic stress disorder are often those people who are exposed to death or threatened death. It's normal to have adverse reactions to these events. Most people will go on to not develop PTSD. But people can be vulnerable to developing post-traumatic stress disorder for a whole range of factors, including adverse childhood experiences, socioeconomic status, access to resources, psychosocial support after the event and engaging in effective therapy.

What makes psychedelics unique, especially MDMA right now, is that they're able to really get at the core of that trauma and the way that they responded to that trauma, and be able to engage with the memories and the fearful experiences of their traumatic experience without so much of what we would call a triggering response where they might be having a flood of adrenaline when they think about or talk about their trauma.

And what's so great about MDMA is that it's able to reduce that fear component so people can more effectively engage with the therapy and get their system out of this kind of fight or flight trigger response whenever they even think about their trauma.

What does the funding picture look like for this research?

Most of the psychedelic research is being funded by private donors that will give millions of dollars to different universities. There are also private foundations that offer grants, as well as different investment firms and venture capitalists and pharmaceutical companies that are starting to come into this space offering funding. But the main source of funding typically, for academic research like this, usually comes from the National Institutes of Health. And they have not supported a whole lot of research in the psychedelic research space.

There has historically been a congressional ban on funding research that will reschedule a Schedule I drug for therapeutic purposes. But the tide is shifting on this as the public perception changes and more evidence comes out. I'm hoping to see that this landscape will change significantly in the future with more federal funds going toward this research.

Is there resistance to this work — academically, pharmaceutically, culturally?

I think the main limitation is just sort of the public perception around perceived dangers that really isn't rooted in any evidence.

So the DEA can schedule anything they want, without any evidence. to say, “This is a Schedule I drug, it seems problematic.” But it takes 30 years of clinical trials to reschedule it down to a Schedule II or III to actually provide that therapeutic evidence.

If you look historically at the use of these compounds, these have been used by Indigenous cultures for thousands of years in religious contexts and ceremonial contexts, safely and effectively.

It's really just a limitation of our western system of needing all of this medical evidence to show that something is safe and effective when other communities have known this for thousands of years.

Who might this research help?

The clinical trials are suggesting that these are going to be beneficial for people with major mental health disorders like post-traumatic stress disorder, treatment-resistant depression or major depressive disorder, obsessive-compulsive disorder, substance use disorders and things like that.

Those kinds of patients really are going to have first access to these things. And that's where a lot of the evidence is being built to suggest that they could potentially be helpful and therapeutic for these conditions.

But there's a lot more research happening in healthy participants just trying to figure out how do these things work, how are they changing the brain, how are they able to induce these profound shifts in consciousness and able to induce such intense emotional release that is able to get people to have such profound healing experiences.

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