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  • Writer's pictureNick Allen

Psychedelics for mental health

Despite a wave of recent interest, the concept of utilizing psychedelics for mental health treatment is not new. As early as the 1970s, a group of psychologists in Oakland experimented with MDMA and “noted that their patients were better able to confront emotionally evocative and distressing memories.” Shortly after, MDMA and other psychedelics were categorized as Schedule I substances by the U.S. Drug Enforcement Agency (DEA). The DEA’s ruling meant that simply possessing these drugs could have severe consequences.


Simultaneously, the research into medical applications for substances like MDMA and psilocybin was essentially halted. Even worse, studies hoping to support the “war on drugs” claimed that psychedelics were neurotoxic. One such study, from notable researchers and published in the journal Science, claimed that a “common recreational dose” of MDMA caused “severe neurotoxicity” in primates. This paper was redacted when it was later discovered that methamphetamine, not MDMA, was used in the trials.


Now, nearly 50 years after their potential for patient care was noted, psychedelics are once again back in the spotlight. These compounds have been decriminalized in many municipalities, and several elite universities have established programs dedicated to studying their potential applications. The research that has been published so far is promising.


Most importantly, safety has been well-established despite the doubts cast by the war on drugs. A landmark study published in the Lancet in 2010 ranked the harm associated with various drugs (Figure 1). Psilocybin-containing mushrooms, LSD, and MDMA (ecstasy) were all in the bottom 5 for combined risk to the user and to others. Their quantified risk was dwarfed by that of commonly used substances including benzodiazepines, tobacco, and alcohol.

Figure 1: The harms of different drugs as quantified in a multicriteria analysis by the Independent Scientific Committee on Drugs (Nutt et al., 2010).


The data is also starting to pile up as it relates to the efficacy of psychedelics for treating a variety of mental health conditions. A phase 3 clinical trial published in Nature in October 2021 found that “MDMA-assisted therapy represents a potential breakthrough” for the treatment of post-traumatic stress disorder (PTSD). Another positive result came from the New England Journal of Medicine, where psilocybin proved to be as effective (if not slightly more effective) than the standard treatment for major depressive disorder.


It’s essential to note that the efficacy of these treatments does not come from the drugs alone. The trials supporting the use of psychedelics for mental health have paired them with therapy from a trained professional. While the mechanism of action is largely unknown, it is thought that psychedelics simply allow the mind of the user to be more flexible and responsive to therapy. For example, people experiencing depression or PTSD can have difficulty rewiring their minds to avoid negative thoughts. Psychedelics are believed to make the mind more labile, so that a trained therapist can then guide the individual towards a better mindset. As Rick Doblin, Executive Director of the Multidisciplinary Association for Psychedelic Studies (MAPS), says, “it’s not the drug — it’s the therapy enhanced by the drug.”


This combination approach is critical, but it is also a big part of why these substances are still not FDA-approved. Despite promising data, the FDA has not previously dealt with drugs that are so sensitive to “set and setting,” meaning the mindset of the user and the setting in which they take the drug. They cannot simply approve these compounds like any other — their usage outside of a very controlled environment could be ineffective or even dangerous. Instead, they have to approve the entire treatment process, including the drug and the corresponding therapy.


While hopes are that approval for MDMA will come by 2023, this regulatory barrier is one of a few remaining obstacles. Another is the fact that psilocybin and MDMA cannot be patented, meaning that pharmaceutical companies will not have an incentive to produce them at scale. Nevertheless, I am hopeful that these compounds will soon strengthen our ability to treat the mental health struggles that are so prevalent in our communities.


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