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Expert Perspectives

The Latest Research into the Mental Health Benefits of Psychedelic-Assisted Therapy

By Shaun Francis, CEO, Medcan

Shaking off the stigma of previous decades, new treatments are displaying promising results in clinical trials.

The pandemic has drawn attention to mental illness—and the lack of effective drug treatments for many conditions. Existing therapies for such issues as depression and severe post-traumatic stress disorder (PTSD) are not as effective as health professionals would like, with 40 to 60 percent of patients not responding to the first-line pharmaceutical treatment for severe PTSD, according to one recent clinical trial. Major depressive disorder is thought to affect about seven percent of the population, with treatment-resistant depression affecting about a third of that group. And two-thirds of the people who receive treatment for bipolar disorder do not fully recover.

The poor results have prompted a search for new therapies. Attracted by promising clinical trials and the attention of popular culture, a growing number of researchers are studying such psychedelic compounds as MDMA, psilocybin and ketamine in clinical trials. The results are promising, prompting some to predict a future that sees patients visiting legal wellness centres for guided psychedelic therapies.

“There’s a lot of excitement about psychedelic therapies for mental illness,” says Dr. Jack Muskat, Medcan’s clinical director of mental health. “A number of clinical trials are being conducted under the guidance of researchers, and the initial findings indicate that these may provide an option to complement existing forms of therapy. Still, we remain early in the journey toward widespread therapeutic use.”

We explored the topic in a recent two-part series for my podcast, Eat Move Think, including my own conversation with Payton Nyquvest, CEO of Vancouver’s Numinus Wellness, a publicly traded company researching the efficacy of psychedelic therapies. Following is a summary of the most promising research happening at the intersection of psychedelics and wellness:

MDMA and severe PTSD

PTSD is often associated with military veterans but it actually affects a wide swathe of the population, with up to 9.2 percent of Canadians and Americans suffering from the condition, and the indigenous population 1.2 times more likely to experience its symptoms, which include anxiety, nightmares and suicidal ideation.

In a trial published this summer by Nature Medicine and led by San Jose’s Multidisciplinary Association for Psychedelic Studies (MAPS), researchers found that MDMA improved PTSD symptoms with an effect that was nearly twice as large as other first-line therapies. For the study, participants took MDMA, then were guided through their trauma by psychologists. After three sessions, 67 percent of participants no longer qualified for a PTSD diagnosis (in other words, they were cured). Also notably, 88 percent of participants experienced a significant reduction in symptoms. Now, Numinus is collaborating with MAPS on another study on MDMA-assisted therapy, in the hopes that the therapy could be approved by health regulators in the U.S. and Canada by 2023.

Psilocybin and substance abuse

Addiction rates have increased during the COVID-19 pandemic. A Canadian Mental Health Association survey of Ontarians earlier this year indicated that 27 percent were using more substances to cope. A small academic study provided promising indications that hallucinogenic therapies, such as psilocybin, the active ingredient in so-called “magic” mushrooms, may be able to help.

In the 2019 study, people experiencing alcohol addiction participated in one or two psilocybin-assisted therapy sessions, complemented by motivational support and numerous therapeutic sessions designed to prepare for, and debrief from, psilocybin use. Afterward, they felt fewer alcohol cravings, and reported an improved ability to abstain from it.

Scientists researching the interaction of psilocybin and alcoholism do not yet know for certain why the improvements are happening, but they do have their suspicions. CAMH psychiatrist Dr. Ishrat Husain, who studies psychedelic treatments for mood disorders, says there’s an indication that psilocybin can have “an antidepressant effect. In addition, psilocybin and the associated therapy may help to change some of the brain’s thinking patterns. “There’s a network in the brain called the default mode network,” he says. “When we’re in our own internal world, thinking about things or wondering how other people view us, that network in the brain is very, very active… It’s thought that psilocybin comes in and disrupts that network, so that we start afresh.”

To learn more, a larger compassionate-access trial for psilocybin to treat substance abuse disorders is underway. Scientists hope the study will lead to even larger research efforts, which could help determine the precise mechanism by which psychedelics treat alcohol abuse, in turn possibly opening up the therapy to other forms of addiction.

Psilocybin and depression

Treatment-resistant depression (TRD) describes a form of the mental illness that hasn’t responded to at least two different medications or therapies. People with TRD spend a lot of time and money attempting to improve their symptoms, without much benefit—and the futility of their efforts can worsen their symptoms.

For some people, psilocybin has broken that cycle. This year, a trial published in the New England Journal of Medicine indicated that psilocybin may be just as effective as the antidepressant escitalopram (also known as Cipralex or Lexapro) as a therapy for TRD. Notably, study participants said they preferred the psychedelic therapy because of the less-severe side effects they experienced.

A new, larger trial also is looking at psilocybin-assisted therapy for TRD, and researchers are hoping that it will lead to a widespread implementation of psilocybin-assisted therapy for patients with depression in the near-term future.

Ketamine and bipolar depression

Depression and bipolar disorder are closely linked, because the bipolar lows can bring on feelings of hopelessness and despair. Because of the way the “lows” come and go, bipolar disorder can be difficult to diagnose, and those who do receive conventional treatments often find them ineffective.

Now, an ongoing study conducted by the University Health Network (UHN) and Braxia Scientific is examining whether intravenously-delivered ketamine may help to treat the depression associated with bipolar disorder. While most depression medications target serotonin or dopamine, ketamine targets the neurotransmitter glutamate in a way that seems to bolster its effects in the prefrontal cortex. It also is thought to calm activity in the “lateral habenula”—the part of the brain responsible for our negative thoughts, worries and feelings of disappointment.

UHN and University of Toronto psychopharmacologist Dr. Roger McIntyre says that he considers ketamine one of the most exciting therapies in his field. “Ketamine has already been FDA-approved for depression, also FDA-approved for people who have depression and suicidal thinking—that is clearly an important milestone for people affected by debilitating and agonising disorders. This is a drug that has a romantic history, but developed safely and appropriately, it found itself in an area that can help many, many people.”

Wrapping Up

Many new therapies have been invented for mental wellness in the last few decades, but few of them work to the extent that we would hope. The search for better treatments has led scientists to a class of pharmaceuticals that has been maligned for decades: Psychedelics. Here’s hoping that the above studies, and many more, fulfil the promise for therapies that can cure some of the most intractable forms of mental illness.

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