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MENTAL HEALTH

mr peabody

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Plant medicines aren’t one-size-fits-all for mental health treatment

by Kelli Foulkrod, MS, LPA, LPC, RYT | Psychedelic Support | 23 Dec 2020

Psychedelics have the potential to heal many mental health ailments, but each plant medicine has its own strengths. Join Kelli Foulkrod, MS, LPA, LPC, RYT in learning more about the different properties of healing plants.

Indigenous healers understand that nature is the original pharmacy. Traditional folk healers and shamans can identify over 80,000 species of plants and trees in the rainforest, and have knowledge that each plant has medicinal, energetic, and healing properties. The industrial revolution and capitalism created a massive disconnection in Westerners from Nature, and we as a culture have forgotten that The Earth is here to help us heal.

Through working in the mental health industry in America for 19 years, I have learned that the approach for healing is based on a medical model, which uses synthetic band-aids for symptom management. In having the privilege to study with other cultures, I learned that the American mental health system is not healing or curing, but rather compartmentalizing treatments only focused on the brain and ego. Other cultures understand that to truly transform and heal from trauma, an integration of the body, spirit, and soul must accompany any treatment addressing the mind.

Over my career, I have learned as many tools and modalities to heal trauma and PTSD as possible. This is because when traumatic energy is stuck within the nervous system, it is not a one size fits all approach in moving the energy out. Many variables influence how trauma is digested; such as early childhood trauma, attachment and relationship trauma, chronic trauma, sexual trauma, a catastrophic event in nature, or unexpected death. Some psychotherapeutic modalities do not go deep enough to work with trauma from a body and psyche level. Luckily, because the Earth loves us, nature provides us with many different plant medicines to put the ego in the back seat in order to radically shift traumatic experiences.

Plant medicines for mental health

This article offers an overview of the specific functions of plant medicines in regards to common mental health concerns. Another article will need to address synthetic psychedelics. Please understand that these plants described below are not legal to use in America; however there are safe and legal ways to access these medicines by traveling to locations where these medicines are legal.

Mescaline Cacti

San Pedro is a cactus that grows in the Andes, Argentina, Bolivia, Chile, Ecuador, Peru, Mexico and Southern States in America. It is traditionally brewed and drank as a tea in a group ceremonial context during the daytime. It is a gentle medicine with masculine energy, often referred to as grandfather energy. The active psychedelic compound is mescaline, which is a phenethylamine, with receptor binding primarily at the serotonin 1A and 2B receptors, and dopamine receptors.

Mental health benefits include empathogenic or heart opening properties, gently taking down the walls around the heart to help with self-acceptance, compassion (to yourself and others), and healing of old wounds in relationships. It is my opinion that San Pedro is less popular because it has subtler effects; however the mental health benefits of addressing the psychological defenses around the heart center are very beneficial to common mental health concerns and traumatic memories.

Psilocybin mushrooms

Psilocybe cubensis is an entheogenic mushroom that grows naturally in some areas of the U.S., throughout Central and South America, Southeast Asia, and Australia. Psilocybe cubensis is a species of psychedelic mushrooms with active compounds of psilocybin and psilocin. Art as far back as 5,000 B.C. depicts cultures across all continents utilizing the mystical and healing properties of mushrooms.

The energetic properties of mushrooms are believed to work at opening the pineal gland, or third eye center, as well as re-wiring circuitry of the brain altered by traumatic experiences. Also known as “los niños”, mushrooms seem to activate the inner child dynamic to offer healing through levity and play. Psilocybin is a tryptamine that targets the the serotonin 2A receptor, and works by activating the same serotonergic system as SSRI antidepressants.

Mental health benefits demonstrated by current scientific research studies and clinical trials show dramatic improvements in treatment of trauma and PTSD, resistant depression, anxiety and OCD, addictive behaviors, eating disorders, and existential anxiety in cancer patients at the end of life stage.

Ayahuasca

Ayahuasca is a tea derived from a combination of the vine Banisteriopsis caapi and the leaves of the plant psychotria viridis. The vine contains a monoamine oxidase inhibitor, while the shrub known as chacruna (psychotria viridis) contains DMT. As a nighttime medicine, ceremonies are held at night in the dark and this is symbolic to the powerful effects the medicine has on activating the Shadow of the unconscious mind.

Often referred to as “la purga” (the purge), due to vomiting and diarrhea being a common experience during an Ayahuasca ceremony. This plant medicine is referred to as The Grandmother. A dieta, or cleansing diet eliminating inflammatory foods such as alcohol, red meat, coffee, and salt is required for the ceremony. Energetically, purging is seen as a positive and healing aspect of the plant, and it is believed that it can cleanse you on all levels; physical, emotional, mental, and spiritual.

Neuroscience brain scans have shown that Ayahuasca increases the neural activity in the brain’s visual cortex, and the emotional center, the limbic system, while also quieting the Ego, or default mode network and rewiring traumatic memories. Research has shown that it is an effective treatment for depressive disorders, anxiety disorders, and addictive behaviors.

Careful considerations for plant medicines

Just like there is not one model in psychotherapy that works for everyone, there is not one type of plant medicine that is a magic bullet for mental health concerns. It is my opinion that plant medicines and synthetic psychedelics are not suitable treatments for everyone. These medicines should be carefully considered, and the type of medicine matters.

It has been my experience that some individuals with dissociative symptoms in complex PTSD, specific personality traits, and certain cases of psychosis can actually have harmful experiences with psychedelics if too much of the psyche is dissolved, without adequate levels of integration. Proper preparation and integration is the foundational key to healing and transformation with plant medicines.

It’s my opinion that integrating the experience of the expanded state of consciousness is more important than the peak experience. While plant medicine ceremonies have become popular in the West, emphasis and focus is also necessary around emotional processing and articulating what insights and wisdom was earned with the expanded state. Please reach out if you have questions about how plants may assist in mental health treatments.

 
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mr peabody

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Mental health issues that don’t mix well with psychedelics

by Karla Ilicic | Healing Maps | 22 Jan 2021

Mental health issues are common these days, especially in the age of COVID-19, where psychedelics treatment has become more popular. Even before the pandemic, researchers and psychotherapists studied how these alternative drugs could help with things like depression, anxiety, PTSD, and addiction. It’s only natural to question whether or not there are some conditions that don’t mix well with these healing methods. Let’s find out.

Psychedelics are classified as hallucinogens, and, therefore, are a subject of legal disputes that are preventing future studies. Since the greatest problem is not knowing for sure how they’ll affect someone who’s dealing with serious a mental health condition, it’s hard to make a case for testing it on human subjects.

Existing studies mostly target depression, anxiety, PTSD, and addiction, and have shown promising results in all areas. This has led to the approval of multiple Phase 2 and Phase 3 trials, as well as legalization of the first psychedelics drugs-assisted treatment in the U.S.

Since even these studies and trials have been scarce, it’s hard to find a lot of information on other mental health issues, and whether or not any studies have been conducted or at least considered. Here are a few we know of.​

Psychedelics and Schizophrenia

Schizophrenia is one of the most serious mental health issues. It affects a person’s thinking, mood, and social functioning, and usually leads to an episode of psychosis. The changes in behavior can be gradual or abrupt and its symptoms generally fall under psychotic (hallucinations, delusions, thought disorders), negative (loss of motivation, willpower, reduced speech and emotional expression), and cognitive (problems in attention, concentration, and memory).

Symptoms can exacerbate, turn into something more persistent than episodic, and become disabling when left untreated. This makes it hard to function in everyday life. Schizophrenia is most prominent in the late-teen years to the early-thirties, and often emerges earlier in the male population.

Research

When it comes to psychedelic therapy, there have been several promising studies. That’s because hallucinogenic drugs have high affinity for serotonin 5-HT2A receptors, which is also the target of psychedelics.

Unfortunately, the number of studies is still extremely low, and the connection between the two is still difficult to fully understand. Therefore, the current mental health space needs more research to prove that treating depression and anxiety is a responsive strategy.​

Psychedelics and Bipolar Disorder

Bipolar disorder is another one of the more serious mental issues. By definition, it involves extreme shifts in mood, energy, activity levels and behavior. This results in manic episodes (a euphoric high), before crashing down into a depressive episode.
It exists in three most common types:​
  • Bipolar I Disorder. The most severe, with manic episodes lasting up to a week, and depressive up to two weeks.​
  • Bipolar II Disorder. Milder than the first category, and lasting for only a few days.​
  • Cyclothymic Disorder. Mood shifts in this category aren’t as extreme as those with bipolar disorders. People with cyclothymic disorder often function in daily life, though it can be difficult.​
Research

With its deep connection to depression and anxiety, it doesn’t come as a surprise that there’s a genuine interest in whether or not psychedelic-assisted treatment would help. The world’s first clinical trial relating psilocybin to Bipolar II disorder is commencing in 2021. It is under the guidance of researchers from the University of California in San Francisco and CREST.BD.

Scientists have shown interest in other studies using psychedelics for depression. However, more research is necessary to compare how psilocybin therapy benefits those with bipolar disorder.

Still, the biggest problem of psychedelics for bipolar disorder is the concern of “high” energy activity. This occurs when hallucinogens in the system, potentially, trigger mania or mood episodes. So, until further research comes with some definite conclusions, it’s hard to know whether the results will be positive or negative.​

Psychedelics and ADHD

One of the more common mental health issues, ADHD (or Attention Deficit/Hyperactivity Disorder), is having the problem of paying attention. However, it also may include the inability to control impulsive behaviors, or have unusually high levels of activity. It is most prominent during childhood, and often lasts into adulthood.

With the help of behavior therapy and medication, ADHD can be kept under control. However, the use of psychedelic intervention could potentially change these current treatment methods.

Research

A company called MindMed is exploring the impact of LSD and MDMA on ADHD, with Phase 1 trials beginning soon. The reason for combining the two instead of trying each one for themselves comes after a thorough research on how one’s negative effects can counteract the other one’s, especially as LSD’s stimulatory impact can potentially exacerbate the hyperactivity in ADHD.

Once again, we’re in a situation where we don’t know much due to lack of research and current findings. Hopefully, studies will yield results to further trigger exploration into the effectiveness of psychedelics for ADHD.​

Mental health issues & risks with psychedelics

Mental health issues are a large group of different illnesses that oftentimes have similar symptoms. However, treatment varies in each. It’s why thorough psychedelic studies and trials need to continue, so researchers can identify what is and isn’t working. Unfortunately, due to current lack of funding, it’s hard to work on simultaneous studies — even with some known side effects of psychedelics.

Therefore, currently, no one knows for sure which mental health issues don’t mix well with certain psychedelics. With more research, that will change. So, hopefully, the next decade will show the true promise of the future of psychedelics against common mental health issues. This will further highlight ways that these alternative drugs can be an efficient and effective tool for millions of people.

 
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mr peabody

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Mental health care is too expensive. Can therapy collectives help?

by Lauren Vinopal| MEL Magazine

They might not be completely mainstream yet, but they’re doing their best to make sure support for depression, trauma and anxiety isn’t only for the rich and well-insured.

I first heard about Open Path Collective last year when I was without insurance and looking for a therapist. For a one-time lifetime membership fee of $59, Open Path offers primarily teletherapy, which starts at $30 a session, depending on your financial situation. That’s not free, but it’s notably less than what therapy usually costs out-of-pocket — upwards of $100 an hour depending on where you live.

A positive of the pandemic is that it’s normalized teletherapy as well as made it more accessible, as a recent study found that 37 percent of U.S. counties don’t have any practicing psychologists. But as therapy from home has become more mainstream, the same cannot be said for the concept of collectives — groups of therapists who come together as independent contractors to collaborate and provide affordable and readily available counseling. Collectives have quietly surfaced over the past decade to address the ongoing mental-health crisis in the U.S. — the number of adults experiencing some form of mental illness increased by 1.5 million people between 2017 and 2018 alone — yet few know what they are and how they can help.

Collectives help address issues around affordability and access that have persisted since deinstitutionalization in the 1960s. When asylums shut down, mental health care was put into two distinct categories: 1) community mental-health organizations that serve people with severe mental illness (nonprofits generally funded by the state); and 2) private practices for more moderate cases, which require patients to have insurance coverage or a lot of extra cash. Collectives seek to fill some of the middle ground, as most people fall somewhere in between — i.e., they’re not sick enough to qualify for community mental-health services, but they also can’t afford to pay for therapy on their own. (Approximately half of people with a mental illness receive no treatment for it, and a study of more than 20,000 adults with depression found nearly half of them cited money as the reason.)

As for Open Path, since the nonprofit was founded in 2012 by psychotherapist Paul Fugelsang, it has matched over 40,000 people with affordable mental health care across the U.S. and inspired a number of other collectives such as the Chicago Therapy Collective, the BEAM Collective and the Therapist Collective. Open Path maintains a small support staff with their one-time membership fees, and pursues grants and other forms of funding. To be a part of the Open Path network, therapists are simply asked to take on just a single Open Path client for a reduced rate. “Our model takes what therapists have been doing in their local communities and scales it up to the national level,” Fugelsang wrote in 2017.

Nicholas Mancini, a Denver-based therapist, thinks Open Path has been very successful in creating “a great platform for people who want to seek services but don’t have insurance.” He joined the Open Path network about three years ago when he was making the transition from community mental health to private practice. Working alone, Mancini was lonely and missed bouncing ideas off a team. He could’ve joined a group practice or a private practice that employs multiple therapists, but at the expense of his independence. A collective like Open Path allowed him to be a part of a community of therapists, but with the freedom of an independent contractor. Embracing teletherapy helped him provide some sessions at a reduced rate and grow his private practice of full-price customers at the same time.

Open Path was such a positive experience for him that last year, Mancini co-founded a collective of his own with fellow counselor Eric Hilborn. “We started Collective Counseling Solutions to help bridge that gap, and to help other providers in private practice feel like they have a community of support, while also honoring their independence and autonomy,” Mancini tells me. After only a year, they’ve grown to 20 mental-health professionals across 10 different locations nationwide.

Again, in terms of pricing, the model of a collective gives Mancini the freedom to have a sliding scale that meets people where they’re at — without putting themselves out of business. “There’s a couple people I see for free, and there are some people I see for our full rate,” Mancini says, adding that a full-price session is $165 out-of-pocket and $175 for the initial intake. When he’s at capacity or not a good fit for a person’s needs, the collective gives him a pool of colleagues to pull from, increasing the likelihood that the patient will receive care.

While Open Path is reserved for people without insurance coverage, Mancini decided to work with insurance companies because he thought the collective could reach more people that way. In addition, dealing with insurance companies was what he struggled with the most in his private practice, so he wanted to help other therapists navigate the process. In order for therapists to bill insurance companies for services, they first have to be accepted to a panel in a process known as “getting credentialed.”

However, individual therapists starting new practices can get denied for reasons that have nothing to do with their licensure, education or ability, and more because of administrative errors, deadlines or capacity issues.

Among other ethical reasons, this is why many private-practice therapists don’t take insurance — they can’t. One loophole is that individual therapists don’t have to bother with getting credentialed if they’re part of a group or collective that’s already approved, which takes a massive administrative task off of their plate and incentivizes them to join.

Yet, as proud as Mancini is of the collective he’s built, he doesn’t think more of them are the answer to fixing the mental-health crisis. At least not until people stop treating therapy like a dark secret, and the stigma around mental-health treatment is better addressed through education and media.

To that end, Mancini encourages his clients to talk about their experience with therapy to whatever extent they feel comfortable, because it could help someone else. "The goal is to make going to a mental-health provider like going to the doctor and getting an annual physical. It’s part of your overall wellness,” Mancini argues. “The question isn’t about more collectives, but about how do we as a nation address mental health?”

 
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mr peabody

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Tripping out of depression: Overcoming mental health disorders with psychedelic drugs

by Pailin Chiaranunt | Impress Magazine | July 20, 2018

You’re in a hut in the jungle, the music of wildlife and aroma of smoking herbs permeating the air. The shaman, dressed in traditional Amazonian garb, hands you the brownish sludgy concoction called ayahuasca. As you drink it – the nastiest, most foul-smelling thing you’ve ever had – the shaman begins singing, calling out to the “spirits of the jungle”. The purging begins: your stomach churns, you sweat profusely and vomit intensely, your skin burning like literal hell. And then it hits. You see yourself melting away, dissolving into the universe, and you relive your life, re-experiencing all your childhood traumas and repressed emotions, the past fusing with the present, until there is no more sense of time nor self. In what feels like multiple lifetimes, you finally awaken a few hours later with a sense of overwhelming tranquility and bliss the likes of which you’ve never felt before…

Such an experience may seem an unconventional and perhaps “unscientific” method of treatment for mental health disorders. Yet psychedelic drugs have recently garnered renewed interest in both the public and scientific communities for their potential therapeutic effects on major depressive disorders (MDD), anxiety disorders, and addictions. The allure of these “enlightenment” drugs is certainly understandable, given the growing incidence and awareness of mental health disorders coupled with the inefficacy of current medications.

The difficulty in finding effective medication for mental health disorders stems from our weak understanding of the pathophysiology of these conditions. For example, there currently exist multiple theories for depression, including monoamine deficiency, neuroinflammation, and dysfunction of the neuroendocrine system. Medications aim to address each of these biological pathways in a rather reductive manner. Despite their low efficacy and plethora of adverse effects, selective serotonin reuptake inhibitors (SSRIs) are still the first line treatment for MDD. In fact, traditional antidepressants have either no effect or adverse ones in a whopping 1 of every 3 patients.

Furthermore, depression is not simply a neurological disorder; social and psychological determinants play a significant, if not primary, role in its pathogenesis. Studies have shown strong correlations between childhood trauma and adult onset MDD, as psychologists suggest that patients develop ingrained behavioural patterns that contribute to depression. Certainly, the heterogeneity of depression itself presents additional challenges not only in how we diagnose it, but also in patients’ responses to different treatments.



Enter psychedelic drugs, which proponents tout as a potential cure for mental health disorders. In contrast to harmful drugs such as alcohol, cocaine, or heroin, psychedelics are neither addictive nor acutely toxic. Human brain functional magnetic resonance imaging (fMRI) studies indicate that psychedelics function by fundamentally changing the architecture of the prefrontal cortex via neurogenesis and induction of novel neural pathways. However, how these changes alter mood and induce hallucinations remains unclear. Some studies suggest neuronal excitation creating transient neural scaffolds is involved, while others demonstrate decreased activity in the brain’s key connector hubs to enable unrestrained cognition.

Of course, the hallmark of psychedelic drugs lies not in its pharmacological actions, but in its phenomenological effects on the user. Despite their similar mechanisms, each type of psychedelic has different methods of administration, hallucinogenic effects, and public perceptions, all of which influence the experience itself and post-trip outcomes. It is important, then, to differentiate the history and uses of each drug for a more nuanced understanding of their therapeutic potential in different mental health disorders.

LSD) was first synthesized in 1938 by Swiss chemist Albert Hofmann. Its psychedelic effects were uncovered after the chemist accidentally ingested it, and in 1947, LSD was introduced as a psychiatric drug to treat alcoholism, neurosis, and schizophrenia. Since then, the drug has been used in an infamous CIA mind control program Project MKUltra, endorsed as a route towards consciousness expansion, touted as “the next big thing” in psychiatry, and prominently featured in the arts and music scene of the 1960s. During this period, LSD became a popular recreational drug, and its association with the counterculture hippie movement prompted the United States government to outlaw the drug in 1968, despite its therapeutic potential and lack of harm or abuse risk. The turn of the 21st century saw a resurgence of research into LSD for psychedelic therapy.

LSD is typically processed into strips that can be placed on the tongue for ingestion. Trips start within 20-30 minutes of ingestion and can last from 6 to 12 hours in a dose-dependent manner. While trips are highly variable and context-dependent, an early clinical study describes them as “psychic states in which the subject becomes aware of repressed memories and other unconscious material”, and anecdotal reports include descriptions of visual hallucinations, synesthesia, and ego dissolution. In terms of medical efficacy, randomized controlled trials have shown beneficial effects of LSD-assisted psychotherapy on alcoholism and on anxiety associated with life-threatening diseases, without any acute or chronic side effects.

Psychedelic mushrooms are a group of fungi that contain psychoactive compounds such as psilocybin, psilocin, and baeocystin. Mushrooms became popularized in modern Western culture after the American mycologist R. Gordon Wasson participated in an indigenous psilocybin ritual in Mexico and publicized his experience in 1957. As with LSD, psilocybin was heavily studied in the 1960s for its therapeutic potential and similarly outlawed by the end of the decade.



In contrast to LSD, psilocybin induces different hallucinogenic experiences. Mushrooms are typically eaten, brewed into tea, or taken in pill form, with trips lasting 3 to 6 hours. Shroom trips have been described as “more giggly than LSD”, during which visions are more saturated, “mundane aspects of life can become comical”, and one’s sense of self disintegrates. Given its relatively mild psychedelic effects and weaker social stigma, it is not surprising then that the scientific community is now turning its head towards psilocybin.

Recently, open-label feasibility studies indicate one to two doses of psilocybin in conjunction with therapy can assist in treatment of alcohol dependence and treatment-resistant depression for up to nine months. Similar results were found on patients with anxiety associated with advanced-stage cancer, obsessive-compulsive disorder, and substance addictions. Nevertheless, these studies have extremely small sample sizes, and definitive conclusions cannot be made due to their absence of placebo-controlled groups. To address these issues, Imperial College London has recently established a Psychedelic Research Group, with upcoming double-blind randomized controlled trials on psilocybin treatment for MDD.

Ayahuasca, Quechuan for “vine of the spirit”, is a psychotropic brew traditionally used for spiritual and therapeutic purposes in Amazonian indigenous populations. The concoction, made from the Banisteriopsis caapi vine boiled with leaves from the Psychotria viridis shrub, contains the powerful hallucinogen N,N-dimethyltryptamine (DMT) and monoamine oxidase A (MAO-A) inhibitors, which allow the former to bypass gastrointestinal degradation and enter the circulation and central nervous system. Interestingly, DMT is the only known psychoactive compound that is naturally found, albeit at low levels, in the human brain.

Unlike LSD and mushrooms, Ayahuasca-induced psychedelic experiences seem much stronger and more spiritual in nature, with stories of users going through “hell”, seeing horrific visions, reliving traumas, and talking to the plant itself, before emerging with a sense of bliss and newfound understanding of one’s place in the world. Physically, Ayahuasca users usually undergo vomiting, diarrhea, and tachycardia, considered to be a necessary purging. Although the Ayahuasca experience may not appear to be a very pleasant one, multiple self-reports of long-lasting psychological improvements suggest the plant may be worth a deeper look.

Psychological guidance is a major part of Ayahuasca ceremonies, with a shaman typically guiding users physically and emotionally. This guidance throughout and after the Ayahuasca experience is vital for the healing process and has been implemented in the clinic. In 2010-2011, Canadian physician Dr. Gabor Mate successfully treated multiple addiction patients at his Vancouver-based clinic with Ayahuasca and guided therapy, helping them to work out their past traumas to get to what he believes is the root cause of many addictions. This approach is widely used in many Ayahuasca retreats in South America, where the drug is legal for spiritual use. To date, researchers from the University of Barcelona and University of Sao Paulo have found significant improvements in addiction patients who received Ayahuasca treatment in preliminary studies. These findings have prompted neuroscientists in the United States to seek government approval to bring this traditional brew to patients in North America.

While preliminary research into psychedelic therapy looks promising, these results should not be interpreted as an endorsement for psychedelic drugs as self-medication nor as recreational use. Most studies so far have been small open-label trials that often do not include placebo controls, have extensive exclusion criteria, and have not measured the long-term outcomes of psychedelic treatment. Appropriate administration, psychological guidance, and extensive support, both during and after the experience, are extremely important; it’s been shown that the psychological context and expectations during the acute psychedelic experience can predict long-term outcomes on mental health.

What this ultimately points to, however, is the need for further research, which is currently restricted by social stigma and the legal status of these drugs. A common thread in the most researched psychedelic drugs is the experience of reliving past traumas and integrating those reflections into reinventing oneself. It is crucial that we look past preconceived notions of these psychotropic plants, which have arguably co-existed with, and helped, us since prehistoric times. In a society that is growing evermore disconnected with the world, perhaps it is time we look deep into our roots and journey back into our interconnected experience of life with nature.

http://www.immpressmagazine.com/tri...ntal-health-disorders-with-psychedelic-drugs/
 
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Psychotic- vs. psychedelic-induced hallucinations: A closer look*

Are there more differences than similarities?

by Jose Alexandre Salerno, MS | Psychedelic Science Review | 17 Mar 2021

The perception of the senses is partially driven by the past experiences, the thoughts at the moment and the expectations for the future, in what is called top-down brain processing. This means that the minds’ background influences how senses are perceived. Thereupon, the sight can play tricks on the brain and vice-versa. For example, it is not uncommon to see shapes that look like objects and things that are not really there.

Interestingly, these experiences fit reasonably into the definition of hallucinations, which is the perception occurring inside the brain in the absence of the corresponding external stimulus. It is true that hallucinations are frequently correlated to psychotic disorders, which makes sense since it is one of the five remarkable symptoms of diagnostic criteria for them.1 However, it is not an exclusive feature of brain malfunction and can be experienced by healthy subjects.

Physicians have proposed in the past that the altered state of consciousness induced by psychedelics could share neural mechanisms and clinical features with psychosis, constituting – therefore – a reliable “model of psychosis.” This theory was fairly well accepted by mainstream culture and even among specialists for some decades. LSD, upon its discovery, was given to people and self-administered by doctors in order to mimic psychosis and better understand it. However, a deeper look into the neurobiological and phenomenological perspectives about hallucinations reveals that they are more nuanced than previously believed regarding the related mechanisms underlying these two experiences.

The two experiences compared using different approaches

The first thing to pinpoint is that it is not completely clear whether synesthesia and synesthesia-like experiences qualify or not as hallucinations. That would be a distinctive feature since they occur very often under serotonergic psychedelics but are quite uncommon in psychotic episodes. Synesthesia is characterized by the blending of the different senses producing the sensation of a different modality, such as hearing shapes and tasting colors.

In terms of the consensual definition of hallucinations, the most common modality in schizophrenia is by far the auditive one, whereas psychedelic-induced hallucinations occur mostly for visual processing. When present, visual hallucinations in schizophrenia are highly detailed and concrete, typically reproducing faces and events from real life. On the other hand, psychedelic-induced visuals are often elementary (fractals, spirals, cobwebs, and geometric patterns), although sometimes more complex hallucinations can occur under higher and heroic doses. However, people under psychedelics usually preserve the acknowledgment about the etiology of hallucinations and can distinguish between drug effects and reality whilst schizophrenic patients lose their self-monitoring of reality.

The molecular mechanisms underlying schizophrenia at the neurotransmitter level are not completely understood by pharmacologists. But, they are known to be mostly linked to dopamine signaling, while psychedelics are use mostly serotonin receptors. Still, some psychedelic drugs mimic certain aspects of schizophrenia, especially paranoia.

A couple of antipsychotics were discovered empirically in the past by their assumed ability to neutralize LSD effects, supporting psychedelics as a model for psychosis. However, LSD also interacts with dopamine receptors, and serotonergic-only high-affinity antagonists show little or no efficacy as antipsychotics. Therefore, if the mechanisms were exactly the same, some psychedelics that act only at serotonin receptors (such as phenethylamines) would not induce hallucinogenic experiences. Moreover, a compound named ketanserin (serotonin receptor blocker) effectively abolishes the psychedelic subjective experience and has little effect on dopamine receptors.

When it comes to brain imaging studies, the differences and similarities between these two phenomena become foggy. The onset of hallucination in schizophrenic patients is correlated with hyperactivity within associative cortices related to the hallucinatory modality (i.e., auditive, visual, etc) rather than primary sensory cortices. LSD and psilocybin seem to induce the opposite – overactivation of primary cortices and reduced association. However, both psychotic- and psychedelic-induced hallucinations are associated with reduced stability of functional brain networks, such as the disintegration of resting-state networks. Recently, a comprehensive speech analysis pushed away the kinship between psychedelic-induced and schizophrenic behavior using machine learning algorithms. Computational modelling now can help to make inferences about the shared mechanisms and clarify whether or not psychedelics trigger psychotic-like hallucinations.

Concluding remarks

In summary, there are probably more differences than similarities underlying psychotic and psychedelic-induced hallucination experiences. It cannot be overlooked that the social stigma and political constraints – that marked the whole history of psychedelics in modern western culture – can shape the general thinking of these drugs as harmful for brain health and devoid of therapeutic value.

It is important to mention that when analyzing answers from more than 135,000 respondents of the US National Survey on Drug Use and Health (NSDUH), individuals who declared having used a “classic” psychedelic at least once were not at increased risk of developing mental health issues, including schizophrenia, psychotic episodes, and suicide attempts.

Psychedelics are believed to be useful tools to treat neuropsychiatric conditions and visual hallucinations are part of the insightful experiences that some argue being necessary for therapeutic effects. Still, the promising therapeutic potential and possible differences between psychosis- and psychedelic-induced hallucinations do not refute the strong contraindication for patients with psychotic disorders or predisposed to developing them.

*From the article here :
 
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LSD could be the key to alleviating the mental health crisis*

Foundation for Economic Education | 9 Jan 2021

The general public is starting to warm to the idea that psychedelics, just like marijuana, should be legalized, or, at the very least, removed from the Schedule I list.

On April 16, 1943, a Swiss chemist by the name of Albert Hofmann accidentally ingested a drug he created five years earlier while working at Sandoz Laboratories (now a subsidiary of Novartis) and began to experience very unusual sensations and hallucinations. He later described this altered state of mind as “a not unpleasant, intoxicated-like condition characterized by an extremely stimulated imagination.”

While I am sure Dr. Hofmann realized that he discovered something worthy of further investigation, he could not have possibly imagined that his drug—lysergic acid diethylamide, popularly known as LSD or acid—would eventually become our best hope for solving the opioid epidemic and the global mental health crisis.

When most of us think of LSD, we are immediately transported to the 1960s—the era of the proverbial sex, drugs, and rock ’n’ roll. Indeed, it is difficult to imagine the 60s without the freedom-loving hippie counterculture that challenged an otherwise extraordinarily conservative nation. However, few people know that during the 50s and 60s, scientists began to explore the potential uses of psychedelic substances, including LSD, for therapeutic purposes.

What eventually came to be known as psychedelic or psychedelic-assisted therapy was first pioneered in Canada by Abram Hoffer and Humphrey Osmond roughly a decade after Dr. Hofmann’s accidental LSD trip. Humphrey Osmond initially speculated that, by giving a high dose of LSD to individuals suffering from alcoholism, he could frighten them to the point where they would want to quit drinking. However, much to Osmond’s surprise, all of the patients’ experiences on LSD were pleasant and, most importantly, transformative.

Between 1954 and 1960, Osmond and Hoffer treated about 2,000 alcoholics with LSD and reported that 40-45 percent of them did not return to drinking after a year. Similar positive results were achieved by a Czech-born psychiatrist by the name of Stanislov Grof, who used LSD to treat heroin addicts in Prague (During this same timeframe, the CIA conducted hundreds of cruel and unethical experiments on unwitting subjects using LSD in the attempt to develop a “truth serum” for interrogations).

The groundbreaking research in the nascent field of psychedelic therapy came to a halt in 1970 with the introduction of the Controlled Substances Act, which not only made the manufacturing, sale, and possession of LSD illegal, but categorized it as a Schedule I controlled substance.

Increasing evidence suggests that psychedelic medicines, such as LSD, MDMA, and psilocybin, can serve as a sort of “reset button” for the brain.

At the same time, the rates of opioid addiction and overdose have continued to rise year after year. Today, roughly 1 percent of our nation’s adult population—2.4 million people—has an opioid-use disorder. Further, virtually every statistic on mental health points to the fact that the US is facing a mental health crisis of unprecedented scale, and yet we have not seen any more breakthrough medicines in the psychiatric-drug industry since Prozac arrived on the market more than 30 years ago.

It is clear that we are desperately in need of something better, and it may as well be LSD.

So what makes LSD, and psychedelics in general, so special? Increasing evidence suggests that psychedelic medicines, such as LSD, MDMA, and psilocybin (the main psychoactive compound in magic mushrooms), can serve as a sort of “reset button” for the brain that gives individuals the tools they need to face and address their struggles in a constructive way. As Julie Holland M.D. points out in her book, Good Chemistry: The Science of Connection, from Soul to Psychedelics...​
Psychedelics are growth promoters and life shifters, in part because they’re meaning makers. The resetting is part of a resettling. First, the default mode network is quieted, then there is a hyperconnection of nearly every other area of the brain. After all these areas communicate, things are never quite the same. The brain may have been “shaken up” a bit, and old ruts and trenches may have been smoothed over in the process. The most impressive resetting occurs with some of the strongest psychedelics.

More recently, Silicon Valley has started a trend of microdosing LSD and other psychedelic substances (i.e. taking less than a tenth of a recreational dose of a drug). Those who partake in this practice have reported an increase in energy and creativity, improved overall well-being, reduced stress and anxiety, and improved sleep without adverse side effects. The vast array of prescription medications currently on the market still cannot consistently accomplish this.

The general public is starting to warm up to the idea that psychedelics, just like marijuana, should be legalized, or, at the very least, removed from the Schedule I list.

During the last decade, a number of biopharmaceutical start-ups, such as COMPASS Pathways PLC and Mind Medicine Inc. (MindMed), have been working on developing psychedelic-inspired medicines through clinical trials. Presently, MindMed is collaborating with the University Hospital of Basel on a Phase 2 Clinical Trial of LSD for cluster headaches and the Maastricht University in Netherlands on a Phase 2 LSD Microdosing Trial for adult ADHD. (In addition to LSD, other psychedelic substances currently are or have been tested in clinical trials, including 18-MC for treatment of opioid addiction, MDMA for treatment of severe PTSD, psilocybin for alleviating depression and anxiety in patients with terminal cancer, and many others).

Given the success of the early research into LSD, as well as the growing body of anecdotal evidence confirming its safety and efficacy, it is extremely likely that the various clinical trials currently in the pipeline will produce life-changing medicines. It is also clear that the general public is starting to warm up to the idea that psychedelics, just like marijuana, should be legalized, or, at the very least, removed from the Schedule I list.

Albert Hofmann used to call LSD his “problem child.” But shortly before his death in 2008, Dr. Hofmann learned that a medical trial of LSD was approved in his native Switzerland. He was truly overjoyed that, after three and a half decades, LSD was once again being recognized for its tremendous potential as a medicine. Eager to share his excitement with his friends, he told one of them that his "problem child had come home, [and] had become a wonder child.”

Indeed, it seems it has.

*From the article here :
 
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Growing interest in psychedelic treatments for mental illness*

by Padraig Moran | CBC Radio | 2 Mar 2021

"Studies are small in scale, should be viewed with 'critical lens,' " says clinician scientist.

After decades of therapy for anxiety and suicidal thoughts, nurse Stephanie Hug says she found relief from a 12-week pilot treatment program that combines the psychedelic anesthetic ketamine with psychotherapy.

"I had tried different medications, I exercised, I did the positive self-talk, you know, I tried so many things," said Hug, an operating room nurse in Nanaimo, B.C.

As a child, Hug says she was groomed and sexually assaulted, long dealing with feelings of shame and high anxiety.

"I just felt like this is just going to be my life. I'm going to be anxious, sad, I'm going to have these [thoughts]."

Late last year, she took part in Roots to Thrive, a ketamine-assisted therapy program run through Vancouver Island University in Nanaimo, B.C. The program, which involved 16 people, is different from a clinical trial that can include thousands of participants.

Ketamine is an anesthetic that is controlled under the Controlled Drugs and Substances Act, and is illegal to use unless authorized for medical, scientific or industrial purposes. The drug is recreationally used by some illegally for its psychedelic properties, ability to separate mind from body, and alter sensory experiences with sight and sound.

Hug says the results she got in the ketamine-assisted therapy have been "amazing."

"My inner monologue is a lot kinder and not so rampant. It used to just be like uncontrolled chaos in there all the time with the underlying negativity."

Dr. Ishrat Husain, a clinician scientist and psychiatrist at the Centre for Addiction and Mental Health in Toronto, says he understands the hope around psychedelic-assisted therapy, but more robust research is needed.

"I encourage that research, but I think that we need the findings of that research — and the research needs to be well-designed and controlled — before we can recommend it for clinical practice."

In recent years, scientists have been looking at treating mental health with psychedelics, including ketamine, MDMA and psilocybin — the active ingredient in magic mushrooms — though approvals from Health Canada remain limited.

Globally there are 74 ongoing registered clinical trials using ketamine as a treatment for depression, according to ClinicalTrials.gov, a U.S. government database, nine of which are underway in Canada.

A recent systematic review of 28 studies, conducted by Quebec researchers, found that while ketamine appears "promising" for short-term treatment of treatment-resistant depression (TRD), "more clinical and experimental data is needed with regards to the efficacy, tolerance and security of long-term administration."



Channel 'inner therapist,' says facilitator

The Roots to Thrive program, run by Shannon Dames, a professor of nursing at Vancouver Island University, was "devised to help front-line workers with TRD and PTSD. Ketamine was added to the existing program for its 'mind-loosening' effects, and to address barriers that are preventing people from living well, she said.

"We don't look at the ketamine as the medicine, we look at it as a facilitator."

Compared to much therapy, which involves talking out the trauma, Dames says the focus of her program is "really about going in."

"We really teach people kind of how to be their inner therapist."

Participants received medical and mental health screenings before the first program last year. They then received three doses of ketamine over 12 weeks, in the form of a lozenge or an intramuscular injection, and wore eye masks in each session to block out external stimuli.

In her first session, Hug said she saw herself as a toddler at her grandparents' house, playing with a bucket of water, and was struck by the unconditional love children receive.

"This knowledge came where I suddenly knew that me and this child have the same heart, we're the same person. And I am just as deserving of love now as I was then."

While Hug felt unwell after the second session — something she attributes to taking her mask off — her third session left her with a feeling that "no matter what happens, I love me, I trust me, I am safe inside of me."

"I just hope that this medicine will reach the people that are feeling hopeless."

"11 of the 16 participants, initially diagnosed with PTSD, screened negative after treatment. Meanwhile, 13 participants suffering from anxiety and depression showed "significant and clinically meaningful improvements,"
Dames said.

"It was almost like it was like riding a magical bus for three months, just watching all of that happen."

"While some results from studies of psychedelic treatments are promising, they should be viewed with 'a critical lens,' "
Husain said.

"Many studies involve a small number of patients by clinical trial standards, and often do not contain a placebo group, or comparisons with standard available treatments. Some studies are also so new that any potential long-term effects are unknown."

"I do think we need to be cautiously optimistic and take a critical look before we just bring them into clinical practice, because we don't want to bring the cart before the horse,"
he said.

"We need robust clinical trials. We need good governance of those studies. We need a critical appraisal of the evidence and they need to be regulated."

Dames received $50,000 in federal funding for the first program, and in January, received $450,000 over five years from the Michael Smith Foundation for Health Research, B.C.'s health research funding agency, and the Lotte & John Hecht Memorial Foundation, a charity that offers grants in education and medicine.



Psilocybin, MDMA being studied

Aside from ketamine-assisted therapy, Canadian researchers are looking at the use of other psychedelics in mental health work.

In August last year, Health Canada granted several exemptions to the Controlled Drugs and Substances Act to allow terminally ill patients to use psilocybin, the psychoactive ingredient in magic mushrooms, to manage end-of-life distress. More than three dozen additional exemptions were granted to patients and health-care providers in the months that followed.

Dr. Bruce Tobin worked on securing the first exemption, and says he has seen a tipping point in how these treatments have been perceived in recent years.

"Five years ago, I wasn't meeting very many doctors who knew much about it or were very supportive of it," said Tobin, founder of TheraPsil, a Victoria-based advocacy group for patients.

"I would say that things have changed dramatically at this point. We have many doctors who are very interested in learning more about this therapy."

Tobin described psilocybin's effect as "a loosening of emotional defences."

"Patients let out the fear, the anger, the anxiety, the grief, old resentments so many of us tend to hold."

The exemptions granted so far have focused on end-of-life distress, but as more research is conducted its use could expand to TRD, chronic anxiety, addictions and PTSD, Tobin said.

"I feel very confident that we're going to see the promise of psilocybin confirmed rather than discredited."

In a statement to The Current, Health Canada said it "thoroughly reviews all requests for exemption and makes decisions after taking into account the risks and benefits."

"We still have much to learn about the risks, which is why the sale and possession of psilocybin is still illegal," the statement continued.

"Until there is a sufficient evidence base, Health Canada will review each request for an exemption on a case-by-case basis."

Dr. Evan Wood, a professor of medicine at UBC in Vancouver, says there is "a real openness" to psychedelic-assisted therapies because existing treatments don't work for everyone.

"Our existing mental health treatments have major limitations. And anyone who works in mental health, you know, has good insight into that," said Wood, who last year became chief medical officer with Numinus, a company licensed by Health Canada to research psychedelic-assisted therapies.

Wood also believes there won't be "the same kind of political headwinds, for instance, that medical cannabis faced" — as long as the studies can robustly demonstrate safety and cost effectiveness.

"Even if psychedelic-assisted treatments become more mainstream, they won't be a cure for everyone or all conditions, but could become another tool in the mental health-care system," he added.

"That will be a huge leg up for people that are looking to be able to make change, that otherwise existing treatments and therapies just simply aren't effective for."

*From the article here :

 

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Are psychedelics the future of mental health care?*

by Maya Singer VOGUE | 19 Feb 2021

At seven o’clock on a recent evening, I dim the bedroom lights, call out a reminder to my boyfriend to rouse me in an hour with a gentle tap, and close the door. “Have a great trip,” I hear him say from the living room as the two ketamine tablets I’ve pressed into the pockets of my cheeks dissolve, leaving a bitter residue. Minutes later, I’m flying over water that reflects a sourceless golden light. Am I the light? The thought triggers a sensation of being stretched like taffy in all directions. It’s not my body being stretched – I don’t have a body anymore – but the immaterial me moving in tune with the ambient music in my headphones. I stretch and spread until at last I’ve dissolved – pixelated – at which point a small voice in my head calls out, “Do you really think this will help you quit smoking?”

The last time I was on ketamine, I was hooked up to an IV following surgery. This time, the drug – in general medical use as an anaesthetic since 1970 – arrived on my doorstep courtesy of Mindbloom, a new telemedicine company specialising in ketamine-based psychedelic therapy. This was no shady dark-web deal. Prescribed by a psychiatric nurse practitioner following an extensive intake evaluation, and compounded by a licensed pharmacy, the ketamine came bundled with an eye mask, a hardbound journal, and a blood-pressure cuff that I was instructed to use before and after dosing, to test my vitals. The tablets themselves were housed in a mirrored pouchette with the tagline ACHIEVE YOUR BREAKTHROUGH spelled out in sleek, sans serif font. I was tempted to post a shot to Instagram, but I had a Zoom call with my psychedelic-integration coach in half an hour, and I wanted to meditate first.

Welcome to the brave new world of psychedelic wellness. After decades underground, hallucinogens such as ketamine, LSD, psilocybin, and MDMA are getting a fresh look from the medical establishment, thanks to myriad studies suggesting silver bullet-like efficacy in the treatment of anxiety, depression, and addiction, among other ailments. MDMA, renowned for its bliss-inducing effect – hence the street name “ecstasy” – is on course to be approved for the treatment of post-traumatic stress disorder (PTSD) in the US within the next year or two. Synthetic forms of psilocybin, the active compound in magic mushrooms, were given “breakthrough” designation by America’s Food & Drug Administration (FDA) in 2018, allowing for the fast-tracking of drug trials. Meanwhile, this past November, Oregon became the first state to legalise psilocybin for medical use, an advance not lost on the investors flocking to start-ups like MindMed and Compass Pathways, both of which are developing psilocybin treatments in anticipation of a cannabis-style psychedelics boom. A mental health revolution is at hand – and it’s long overdue, according to experts such as Frederick Streeter Barrett, PhD, assistant professor of psychiatry and behavioural sciences at Johns Hopkins School of Medicine and a faculty member at the university’s recently opened Centre for Psychedelic & Consciousness Research.

“The current model for treating problems like anxiety and depression just isn’t very good,” Barrett says. “Patients take pills every day, for years, and these medications not only have nasty side effects, they often don’t even work. But with psychedelics-assisted therapy, there’s the potential to truly alter someone’s life with just one or two sessions, because you’re getting at suffering at the source.”

I’m not suffering, exactly, but for lack of more technical language, I’ve kind of been freaking out. Straining to maintain a productive work schedule under lockdown, I fell back into the habit of smoking as I write – and soon thereafter, the habit of trying to quit. The addiction struck me as fundamentally psychological. If I was so hooked on nicotine, why did I reach for my American Spirits only when I was stuck at my desk, staring down a deadline? But reach for them I did, and the harder I worked not to – with the aid of gum, apps, hypnosis, you-name-it – the more fixated I became on the fear that I simply could not write without cigarettes. I was starting to feel truly hopeless when I stumbled across a news item about studies showing that with the aid of psilocybin, long-time smokers were quitting cold turkey and sticking with it at rates that put all other remedies to shame; two-thirds of participants in one recent study were confirmed cigarette-free after one year.



Intrigued, I did a little more digging and discovered that ketamine – a dissociative hallucinogen that is already legal for supervised medical use, including in the treatment of depression – seemed to draw out the mind in a way similar to psilocybin by putting the brain in a “neuroplastic” state, explains Julie Holland, MD, a New York-based psychiatrist and the author of the 2020 book Good Chemistry. “They have different chemical properties, but both ketamine and psilocybin have an ego-dissolving effect, where you’re breaking the mental loop that’s symptomatic of conditions like depression and anxiety and addiction, and allowing the brain to form new connections.”

Maybe a little ego-dissolution was the answer, I mused as I stamped out another butt in the ashtray next to my laptop and Googled “ketamine therapy – New York.”

“The truth is, we don’t really know how this stuff works,” Michael Pollan, author of the bestselling psychedelics primer How to Change Your Mind, tells me. “A leading theory is that psychedelics quiet the brain’s ‘default-mode network’, and that opens up new pathways for thought.” As Pollan goes on to explain, the default-mode network is where “the ego has its address” – it’s the part of our brains where we construct the narrative of who we are and, thus, the place we get stuck in destructive thought patterns about ourselves. “That could be ‘I’m a worthless person who doesn’t deserve love,’ or it could mean telling yourself that you can’t get through the day without smoking,” Pollan continues. “Either way, the idea is that, by muffling those thoughts, psychedelics help you out of the rut.”

Pollan’s précis on the science of psychedelics is reassuringly down-to-earth. For years, I’d been put off by the drugs’ woo-woo connotations, and to judge by the refined, minimalist aesthetics of new ketamine-therapy chains such as Field Trip Health, which has serene locations in New York City, Toronto, Atlanta, Chicago, and Los Angeles, I’m not the only person with zero interest in a tie-dye mental makeover. It’s all a far cry from Timothy Leary and The Electric Kool-Aid Acid Test. But Leary – who famously conducted psychedelics experiments at Harvard in the early 1960s, before he ran afoul of the law and, in turn, helped prompt the criminalisation of psilocybin and LSD – does continue to exert an influence. His “set and setting” theory is a cornerstone of all contemporary psychedelics-aided therapy. “Set basically refers to mindset, going into your journey, and setting is your environment,” explains Ronan Levy, who cofounded Field Trip in 2019 after establishing – then selling – Canada’s largest network of cannabis clinics. “They matter as much as the drug you’re taking,” he continues. “You need to be in a place – mentally and physically – where you feel inspired and at ease.”

Because I’d chosen to work with Mindbloom, thanks to their Covid-friendly process, the setting for my four, hour-long treatments, was my bedroom. To be perfectly clear, I wasn’t microdosing. Nor was I popping a pill just to see what colours spilled out of my head. Prior to receiving my Mindbloom package, I spent over an hour on Zoom with a board-certified psychiatric nurse practitioner who quizzed me on everything from my family medical history to my typical responses to stress. (According to Mindbloom founder and CEO, Dylan Beynon, about 35 per cent of potential patients are screened out at this point, for reasons such as past experience of psychosis or, at the other end of the spectrum, not meeting the threshold for a diagnosis of anxiety and/or depression.) “Set” was established in conversation with Laura Teodori, my psychedelic-integration-support coach, who – after obtaining confirmation from my boyfriend that he’d check on me every 20 minutes – helped me formulate an “intention” for the trip immediately after our call. My goal, we ascertained, was to recall moments in my life when I could create without smoking. With that in mind, I tucked the tablets inside my mouth, pressed play on the Mindbloom-curated soundtrack that would be piping through my headphones, lowered my eye mask, and waited for my default-mode network to go off-line.

Hallucinogens come in many forms, from the low-dose ketamine I was taking to wallop-packing plant medicines, like ayahuasca and ibogaine and peyote, that have been used in sacred rituals for hundreds, perhaps thousands of years (and are illegal in the US). But a feature common to all is the sense of coming into contact with the cosmic. “It’s like there’s no boundary between you and others, or you and the universe,” notes Johns Hopkins’s Barrett, saying that "virtually all subjects in psilocybin studies have reported such a feeling of oneness. Some people call this an experience of God, or nirvana.” I went into my first ketamine journey matter-of-factly, with a problem to solve, and even so, that first trip commenced with a vision of the world rewinding, a kind of reverse big bang that exposed the heretofore invisible filaments connecting everyone and everything. The vision moved me – tears puddled behind my eye mask – and then it yielded to more personal impressions, such as a recurring image of myself, age six or seven, playing with my dollhouse.

“What do you think was important about the dollhouse?” Teodori asked me in our post-trip call. I was still pretty woozy as we Zoomed – the effect wore off by the next day – but suddenly, it was like a light bulb went on in my head. “I think…I think I was remembering what it felt like to create without smoking,” I told her. “When there wasn’t any pressure, and I could just play.”

This download is part of integration, another cornerstone of modern psychedelic medicine. “The goal is to take advantage of the neuroplastic state, which lasts for about a week after dosing,” explains Beynon. “You want the changes in your brain to stick, so the question becomes, ‘How do you turn these new thoughts into new behaviours?’” For me, this entailed finding ways to get back in touch with that dollhouse sense of play.



Easier said than done. My ketamine experiences were clarifying and often even profound, but they didn’t change certain nerve-racking facts of life, such as that I write for a living and thus have deadlines to meet if I wish to pay my bills. Or that it’s hard – like, really hard – to stay motivated in the midst of a global pandemic, when each day brings fresh spurs to panic and depression. “There’s a huge mental health crisis happening parallel to, and in response to, this pandemic,” notes Benjamin Brody, MD, assistant professor of clinical psychiatry at Weill Cornell Medicine in New York, and chief of the Division of Inpatient Psychiatry at the university hospital, where ketamine infusions are typically administered. “People who are grieving, people who have lost jobs, people who are feeling disconnected, whose lives have been upended .…” With demand for care rising “across the board”, as Brody notes,"it’s no surprise that psychiatrists such as Amanda Itzkoff, MD, are seeing a huge uptick in inquiries about ketamine therapy. But it may or may not be the right tool for every job, Itzkoff points out."

“The thing is, if you got laid off and you don’t know how you’re going to pay rent, ketamine won’t change that,”
says Itzkoff, an early adopter who has been providing ketamine infusions at her Manhattan practice since 2014. “It doesn’t remove the external pressures. But when you’ve got someone with severe depression, who has kind of given up, then there’s real promise in this treatment.” Itzkoff cites the example of a former patient, a high-powered attorney and mother of two, who was on disability and “almost catatonic” when they began working together. “She had to be retrieved from this state,” recalls Itzkoff. “By breaking the negative thought loop – even temporarily – you show someone it’s possible to feel another way. And that,” she adds, “can be channeled toward getting people back on their feet.”

Chad Kuske didn’t just get back on his feet following his first psilocybin treatment a year and a half ago; he experienced what he calls an immediate and profound “sense of meaning and a desire to live”. A former Navy SEAL, Kuske, 40, had tried psychoanalysis and various pharmaceuticals before being medically retired from the service in 2017. Reentering civilian life, he found himself using drugs and alcohol as a way of coping with the anxiety, depression, and alienation that he now comprehends as the symptoms of PTSD. “Nothing else had worked. And I knew that sooner or later, if I kept doing things the same way, my life would be over – either literally or metaphorically, like I’d wind up in jail,” Kuske explains. “The mushrooms helped me see my situation clearly: I was in hell, but it was a hell of my own creation, and I could make the choice whether to stay there and suffer or leave and start the work of changing.”

One of the key insights Kuske has taken away from his trips – and from his integration process, which is ongoing – is that he’s not alone in struggling to meet the challenges of daily life. Likewise, Itzkoff suggests that the feeling of interconnectedness induced by psychedelic therapy – and near-psychedelics, such as ketamine and MDMA – may help alleviate the isolation brought on by Covid. It may also play a role in helping the people hardest hit by the pandemic recuperate: Nautilus Sanctuary, a nonprofit psychedelics-research and training centre in New York, is already planning a study exploring the use of MDMA to treat frontline workers with severe PTSD – one of the many inquiries to expand on the drug’s groundbreaking FDA trials sponsored by MAPS, which entered phase three in 2017. Other studies sponsored by the organisation have focused on veterans in Israel and the US, and the Department of Veterans Affairs has exhibited a willingness to approve such studies, so long as they are safe, beneficial, and scientifically sound.

This kind of conservative approach is merited, notes Weill Cornell’s Brody. “I’m very concerned about this atmosphere, that the floodgates are opening. I work with ketamine, a drug that’s been in use for decades, and even there, we don’t know all that much about its long-term effects,” says Brody, who provides ketamine-infusion therapy only to patients in whom he’s observed severe, treatment-resistant depression – and who was positively aghast when I relayed rumours that self-dosing with inhalers of esketamine, a synthetic form of the drug given FDA approval for supervised use in 2019, was all the rage in LA. “Ketamine is a serious drug!” he reiterates. “This isn’t a spa service. It’s not like getting Botox. And what worries me about all these clinics popping up is that people are going to start thinking about it that way.”

Brody is hardly alone in fearing the commercialisation of psychedelics – a trend that, if canny investors like Peter Thiel, a backer of Compass Pathways, are correct, is on pace to increase rapidly. “It’s a unique space because so much of the technology has been developed by Indigenous healers,” notes Pip Deely, cofounder of the venture-capital firm Delphi, which is eyeing investments in psychedelics start-ups and supporting a new psilocybin-legalisation campaign in Hawaii. “We see a lot of dread that if this all goes the way of cannabis, the people who have been doing this work the longest will be cut out of the conversation, and those Indigenous roots will be erased.” Unprompted, I hear a version of this concern from one Berkshires-area healer who, for legal reasons, prefers to remain unnamed; she tells me that, although she supports expanding access to psychedelics, she worries about the experience becoming pro forma and “clinical.”



Though they come at their misgivings from opposite angles, both traditional healers and Brody are wary of psychedelics’ getting marketed as a quick fix – and in all honesty, I’m the target demographic for that pitch. When I sat down at my computer to fill out Mindbloom’s candidate questionnaire, what I wanted was to detangle a few mental wires. By the time I’d completed my final ketamine treatment, I’d come to realise that those wires were crossed very deep down. My writing-while-smoking problem was really a problem with the little voice in my head telling me that I’m not good enough, I haven’t achieved enough, I’m falling behind. As I wrote in my integration journal after my second session, “Every little deal is a big deal.” I added a frowny face to underline the point.

I can’t blame Mindbloom for my failure of mindset. All my conversations with Teodori were oriented around getting me to probe the heart of my fears, and she was diligent in supporting me as I attempted to integrate the lessons of my journeys into daily life, checking in with me every few days via text and reminding me that she was always available to talk. Alas, I didn’t take her up on that offer as often as I should have – I had a ton of writing to do! – and in the end, I felt changed but not transformed. Which could be a me thing, or it could be a drug thing. Barrett of Johns Hopkins pointed me to studies from the university’s Centre for Psychedelic & Consciousness Research indicating that, where smoking cessation is concerned, the more “mystical” the trip, the more effective the treatment. “There’s a big difference between a low dose of ketamine and taking what we call a ‘breakthrough’ dose of psilocybin,” he notes. “That’s where you’re really going to break down your sense of self.”

Is that what I want? Is that what we all want, in some subconscious way? “There’s a spiritual hunger these medicines satisfy,” Pollan points out, and I can attest that once you’ve visited the astral plane, you want to go back. Most hallucinogens are not physically addictive, but the psychedelic experience is itself addicting. I spoke to numerous people for this story who described their encounters with psychedelics as “life-changing” in ways large and small; one woman even credited peyote with restoring movement to her paralysed arm. But Ann Watson’s account is the most relatable. A former VP and fashion director at Henri Bendel in New York City, and now a cochair of The Vaquera Group, a global marketing firm, Watson, 52, is also a self-described “explorer” who, like me, kept a pretty tight lid on her deepest, darkest feelings – until she began working with psychedelics 12 years ago. “My childhood was chaotic; there was a lot of abandonment, but I didn’t associate with the word trauma, because I thought it was reserved for people who have experienced things like rape or war. But I was seeking something,” explains Watson, who tried a variety of treatments to relieve an “ever-present vibration of anxiety,” including counselling and prescribed antidepressants, before experimenting with a long list of psychedelics. Eventually she arrived at a treatment plan with a doctor in Los Angeles she sees four times a year for guided psilocybin trips; she also microdoses psilocybin on a more regular basis, mixing magic mushrooms with Lion’s Mane. “It’s an ongoing process,” she tells me. “The thing is, once you start looking inward, you realise there’s always more to see.”

Perhaps that is the main takeaway from my own journey: that I’m just at the start of it. I have work to do on myself. But in the meantime, I also have work to do, period – as in, I’m on deadline for this piece. And I regret to inform you that as I write these words, I am indeed smoking.

*From the article here :
 
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Can magic mushrooms heal us?

by Ezra Klein | New York Times | 18 Mar 2021

A very promising mental health experiment is taking shape in Oregon.

Gov. Kate Brown of Oregon announced the members of the state’s newly formed Psilocybin Advisory Board this week. Why does Oregon need an official board to offer advice about the active ingredient in magic mushrooms, you ask? Because Oregon is about to become the first state in the country to try to build a support infrastructure through which psychedelic mushrooms can be woven into everyday life. This framework is different from what we’ve seen before: not legalization, not medicalization, but therapeutic use, in licensed facilities, under the guidance of professionals trained to guide psychedelic experiences. Whoa.

“Like many, I was initially skeptical when I first heard of Measure 109,” Brown said in a statement. “But if we can help people suffering from PTSD, depression, trauma and addiction — including veterans, cancer patients, and others — supervised psilocybin therapy is a treatment worthy of further consideration.”

Measure 109, the Oregon Psilocybin Services Act, approved as a ballot measure in November, is the brainchild of Tom and Sheri Eckert, who shared a therapy practice in Portland. In 2015, the Eckerts read an article by Michael Pollan in The New Yorker titled “The Trip Treatment.” The article described the emerging research around using psychedelics as a therapeutic tool and unearthed the largely forgotten pre-Timothy Leary period in which psychedelics were widely used by psychiatrists. In the past, the government had funded more than a hundred studies, and as Pollan recounts in “How to Change Your Mind,” his subsequent book, Anaïs Nin, Jack Nicholson and Cary Grant all underwent LSD-assisted therapy. Bill Wilson, a co-founder of Alcoholics Anonymous, who’d given up drinking with the aid of a hallucinogenic plant called belladonna, considered bringing LSD-assisted therapy into AA in the 1950s, but was met with disapproval from his board.

This was a very different model of psychedelic use: There was a trained mental health professional in the room and subsequent therapy to help turn the insights into action. The early results were promising, though the studies were poorly designed. At times, the fear was that the compounds were too powerful and left people too malleable to the suggestions of their guide. One early practitioner worried that on psychedelics, “the fondest theories of the therapist are confirmed by his patient,” and that even though the healing was real, the pathway was “nihilistic,” bordering on something like hypnosis. This era of study ended before these questions could be resolved, when psychedelics slipped into the counterculture, where they were used without therapeutic safeguards, and the Nixon administration targeted them as part of its culture war. A remnant of healers who used psychedelics in their work remained, but they were driven underground.

The Eckerts had personal experience with psilocybin, and Pollan’s piece, and the research it led them to, made sense to them as therapists. This was work they could do, should do, but the law made it impossible. “It was a desire to specialize in this field, and we realized we couldn’t,” Tom Eckert told me. “And then the question was: Would we accept that answer or were we going to do something about it?”

Sheri Eckert passed away unexpectedly, after a surgery in December, but Tom recounted a hike they had taken together before embarking on what they knew would be a consuming, multiyear political project. “We decided to consult the mushroom,” he said. They drove to Mount Rainier, hiked through the woods and took psilocybin over a campfire. Tom found his mind wandering to the far future, when historians would look back on our era. “I got to thinking that they probably wouldn’t care so much about our politics and technologies,” he said. “They’d probably notice how estranged and detached we are from our own consciousness.” The couple couldn’t have children but Tom remembers Sheri’s voice piercing the quiet. “An idea could be like a child,” she said.

This is where I should stop for a moment, before I lose you. The only thing worse than hearing about someone else’s dream is hearing about their mushrooms trip. But these experiences have an unusual power, a power Oregon is trying to harness. “The definition of personality is it’s a trait, it doesn’t change,” Matthew Johnson, a professor psychiatry at Johns Hopkins University and the associate director of its Center for Psychedelic and Consciousness Research, told me. But Johnson has conducted multiple studies in which participants ranging from the very ill to so-called healthy-normals report profound changes to outlook and even personality after one well-facilitated dose.

In particular, traits revolving around openness to change and uncertainty seem to loosen, with people questioning their own judgments, holding other viewpoints and tolerating more ambiguity with greater ease. Openness to new experiences tends to diminish as we age, so the potential of psychedelics to unlatch the windows of the mind is, in Johnson’s words, “a bit of a fountain of youth effect.” Psilocybin is also a reliable generator of profound, mystical experiences in people who try it with the right intentions and the right support — experiences that, months and years later, many recall as among the most meaningful of their lives. “Until our work with psilocybin, there was never an experimental manipulation which you could schedule for a Thursday and change your personality,” Johnson told me.

But the more pressing case for psilocybin comes from research out of Johns Hopkins, U.C.L.A., N.Y.U. and elsewhere that has shown it to be a potentially effective treatment for major depression, end-of-life anxiety and drug addiction. “One of the things I’ve come to is that addiction medicine in 2021 is in desperate need of transformative technologies,” Todd Korthuis, a professor of medicine who specializes in addiction at Oregon Health & Science University and a member of Oregon’s Psilocybin Advisory Board, told me. The studies so far are preliminary, but they are “showing dramatic change in people’s lives — that’s what we need for cocaine use disorder, methamphetamine use disorder, even alcohol and tobacco.”

Some of the early results are so remarkable that they fall into the too-good-to-be-believed category, at least until far more research is done. A recent study on major depressive disorder, published in JAMA Psychiatry, found more than half of the subjects in remission four weeks later, after just two treatments alongside psychotherapy. A study on tobacco addiction, out of Johns Hopkins, found two-thirds of the subjects who received psilocybin in combination with cognitive behavioral therapy abstinent a year later. These would be miraculous effect sizes if they hold up in larger samples and other contexts. Even if further research finds psilocybin only 50 percent as effective as these experiments suggest, it would be still be a breakthrough.

There isn’t a simple explanation for why psychedelics possess these powers. M.R.I. scans show the psychedelic brain aflame with activity, with areas that rarely connect lighting up in electric conversation. “I think that’s what’s responsible for this radically different associative net, this different ability to absorb the gestalt,” Johnson told me. "You are hearing, thinking, processing differently than normal, which can lead to new experiences and epiphanies. Some of those are classic psychedelia, the kind of thing visualized in 'Yellow Submarine.' Synesthesia, for instance, where you’ll hear in colors. But just as often, the experience defies those expectations: It’s more like a difficult, but powerful, therapy session."

I avoided psychedelics when I was younger, fearful of the loss of control, and tried them later, desperately, when there was more darkness in my mind than light. It was not an easy time for me, and these were not easy experiences. They kicked down doors around my anxiety, my marriage, my work, my family, my resentments, my attachments, my self. Those rooms were often unpleasant to enter. There was ecstasy and beauty, yes, but also fear and, often, so often, intense nausea. Things I’d fought to ignore resurfaced. Disparate parts of my life and beliefs and personality connected, and I became more legible to myself. I am not cleansed of anxiety, but I am more aware that my outlook, at any given moment, is just a dance of brain chemistry and experience, and far from the only state possible. That a few micrograms of chemical was all it took to upend my confident grip on reality shook me in ways I’m grateful for. I hold my judgments and worldviews more lightly, and I am friendlier to mystery and strangeness.

But as with more traditional therapy, to the extent that these experiences changed me, it is because I acted on the insights later, once sobriety had returned. A trip is of little value if you refuse to leave the hotel after you arrive. “You can have an amazing experience, but if you don’t do the work to ground it in a practice of self-development, it may not have the impact you would hope,” Eckert told me. "It can fade, like a dream.”

Or it can crack you. Psilocybin isn’t addictive, and there is no known lethal dose. “If you look at the safety profile of psilocybin, it’s dead last in terms of its risk of harm either to self or others,” Korthuis told me. But these experiences can be psychologically searing, even scarring. There is evidence that terror-filled trips can cause lingering trauma or even trigger psychosis or suicide in rare cases. Looking back, I wish I had had the option of skilled support, both to get more out of the experiences and to protect me from harm. These are not trivial chemicals. Here there be dragons.

The Eckerts wanted to bring back not the louche psychedelic use of the late ’60s and ’70s, but the supported psychedelic use of the ’50s and early ’60s. “We wanted to put psychedelic therapy and wellness on its own foundation,” Tom told me. Under Measure 109, no one will be able to walk into a store and buy magic mushrooms. Instead, there will be regulated centers, with trained and licensed facilitators who are there both for the trip itself and to help people integrate the experience afterward. There will be screening for psychological and physical conditions that could make the experience unsafe and help on-site for anyone who does fall into psychological or physical crisis. “We wanted to think deeply about how we might integrate psychedelics back into the culture,” Eckert said.

The Eckerts’ initiative caught the attention of a broader group of organizations trying to shift the laws around psychedelics. They were invited to present at a meeting of the Multidisciplinary Association for Psychedelic Studies, or MAPS. There, they met with other key groups that would become backers of their project: David Bronner, the chief executive of Dr. Bronner’s soaps, which uses some of its profits to support drug reform initiatives, and Graham Boyd, a co-founder of the Psychedelic Science Funders Collaborative, who brought his experience winning ballot initiative campaigns to the effort.

MAPS, which is led by its founder, Rick Doblin, is at the center of the decades-long effort to revive research into the medical benefits of psychedelics and is currently deep in F.D.A. trials to get MDMA, an empathogenic chemical associated with the drug ecstasy, approved as a treatment for post-traumatic stress disorder. Doblin supports the Oregon initiative, but he is cautious about the difficulties inherent in getting it right. How will facilitators be trained? How will patients be screened? Psilocybin remains illegal at the federal level, and the federal government could choose to act on that at any time, he noted. In the early years of state cannabis legalization, there were raids on dispensaries. “I worry those with the most at stake in terms of licenses will be fearful of participating, when those are the people we most want to participate,” Doblin told me.

Lurking in Doblin’s comments is a concern I heard from many reformers working to change the legal status of psychedelics: Too much, too fast could imperil decades of hard work and steady progress. A few stories, even exaggerated ones, of harmful trips and incompetent or predatory facilitators, could turn this into a rerun of the ’70s, when society turned sharply against these substances. “There’s a real Achilles’ heel,” Boyd told me. “Public opinion can really turn against this. Just because you’ve got science on your side doesn’t mean public policy will follow.” It was his influence, in part, that got a two-year implementation process included in the ballot initiative, where regulators and scientists could come together to carefully devise the program and to roll it out slowly, with plenty of public education and legal consideration.

What’s striking to me about Measure 109, though, is that it breaks away from the medicalization-legalization binary that has defined drug reform for the past few decades. It does not allow anyone to sell psilocybin pills in stores. Nor does it restrict treatment to those with a diagnosis of mental illness. The measure does not grudgingly accept psilocybin as the lesser evil compared with, say, the drug war or PTSD. Instead, it is based on the idea that psilocybin has the potential to change our lives for the good, whether we are sick or well, and so it is worth investing in the frameworks and safeguards so that it can be used safely and productively. It would be foolish to posit psilocybin-assisted therapy as an answer to all that ails our society, or even our mental health system. But it would be one more option for those who need it, and both evidence and anecdote suggest it would be life-changing for many. That would be enough. That would be so much.

“Oregon has always been a pioneer state,” Korthuis told me. “It’s been a hotbed of innovation around drug policy for at least 25 years. This is just the next contribution in that history.”

 
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79% of those microdosing psychedelics report improvements in their mental health, study*

by Beth Ellwood | PsyPost | 28 Oct 2020

A study published in Psychopharmacology suggests that people may turn to microdosing with psychedelics in an attempt to improve their mental health. According to most self-reports, these attempts may be effective.

Interest in psychedelic drugs as a potential treatment option for mental health disorders has been steadily increasing. One reason for the upsurge in interest might be the lack of effective treatments for certain psychiatric disorders, such as depression and post-traumatic stress disorder (PTSD).

Study authors Toby Lea and his team were motivated to examine a particular gap in the research by focusing on something called “microdosing.” The practice of microdosing refers to the consumption of very small, routine doses of a psychedelic drug, such as LSD or psilocybin, for reasons other than achieving hallucinogenic side effects.

“To date, most quantitative microdosing studies have excluded people with a history of mental illness, have not reported microdosing motivations, and no study has examined the sociodemographic and other correlates of microdosing as mental health and substance use therapies, nor the sociodemographic and other correlates of perceived improvements in mental health that people attribute to microdosing,” Lea and colleagues say.

An international, online survey questioned 1,102 individuals who were either currently microdosing, or had tried microdosing in the past. The average age of respondents was 33, and 57% had at some point been diagnosed with a mental health disorder.

When questioned about their motivations for microdosing, 39% indicated that improving their mental health was their main motivation. Of these, 21% were microdosing to improve their depression, 7% for their anxiety, 9% for other mental disorders including PTSD, and 2% for drug or alcohol use.

Importantly, 85% of those practicing microdosing to improve their mental health had previously received either medication or counselling therapy. Moreover, among those who had received prescriptions for medication, “half (51 percent reported having ceased antidepressants and 40 percent reported having ceased other psychiatric medications). This suggests that respondents may have been microdosing as a way to replace traditional forms of therapy.

“Respondents who had been microdosing for a longer duration were also more likely to be motivated to microdose for mental health. This may suggest that microdosing is working for these people, and that they are continuing to microdose as an ongoing therapy to replace or supplement psychiatric medications, some with the knowledge of their doctor and/or psychotherapist,” Lea and associates note.

The results indicated that, at least from the perspective of respondents, the practice of microdosing elicited positive mental health effects. As the researchers report, “Forty-four percent of all respondents perceived that their mental health was much better and 36% perceived that it was somewhat better because of microdosing.

Nineteen percent of respondents perceived no changes to their mental health.” Only 1.3% indicated that their mental health was somewhat worse since microdosing, and 0.2% said it was much worse.

Lea and colleagues acknowledge that several key limitations limit the inferences from their findings. It is not possible to discern from their study whether the reported mental health improvements were due to microdosing, or rather the result of a placebo effect or other factors like lifestyle changes.

The authors stress the importance of continued study into the effects of microdosing. “While we await the findings of clinical trials, which could take some years, people will continue to self-manage their health with microdosing. It is therefore important to monitor people’s microdosing practices and experiences in the long term in order to provide appropriate harm reduction resources and other support.”

The study, “Perceived outcomes of psychedelic microdosing as self-managed therapies for mental and substance use disorders”, was authored by Toby Lea, Nicole Amada, Henrik Jungaberle, Henrike Schecke, Norbert Scherbaum, and Michael Klein.

*From the article here :
 

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UM SOM researchers identify potentially revolutionary antidepressant compound​

University of Maryland School of Medicine | May 04, 2016

In mice, ketamine metabolite Hydroxynorketamine lifts depression quickly, without serious side effects.

For years, scientists and doctors have known that ketamine can treat depression very rapidly, often working within hours, compared to weeks or months for widely used antidepressants. However, the drug, which is approved as an anesthetic, has major side effects – it is linked to hallucinations and dissociation - a sense of being outside your own body – and for these reasons is abused as a club drug. Not surprisingly, this limits its use in the treatment of depression.

A solution may be at hand. Researchers at the University of Maryland School of Medicine (UM SOM) have identified a metabolite of ketamine that quickly reverses depression in mice, but without ketamine's side effects. The study was published today in the journal Nature.

“This is potentially a major breakthrough,” said the study's senior author, Todd Gould, MD, an Associate Professor of Psychiatry at UM SOM. “It could allow depressed patients to get the rapid benefits of ketamine, while at the same time avoiding the risks.”

Most people with depression take medications that increase levels of the neurochemicals serotonin or norepinephrine in the brain. The most common of these drugs, such as Prozac and Lexapro, are selective serotonin reuptake inhibitors, or SSRIs. However, SSRIs are effective in only half of patients with depression, and even when these drugs work, they typically take between three and eight weeks to relieve symptoms. Ketamine, which does not work via serotonin or norepinephrine, can lift depression much more quickly, within hours after administration.

The work was a collaboration between scientists at UM SOM, the NIH National Institute of Mental Health (NIMH), the NIH National Center for Advancing Translational Sciences, the NIH National Institute on Aging, and the University of North Carolina.

“For years, we have been searching for ways to treat depression faster and more effectively,” said another co-author, Scott Thompson, PhD, Professor and Chair of the Department of Physiology at UM SOM, who has spent more than a decade studying glutamate and depression. “These results open up exciting new vistas for the first new generation of antidepressant compounds in the last 30 years.”

Using mice, the researchers tested the effects of several ketamine metabolites, chemicals produced by the breakdown of ketamine. They eventually focused on one called hydroxynorketamine, a compound that had been thought to have no psychoactive effects. In mice, blocking the transformation of ketamine to hydroxynorketamine prevented ketamine's antidepressant actions. Hydroxynorketamine itself also showed antidepressant effects, and none of ketamine's side effects.

“This discovery fundamentally changes our understanding of how this rapid antidepressant mechanism works, and holds promise for development of more robust and safer treatments," said Carlos Zarate, MD, of NIMH, a study co-author and a pioneer of research using ketamine to treat depression. "By using a team approach, researchers were able to reverse-engineer ketamine from the clinic to the lab to pinpoint what makes it so unique.”

The anesthetic and dissociative actions of ketamine are due to the fact that it blocks a particular glutamate receptor, the NMDA glutamate receptor. Researchers had assumed that ketamine acts as an antidepressant via the same mechanism. This appears not to be true, however, because hydroxynorketamine does not inhibit the NMDA receptor. Instead, hydroxynorketamine seems to activate another type of glutamate receptor, the AMPA receptor. Gould says that hydroxynorketamine likely works on depression via these AMPA receptors, either directly or indirectly.

Gould and his colleagues at NIH are already planning to begin testing hydroxynorketamine for its safety in humans. But he points out that the compound has, in effect, already been in humans in years as a metabolite following ketamine administration. "This gives us confidence it will be safe," said Gould.

“This study underscores the fact that our school is doing a range of important brain research. The Departments of Psychiatry, Physiology, and Neurology, as well as the Brain Science Research Consortium Unit and others, all are doing their part to advance our understanding of the brain and its diseases,” said UM SOM Dean E. Albert Reece, MD, PhD, MBA, who is also the vice president for Medical Affairs, University of Maryland, and the John Z. and Akiko K. Bowers Distinguished Professor. “In years to come, this finding may well change how depression is treated in millions of patients.”

About the University of Maryland School of Medicine

The University of Maryland School of Medicine was chartered in 1807 and is the first public medical school in the United States and continues today as an innovative leader in accelerating innovation and discovery in medicine. The School of Medicine is the founding school of the University of Maryland and is an integral part of the 11-campus University System of Maryland. Located on the University of Maryland’s Baltimore campus, the School of Medicine works closely with the University of Maryland Medical Center and Medical System to provide a research-intensive, academic and clinically based education. With 43 academic departments, centers and institutes and a faculty of more than 3,000 physicians and research scientists plus more than $400 million in extramural funding, the School is regarded as one of the leading biomedical research institutions in the U.S. with top-tier faculty and programs in cancer, brain science, surgery and transplantation, trauma and emergency medicine, vaccine development and human genomics, among other centers of excellence. The School is not only concerned with the health of the citizens of Maryland and the nation, but also has a global presence, with research and treatment facilities in more than 35 countries around the world. http://medschool.umaryland.edu/

 
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Growing interest in psychedelic treatments for mental illness

by Padraig Moran | CBC Radio | 3 Mar 2021

After decades of therapy for anxiety and suicidal thoughts, nurse Stephanie Hug says she found relief from a 12-week pilot treatment program that combines the psychedelic anesthetic ketamine with psychotherapy.

"I had tried different medications, I exercised, I did the positive self-talk, you know, I tried so many things," said Hug, an operating room nurse in Nanaimo, B.C.

As a child, Hug says she was groomed and sexually assaulted, long dealing with feelings of shame and high anxiety.

"I just felt like this is just going to be my life. I'm going to be anxious, sad, I'm going to have these."

Late last year, she took part in Roots to Thrive, a ketamine-assisted therapy program run through Vancouver Island University in Nanaimo, B.C. The program, which involved 16 people, is different from a clinical trial that can include thousands of participants.

Ketamine is an anesthetic that is controlled under the Controlled Drugs and Substances Act, and is illegal to use unless authorized for medical, scientific or industrial purposes. The drug is recreationally used by some illegally for its psychedelic properties, ability to separate mind from body, and alter sensory experiences with sight and sound.

Hug says the results she got in the ketamine-assisted therapy have been "amazing."

"My inner monologue is a lot kinder and not so rampant. It used to just be like uncontrolled chaos in there all the time with the underlying negativity."

Dr. Ishrat Husain, a clinician scientist and psychiatrist at the Centre for Addiction and Mental Health in Toronto, says he understands the hope around psychedelic-assisted therapy, but more robust research is needed.

"I encourage that research, but I think that we need the findings of that research — and the research needs to be well-designed and controlled — before we can recommend it for clinical practice."

In recent years, scientists have been looking at treating mental health with psychedelics, including ketamine, MDMA and psilocybin — the active ingredient in magic mushrooms — though approvals from Health Canada remain limited.

Globally there are 74 ongoing registered clinical trials using ketamine as a treatment for depression, according to ClinicalTrials.gov, a U.S. government database, nine of which are underway in Canada.

A recent systematic review of 28 studies, conducted by Quebec researchers, found that while ketamine appears "promising" for short-term treatment of treatment-resistant depression (TRD), "more clinical and experimental data is needed with regards to the efficacy, tolerance and security of long-term administration."

Channel 'inner therapist,' says facilitator

The Roots to Thrive program, run by Shannon Dames, a professor of nursing at Vancouver Island University, was devised to help front-line workers with TRD and PTSD. "Ketamine was added to the existing program for its 'mind-loosening' effect to address barriers that are preventing people from living well," she said.

"We don't look at the ketamine as the medicine, we look at it as a facilitator."

"Compared to much therapy, which involves talking out the trauma, the focus of her program is 'really about going in,' "
Dames said.

"We really teach people kind of how to be their inner therapist."


Shannon Dames

Participants received medical and mental health screenings before the first program last year. They then received three doses of ketamine over 12 weeks, in the form of a lozenge or an intramuscular injection, and wore eye masks in each session to block out external stimuli.

In her first session, Hug said she saw herself as a toddler at her grandparents' house, playing with a bucket of water, and was struck by the unconditional love children receive.

"This knowledge came where I suddenly knew that me and this child have the same heart, we're the same person. And I am just as deserving of love now as I was then."

While Hug felt unwell after the second session — something she attributes to taking her mask off — her third session left her with a feeling that "no matter what happens, I love me, I trust me, I am safe inside of me."

"I just hope that this medicine will reach the people that are feeling hopeless."

Dames said 11 of the 16 participants, initially diagnosed with PTSD, screened negative after treatment. Meanwhile, 13 participants suffering from anxiety and depression showed "significant and clinically meaningful improvements."

"It was almost like it was like riding a magical bus for three months, just watching all of that happen."

Husain says that while some results from studies of psychedelic treatments are promising, they should be viewed with "a critical lens."

Many studies involve a small number of patients by clinical trial standards, he said, and often do not contain a placebo group, or comparisons with standard available treatments. Some studies are also so new that any potential long-term effects are unknown.

"I do think we need to be cautiously optimistic and take a critical look before we just bring them into clinical practice, because we don't want to bring the cart before the horse," he said.

"We need robust clinical trials. We need good governance of those studies. We need a critical appraisal of the evidence and they need to be regulated."

Dames received $50,000 in federal funding for the first program, and in January, received $450,000 over five years from the Michael Smith Foundation for Health Research, B.C.'s health research funding agency, and the Lotte & John Hecht Memorial Foundation, a charity that offers grants in education and medicine.



Psilocybin, MDMA being studied

Aside from ketamine-assisted therapy, Canadian researchers are looking at the use of other psychedelics in mental health work.

In August last year, Health Canada granted several exemptions to the Controlled Drugs and Substances Act to allow terminally ill patients to use psilocybin, the psychoactive ingredient in magic mushrooms, to manage end-of-life distress. More than three dozen additional exemptions were granted to patients and health-care providers in the months that followed.

Dr. Bruce Tobin worked on securing the first exemption, and says he has seen a tipping point in how these treatments have been perceived in recent years.

"Five years ago, I wasn't meeting very many doctors who knew much about it or were very supportive of it," said Tobin, founder of TheraPsil, a Victoria-based advocacy group for patients.

"I would say that things have changed dramatically at this point. We have many doctors who are very interested in learning more about this therapy."

Tobin described psilocybin's effect as "a loosening of emotional defences."

"Patients let out the fear, the anger, the anxiety, the grief, old resentments so many of us tend to hold."

The exemptions granted so far have focused on end-of-life distress, but as more research is conducted its use could expand to TRD, chronic anxiety, addictions and PTSD, Tobin said.

"I feel very confident that we're going to see the promise of psilocybin confirmed rather than discredited."

In a statement to The Current, Health Canada said it "thoroughly reviews all requests for exemption and makes decisions after taking into account the risks and benefits."

"We still have much to learn about the risks, which is why the sale and possession of psilocybin is still illegal,"
the statement continued.

"Until there is a sufficient evidence base, Health Canada will review each request for an exemption on a case-by-case basis."


Dr. Evan Wood

Dr. Evan Wood, a professor of medicine at UBC in Vancouver, says "there is 'a real openness' to psychedelic-assisted therapies because existing treatments don't work for everyone."

"Our existing mental health treatments have major limitations. And anyone who works in mental health, you know, has good insight into that,"
said Wood, who last year became chief medical officer with Numinus, a company licensed by Health Canada to research psychedelic-assisted therapies.

"There won't be the same kind of political headwinds, for instance, that medical cannabis faced — as long as the studies can robustly demonstrate safety and cost effectiveness," Wood said.

He added that even if psychedelic-assisted treatments become more mainstream, they won't be a cure for everyone or all conditions, but could become another tool in the mental health-care system.

"That will provide a huge leg up for people that are looking to be able to make change, that otherwise existing treatments and therapies just simply aren't effective for."

*From the article here :
 
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