Mental Health New wave of research puts psychedelics forward to treat mental health ->

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Psychedelics as an emerging treatment for mental illness*

Martin Williams and Stephen Bright | The Conversation | Apr 24 2019

An estimated one in ten Australians were taking antidepressants in 2015. That’s double the number using them in 2000.

Yet some studies have found that antidepressants might be no more effective than placebo.

Not only does this mean many Australians aren’t experiencing relief from their psychological distress, but some may also be contending with adverse side effects from their medications.

Also, the provision of these medications is costing Australian taxpayers millions of dollars through the Pharmaceutical Benefits Scheme.

Read more: If you're coming off antidepressants, withdrawals and setbacks may be part of the process

Australia needs a paradigm shift in the way we treat mental illness. Scientific research is increasingly pointing to psychedelic drugs like psilocybin and MDMA (methylenedioxymethamphetamine, more commonly known as Ecstasy) as viable options.

While Australia lags behind other countries in this area of research, we are on the cusp of the first Australian trial of psychedelic drugs for mental health.

This research is going to look at psilocybin-assisted therapy for anxiety and depression among terminally ill patients.

A brief history of psychedelic drugs

Psychedelics are a broad category of drugs that can produce profound changes in consciousness. “Magic mushrooms”, containing psilocybin, have been used by some indigenous communities for at least 1,000 years. Other psychedelics, such as LSD and MDMA, were first synthesised in the laboratories of major pharmaceutical companies early in the 20th century.

In the 1950s, psychedelics were considered “wonder drugs”, used with psychotherapy in treating a range of conditions. These included depression, end-of-life anxiety, post-traumatic stress disorder (PTSD) and alcohol dependence.

But, in the 1960s, psychedelics escaped the clinic and became popular among the younger generation. In response to their association with the counterculture movement, a moral panic ensued. Psychedelic drugs were made illegal internationally in 1971.

Research and practice were abandoned, until recent shifts in attitude led to the re-emergence of medical research using psychedelics.

In 2013, we wrote a piece in The Conversation about this international psychedelic science renaissance.

By that time, researchers at Johns Hopkins School of Medicine had shown psilocybin could reliably induce mystical states leading to positive changes in personality such as openness and sociability. Psychotherapists at UCLA harnessed these effects to reduce anxiety and depression in people with terminal cancer.

Meanwhile, researchers across the USA, Switzerland, Canada and Israel had achieved promising results treating PTSD with psychotherapy (“talk therapy” guided by trained therapists) assisted by MDMA.

In the past six years, two phase 2 clinical trials have shown psilocybin can improve quality of life for people with terminal cancer.

Another study showed psilocybin-assisted psychotherapy can effectively treat depression. Some 67% of participants showed clinically and statistically significant reductions in depressive symptoms.

Phase 3 trials are now planned. If these confirm the treatments to be effective, MDMA and psilocybin are likely to become approved medications in some countries within the next five years.

Psilocybin even appears useful in treating alcohol and nicotine addiction. And MDMA may ease social anxiety in people on the autism spectrum.
How psychedelics work in the brain

We’re now beginning to understand the neurological mechanisms responsible for the mystical states and creative thinking psychedelics can produce, and how they can aid the treatment of anxiety and depression.

Psychedelics reduce the activity of a neural circuit in the brain called the default mode network (DMN).

The DMN is responsible for our “resting state” sense of self, which can become distorted as depression and similar mental illnesses take hold. By temporarily decreasing the activity of the DMN, psychedelics appear to enable other less direct neural pathways to be established.

These interconnections can reduce the amount we persistently rethink the same thought, which is characteristic of depression. Similarly, they promote the development of fresh perspectives on personal situations and interpersonal relationships.

It also appears psychedelics can promote the physical regrowth of neuronal connections that have withered away in people who experience long-term depression.

The mechanism of this process is not yet understood, but it seems to correlate well with the demonstrated positive mental health outcomes of psychedelic-assisted psychotherapy.

On the other hand, various health conditions for which psychedelics are not suitable are widely recognised. In particular, people with underlying personality disorders or psychiatric conditions such as schizophrenia risk worsening of their symptoms.

People who have medical conditions such as heart or liver disease, or who are using a wide range of medications including antidepressants, are also advised to avoid psychedelics without careful medical supervision.

In all cases, it is stressed that psychedelic therapy should always take place under professional supervision to minimise potential health risks.

An Australian first

Since our last Conversation article, we’ve seen some fundamental shifts in Australia.

Later this year, a phase 2 study of psilocybin-assisted therapy for anxiety and depression in 30 terminally ill patients will begin at St Vincent’s Hospital in Melbourne.

This trial, due to be completed in 2021, will look at the effects of psychedelic psychotherapy in people with terminal conditions other than cancer, in addition to those with cancer.

Meanwhile, a newly established charity, Mind Medicine Australia, is aiming to negotiate Australia’s regulatory framework to have psychedelics reclassified from the most restrictive drug category to one that accommodates prescription medicines.

If the results of our study, and those of others around the world, confirm the promise of the initial trials already completed, there is an excellent chance several of these treatments will be approved for prescription use within three to five years.

But, as well as proving the efficacy of these treatments, we will need to continue to demonstrate their safety, negotiate regulatory hurdles and ultimately convince doctors and the public that psychedelic psychotherapy is a viable approach for mental health treatment.

*From the article here :

Psychedelics to treat mental illness? Australian researchers are giving it a go

Australia is about to start its first trial of psychedelic drugs for the treatment of anxiety and depression. If the results are positive, this could transform the way we treat mental illness.

theconversation.com

 

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Study finds no link between psychedelics and mental problems

by Scott Hensley

How risky are psychedelic drugs to mental health? Not nearly as much as you might have imagined.

People who had taken LSD, psilocybin (the brain-bending chemical in magic mushrooms) or mescaline at any time in their lives were no more likely than those who hadn't to wind up in mental health treatment or to have symptoms of mental illness, according to an analysis by some Norwegian researchers.

And there was some evidence that people who had taken the drugs at some point were less likely to have had recent mental health treatment.

"There seems to be no evidence of overall negative impact — and even some hints of benefit — associated with the use of psychedelics," says Matthew W. Johnson, a psychologist in the psychiatry department at Johns Hopkins School of Medicine.

Johnson wasn't involved in the study but had read the work, which was published online by PLOS ONE. In separate human experiments, Johnson and his colleagues at Hopkins have given psilocybin to cancer patients under carefully controlled conditions to help them cope with anxiety and depression.

The latest study comes from researchers at the Norwegian University of Science and Technology who analyzed data from the National Survey on Drug Use and Health, sponsored by the U.S. Substance Abuse and Mental Health Administration. Previously, the Norwegian researchers looked back at old data on LSD as a treatment for alcoholism and concluded that it wasn't a bad idea at all.

In this study, the researchers looked at survey data collected from more than 130,000 randomly selected Americans between 2001 and 2004. Nearly 22,000, or about 13 percent, said they had taken hallucinogenic drugs at some point. About 1 in 6 Americans aged 21-64 have tried psychedelics.

"The lack of association between the use of psychedelics and indicators of mental health problems in this large population survey is consistent with clinical studies in which LSD or other psychedelics have been administered to healthy volunteers," the researchers wrote.

This study has limitations. It's possible that healthier people are more likely to take psychedelics than those already struggling with mental illness, for instance. The study also didn't take the dose of drugs into account. The researchers also didn't have any information about family history of mental illness, which could be an important factor.

"The design of our study does not allow conclusions about causality," Teri S. Krebs, the lead author of the study, wrote in an email to Shots. "However, there is a lack of evidence that psychedelics cause lasting mental health problems."

While the findings are broadly reassuring about the safety of hallucinogenic drugs, they don't guarantee a good trip. "This should not be taken to state that there are never individual cases of harm. We know that there are," Johnson says. "It's a question of how frequent they are and under what circumstances they happen."

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Single dose of CBD may treat psychosis

by Sofia Quaglia | INVERSE | 28 Jan 2020

CBD may help treat symptoms of psychosis, according to the latest findings on how CBD affects the human brain.

The results suggest that CBD could offer a treatment for the memory problems associated with psychosis, a common mental-health condition that affects 20 million people worldwide, according to the World Health Organization.

“Now not only do we know that CBD works as an antipsychotic, we know it targets the areas of the brain that need to be targeted. This really gives us confidence, and it gives us scientific justification for large scale clinical trials," lead researcher on the study Sagnik Bhattacharyya tells Inverse.

Scientists compared brain scan results of people with a diagnosis of psychosis and people without the disorder as they were doing a memory exercise. In the people with psychosis, the researchers found clear differences in the activity patterns in their prefrontal, mediotemporal, and striatal areas of the brain — those that regulate decision making, learning and memory. But when these participants were given a single dose of CBD, their brain activity patterns were more similar to those of people without the disorder.

The results provide insight into which part of the brain is affected by CBD and suggest CBD may curb symptoms of psychosis in the human brain.

CBD and brain activity

The study included a group of 13 people with a diagnosis of psychosis and 16 people without the disorder. The participants were asked to perform three different verbal-association memory tasks (such as deciding whether words were paired in a logical way, and recalling which words they’d previously seen paired, or what font they were in) while in an fMRI machine.

Those with psychosis were already on standard antipsychotic treatment at the start of the study, and they continued on the treatment throughout the study. After taking scans of their brains to establish baseline activity, the researchers then gave each participant a placebo drug and then 600 mg of CBD, and rescanned their brains.

The single dose of CBD appeared to diminish the differences in activity in the brains with psychosis and those without. For example, during memory exercises like recalling something verbally, a brain affected by psychosis has abnormal activity such as greater connectivity in the front of the brain (prefrontal, mediotemporal and striatal areas), which makes it harder to recall things logically. But after taking even just a single dose of CBD activation in these areas tended to look similar to that of a person without the condition.

The results build on a 2018 study from the same team suggesting that CBD can normalize brain activity in people with symptoms of psychosis. This new study takes the work forward by including people with a clear diagnosis.

Can CBD treat psychosis?

These results add to a growing body of research into the ways CBD may offer a treatment for different psychiatric conditions. The need is great: “Current gold-standard treatments tend to work only in a subset of people and can have serious side effects when taken over the long term. CBD may be easier for the body to process, making it a more tolerable long-term option for people with chronic mental health conditions,” Bhattacharyya says.

“This study is essentially showing how CBD might work, and which effects might underlie symptoms of psychosis,” he says. “But we seldom treat psychosis giving single doses; we have to give doses for various weeks before seeing clinical, meaningful results.”

Ultimately, the study sample is too small to draw definite conclusions on CBD as a treatment for psychosis patients as a group. The study also doesn't look at how brain activity changes matched up to behavior in the participants with psychosis — which means we can't know if CBD improved their performance on the memory tasks.

Bhattacharyya says his team is looking into further research on CBD treatment for psychosis with larger samples and longer time frames. The team also hopes to explore CBD as a potential treatment in other disorders with similar symptoms, like Parkinson's or dementia.

Single dose of CBD may treat psychosis, study suggests

“Now not only do we know that CBD works as an antipsychotic, we know it targets the areas of the brain that need to be targeted."

www.inverse.com

 

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Psychedelics and mental health

by Marlene Rupp | sapiensoup.com

“When you take psilocybin, it’s like taking onboard your own psychotherapist.” said a study participant about his psychedelic experience. A widespread belief about psychedelic drugs is that they can turn users mentally ill; what the data shows, however, is that psychedelics can achieve quite the opposite effect: they afford patients a relief of symptoms. Indeed, a growing body of evidence supports that psychedelic drugs may be extraordinarily effective in treating mood disorder and addiction.

Depression. Anxiety. Addiction. Most everyone of us knows somebody who is battling such a condition. Talk therapies may help, but sometimes they don’t. Antidepressants may help, but sometimes they don’t. Some patients are of the opinion that antidepressants are like “Band-Aids” in the way that they never really tackle the underlying issues of their problems.

I haven’t yet heard psychedelics getting described as “Band-Aids.” What I have heard from users is that psychedelics do something like the opposite: they confront you with your greatest vulnerabilities and help you come to peace with them.

“We’re looking at a new paradigm for the way these mental disorders can be treated” says pharmacologist Dr. David Nichols, president and co-founder of the Heffter Research Institute. In this post we’ll look at the latest results from psychedelic research and how they may revolutionize our approach to mental health.

Treating mental disorders

Recent studies have found psychedelics to reduce symptoms of anxiety, depression, and obsessive-compulsive disorder as well as addiction. The effects often lasted for several months after just one or two exposures to the drug.

The results of these recent studies are frankly mind-blowing. I’d like to present to you three of them, all carried out by reputable research teams across the U.S. and Europe.

1. Treatment-resistant depression

The World Health Organization estimates that more than 300 million people suffer from depression. Antidepressants and psychotherapy can offer some relief, but 20 percent of patients are treatment-resistant, meaning they don’t respond to any intervention whatsoever.

In a recent pilot study performed in the U.K., Dr. Carhart-Harris and his team studied the effects of psilocybin in exactly these kinds of treatment-resistant patients. The participants had suffered from moderate to severe depression for, on average, 18 years of their lives. All of them had previously tried psychiatric drugs and therapy or counseling, but with no success.

The chart below shows the individual depression assessments of the twelve participants. One week after the dose, 67 percent were free from depression. And three months after the dose, 42 percent remained in remission.

And the long-term effects? Six months after the experiment, 30 percent of the initially treatment-resistant patients remained entirely free from depression. For 75 percent, the psychedelic experience brought some degree of reduction in depressive symptoms.

Note that this was an open-label study with a small number of participants and no control group. A lack of controls is usually a red flag and tells you that the study shouldn’t be taken at face value. In this case however, the study at hand was a pilot for larger randomized controlled trials. Research is expensive and just like engineers build a prototype before they roll out large-scale production, researchers do pilot studies before they run full-blown trials. With dramatic results like these, it’s reasonable to expect fully randomized, double-blind, placebo-controlled studies in the near future. And speaking of placebo-controlled studies…

HOW DO YOU FAKE A TRIP?

Controlling for the placebo effect poses a real challenge in psychedelic research. With a psychoactive substance, it’s easy for participants to know whether they have received the placebo or the active substance, and this can render the controls ineffective.

So what can be done? Some researchers use active placebos. Instead of giving the participant a do-nothing pill, they’re given either a very mild dose of the tested drug or an entirely different psychoactive substance. This approach obviously comes with its own challenges, but given the limited options it might be the better bet.

2. End-of-life anxiety

How would you feel if you were diagnosed with life-threatening cancer? Not surprisingly, facing one’s own mortality can unleash strong emotions. Up to 40 percent of cancer patients develop a mood disorder which in turn interferes with their chances of recovery. Psychedelic drugs certainly can’t heal cancer, but it appears they can mitigate the accompanying psychological distress.

Lead researcher Roland Griffiths and his team at Johns Hopkins University School of Medicine tested this hypothesis with 51 cancer patients. One group received a high dose of psilocybin, whereas the control group received an active placebo, which in this case was a very low dose of psilocybin that had no detectable behavioral effects. In this way, all participants were told they were taking psilocybin and this controlled for expectancy.

Five weeks after the treatment with high-dose psilocybin, 92 percent of depressed patients and 76 percent of anxious patients showed significant improvements in symptoms. These positive results were not only immediate, but also long-lasting. Six months after their psychedelic experience, the patients suffering from depression were still going strong with improvement rates of 79 percent. Regarding end-of-life anxiety, the improvement rate further increased from 76 percent five weeks after the treatment to 83 percent six months after the treatment. What’s more, half a year after the psilocybin session, over 80 percent of all participants stated that the experience had increased their well-being and/or life satisfaction.

“Such a substantial and enduring effect after one dose is unprecedented in the field of psychiatry.” says Roland Griffiths, professor of neuroscience and psychiatry at Johns Hopkins.

3. Nicotine addiction

Smoking causes almost half a million deaths in the U.S. every year and is related to annual health care expenditures of $170 billion. Overcoming nicotine addiction poses a real challenge to smokers. Smoking cessation programs such as the popular Quit for Life program achieve abstinence rates of only 17.2 percent at six months. If supported with medication and weekly counseling meetings, the success rate can rise to 35 percent, dependent on the medication used. The highest success rates were seen in programs containing extensive cognitive-behavioral therapy, plus pharmaceuticals, plus nicotine replacements. Such comprehensive programs show abstinence rates of 45 to 59 percent at six months.

Matthew Johnson, expert in drug dependence at Johns Hopkins, wanted to see if psilocybin could help smokers to quit their addiction. In an open-label pilot study, 15 nicotine-dependent smokers were guided through a 15-week smoking cessation protocol which provided high levels of psychological support, but no pharmaceuticals or nicotine replacements. The participants had smoked on average 19 cigarettes per day for 31 years and had attempted to quit smoking six times before. After the program, which included up to three psilocybin sessions, 80 percent of the participants were smoke free at the six-month mark.

At 12 months after the quitting date, 67 percent of participants were smoke free, and 87 percent rated their psilocybin sessions amongst the five most personally meaningful and spiritually significant experiences of their lives. Even at around 2.5 years after the quitting date, a solid 60 percent of study participants remained smoke-free.

The numbers produced by these three studies are impressive to say the least. Equally impressive is hearing what the participants have to say about these treatment experiences.

Real people, real experiences

Recall the treatment-resistant depression study from above. Six months after the single psilocybin session, the research team followed up with the participants and interviewed them about their session experience and their life ever since.

“It was like the light switch being turned on in a dark house.”

Almost half of participants reported major lifestyle changes during the months following the psilocybin session. Frequent changes involved improvements to diet, exercise, and cutting down on drinking alcohol. “I lost a lot of weight just purely because I didn’t want to eat badly and that went on for some months. I couldn’t eat what I knew wasn’t good for me.” Some changed their social circles, went out more, got new jobs, learned to drive, built a new kitchen, volunteered with refugees, traveled or picked up acting, comedy or dance classes.

Across all the stories, researchers identified two major themes of inner change. First, a change from disconnection to connection and second, a change from emotional avoidance to acceptance.

Disconnection to connection

Depression can feel as if you’re in a “mental prison” where you’ve gotten stuck in your thoughts. It “robs you of your confidence in yourself” and makes you increasingly less able to engage with your environment. The result is isolation, and whether it’s a perceived or actual isolation, depression is a lonely condition.

About the time following the psilocybin session, participants reported how they “had the mental agility to overcome problems.” They noticed a boost in self-worth, how they were able to adopt fresh perspectives and how they rekindled previous interests. “My wife and I went for dinner for the first time in 6 years: we were like a couple of teenagers.” told one participant. Another shared “I went past a bike shop and went in off the street and said ‘can I hang out and help out?’ I went there for 6 months and helped renovate his shop.”

Some described it as reconnecting to “who they had been” before the depression had developed. Their self-perception changed. Nearly half of the group described realizations of “being a good person” and feelings of self-compassion and self-worth. They felt not only more connected to their surrounding but also more connected to themselves.

Avoidance to acceptance

Boys don’t cry. A common root of depression is the inability or unwillingness to deal with certain emotions. “My whole life I’ve self-medicated to try to make emotions more bearable, sometimes with food, cigarettes, painkillers.”

One participant saw 'emotions as weakness' because he had been raised in an environment where he learned to “put his feelings in a box because you can’t be upset, you’re a man.” Others had gone through traumatic events in their past. Regardless the origin, when participants came face-to-face with their emotions during the psilocybin sessions—which happened regularly—it triggered intense yet cathartic experiences. Powerful bouts of sobbing were observed throughout the sessions, which participants later described as “purification”.

After the session, participants noticed a fresh openness to experiencing emotions, a change that was often long-lasting. One participant described it as “a rebooting of the mind”, another noting that “it reconfigures you somehow.”

All participants said they preferred psilocybin over conventional treatments. To many of them, antidepressants and talk therapies seemed as if they were reinforcing disconnection and emotional avoidance. Some participants explained that their past therapists were trying to motivate them from the ‘outside’. Psilocybin, however, helped them to access an ‘inner voice’ which they said felt immensely powerful and highly motivating. “It’s almost as if when you take the capsules it’s like taking onboard your own psychotherapist.” With psilocybin, they had an empowered experience of self-reflection, which previous therapy attempts did not provide.

Rosalind Watts, the lead researcher of this study, proposes that with psilocybin “patients and clinicians may be granted a broader palette of treatment options in the future, affording them an opportunity to select a treatment that best suits the specific needs and/or desires of a given patient.”

A new approach to mental health

Why are psychedelics so fundamentally different from regular antidepressants? Antidepressants work by increasing the overall levels of serotonin in the synapse, which in turn, leads to more frequent activation of serotonin receptors. Psychedelics activate serotonin receptors too, but in a more targeted way than antidepressants. They activate only certain subtypes of serotonin receptors which are understood to increase cognitive flexibility. Like one of the study participants stated above, psilocybin gave him “the mental agility to overcome problems” and that is precisely what’s required to achieve long-lasting results.

In a nutshell: do psychedelics alone cure mental disorders? No. Rather, psychedelics may serve as a catalyst for patients adopting new perspectives and making important lifestyle changes. Hence, kicking off a treatment protocol with strategically planned dosing session may substantially increase the overall effectiveness of the treatment.

Given the growing body of evidence supporting the safety and efficacy of psychedelic drugs, I believe it’s a matter of time until jurisdictions around the globe will approve psychedelics for medical use. Organizations like MAPS, Beckley Foundation and Heffter Research Institute play a key role in advancing psychedelic research and driving drug-policy reforms in a peaceful and sensible manner.

Psychedelics and Mental Health

Psychedelic drugs appear to be extraordinarily effective in treating mental disorders: latest research results show immediate and long-lasting effects in mood disorders and addiction.

sapiensoup.com

 

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Psychedelics could revolutionize mental health treatment

By Meghana Krishna | Mar 22, 2019

Psychedelic drugs like ecstasy and mushrooms may hold the key to altering the way mental health patients receive treatment, according to best-selling author Michael Pollan and globally recognized psychedelic expert David Nichols.

On Wednesday, the two were invited to speak at Stewart Center's Fowler Hall as part of Purdue's Ideas Festival. Nichols spoke about the progress that has been made in psychoactive drug research over past decades, and Pollan discussed some of the provocative new findings from his latest book, titled “How to Change Your Mind.”

According to Nichols, scientists at Purdue played a critical role in furthering research on psychedelics. When Nichols joined Purdue as a professor during the drug war in 1974, psychedelics had been “demonized and trivialized.” Drugs like LSD were associated with the counterculture of the 1960s and stigmatized, largely due to misinformation.

“(Many people believed) that psychedelic agents had no redeeming value,” Nichols said. “I, however, did not buy into that belief.”

In his lab, Nichols developed an MDMA (also known as ecstasy) compound for use in a clinical trial for the treatment of post-traumatic stress disorder. Remarkably, scientists saw an 80 percent total remission rate among subjects, many of whom were war veterans. There are currently no other treatments for PTSD that have demonstrated such efficacy.

Nichols also discussed psilocybin, a compound at the forefront of psychedelic research into assistive therapy for depression. Today, 16 million American adults suffer from major depressive disorder, and anti-depressants on the market are hit-or-miss, said Nichols. They are often ineffective, slow-acting and laced with undesirable side effects. In contrast, clinical trials have shown that psilocybin treatment can induce complete remission of depression for months — and sometimes even years — after just one dose. As a result, the compound has been awarded breakthrough therapy status from the Food and Drug Administration.

Pollan’s interest in the science of psychoactive drugs was sparked after learning of a clinical trial at New York University that used psilocybin therapy to address the fear of death and “existential distress” in terminal cancer patients. Pollan, who at the time was doing research for an article about psychedelic therapy, was astounded by the effect these drugs had: Several patients reported a “complete removal of the fear of death” after therapy.

Pollan became driven to understand in greater depth how people could have such powerful and spiritually transformative experiences with psychoactive compounds. Although he admitted to entering the realm of psychedelics with a “healthy dose of skepticism,” he said his doubts were eventually replaced by a strong faith that these compounds could permanently alter the landscape of mental healthcare.

Psychoactive drugs are known to suppress activity in the default-mode network of the brain, which is responsible for processing memories and emotions. The DMN provides a basis for the sense of self, also known as the ego. Psychedelics work by decreasing DMN activity and therefore essentially dissolving the ego, which, according to Pollan, is why they are thought by many to act as a spiritual gateway.

“A lot of people report what’s called a mystical-type experience,” Pollan said. “(It’s) defined as feeling like a part of something larger, (like a) transcendence of time and space.”

Pollan reflected on his own experiences taking psychedelics, which occurred in a controlled therapeutic setting as part of his research.

“I saw myself disappear — but I (was untroubled and) perceived it from a new vantage point,” Pollan recalled. “(The experience) taught me that we are not identical to our ego. … The ego is just this voice in your head trying to run the show, and you don’t have to listen to it.”

The experience changed Pollan’s perspective on spirituality during a difficult period in his life as he was faced with his father’s terminal cancer diagnosis. Pollan believes that his psychedelic experience enabled him to become more emotionally aware and fully present as he confronted the reality of his father’s mortality.

Pollan, who is a self-described former “materialist,” acknowledged the skepticism regarding the legitimacy of spiritual experiences. However, he pointed out that, spirituality aside, psychedelics still hold many benefits over traditional drugs for treating mental illnesses. Psychedelics have no known lethal doses and are non-habit forming. In addition, he maintains that using these drugs safely through guided trips provides a “radically different experience” than the wilder, more uncoordinated trips associated with recreational drug use.

Pollan did, however, caution that psychedelic usage does not come risk-free. “Bad trips” are a real phenomenon and users should be mindful of the setting and company in which they choose to consume these drugs. In particular, users with a family history of illnesses like schizophrenia and bipolar disorder are at a higher risk of experiencing drug-induced psychotic breakdowns.

According to Pollan, the FDA is likely still two to five years away from approving psilocybin and MDMA, after which the drugs will presumably be available through prescription. Obtaining FDA approval for the legalization of psychedelics can be complicated due to regulations placed on experiments with human subjects, in addition to the taboo that these drugs hold.

In the aftermath of his latest book being published, hundreds of readers have reached out to Pollan, sharing deeply personal stories of how mental illness has affected their lives.

“We still can’t say with perfect confidence that we have a cure for depression (and other mental illnesses),” Pollan said. “(But the outreach I received) acquainted me with the scale of mental suffering (that exists today), and gives me a sense of urgency about this work.”

https://www.purdueexponent.org/campus/article_56ff86be-4ca0-11e9-a378-4320fefe028c.html

 

[mr peabody]

'Ego-dissolving' psychedelic drugs could assist with mental health

University of Adelaide | Aug 8, 2017

The altered state of consciousness and temporary lack of ego that results from using psychedelic drugs could help some mental health patients recover from their symptoms, according to academics at the University of Adelaide.

Researchers in the University's Department of Philosophy have been studying the body of evidence around the use of psychedelic drugs such as LSD and magic mushrooms, and the impact they have on people's sense of "self."

In a new article published online in Aeon (https://aeon.co/essays/psychedelics-work-by-violating-our-models-of-self-and-the-world), authors Professor Philip Gerrans and recent PhD graduate Dr Chris Letheby say there is growing evidence to suggest that psychedelic experiences can be truly "transformative" -- including helping some people with anxiety, depression, or addiction.

"We know quite a lot about the neurochemistry of psychedelic drugs and how they work on the brain. What's poorly understood is the more complex relationship between the brain, our sense of self, and how we perceive the world," says Professor Gerrans, who has been researching self-representation in psychiatric disorders.

In a recent paper published in the journal Neuroscience of Consciousness, Professor Gerrans and Dr Letheby explain how users of psychedelic drugs often report that their sense of being a self or 'I' -- distinct from the rest of the world -- has diminished or completely "dissolved."

"This 'ego dissolution' results in a moment of expanded awareness, a feeling in which the mind is put more directly and intensely in touch with the world," Professor Gerrans says.

"Through this experience it may be possible to re-engineer the mechanisms of self, which in turn could change people's outlook or world view. The profound sense of connection produced by this experience has the potential to be beneficial for people suffering from anxiety, depression, and some forms of addiction," he says.

Dr Letheby says one of the reasons why psychiatric disorders are so hard to shake is that it's almost impossible for sufferers to view things differently.

"People who go through psychedelic experiences no longer take it for granted that the way they've been viewing things is the only way," Dr Letheby says.

"Psychedelics can assist in enlightening people about the processes behind their subjectivity. Ego dissolution offers vivid experiential proof not only that can things be different, but that there is an opportunity to seek change."

The researchers do not advocate unsupervised recreational use of psychedelic drugs.

"These drugs were originally researched and used as treatments for various psychiatric conditions in the mid-20th century, with psychiatrists in the 1950s claiming success in treating alcoholism and other mental health conditions."

"It may be time for these drugs to make a psychiatric comeback, under controlled circumstances. More research would be needed to establish just how important they could be as part of an overall treatment program," Professor Gerrans says.

https://www.sciencedaily.com/releases/2017/08/170808145443.htm​

 

[mr peabody]

From chaos to calm: A life changed by ketamine

by Jon Hamilton | NPR | June 4, 2018

For six years now, life has been really good for James. He has a great job as the creative director of an advertising firm in New York City. He enjoys spending time with his wife and kids.

And it has all been possible, he says, because for the past six years he has been taking a drug called ketamine.

Before ketamine, James was unable to work or focus his thoughts. His mind was filled with violent images. And his mood could go from ebullient to dark in a matter of minutes.

Ketamine "helped me get my life back," says James, who asked that we not use his last name to protect his career.

Ketamine was developed as a human and animal anesthetic in the 1960s. And almost from the time it reached the market it has also been used as a mind-bending party drug.

But ketamine's story took a surprising turn in 2006, when researchers at the National Institutes of Health showed that an intravenous dose could relieve severe depression in a matter of hours. Since then, doctors have prescribed ketamine "off label" to thousands of depressed patients who don't respond to other drugs.

And pharmaceutical companies are testing several new ketamine-related drugs to treat depression. Johnson & Johnson expects to seek approval for its nasal spray esketamine later this year, though the approval would be limited to use in a clinical setting.

Meanwhile, doctors have begun trying ketamine on patients with a wide range of psychiatric disorders other than depression. And there is now growing evidence it can help people with anxiety, bipolar disorder, post-traumatic stress disorder, and perhaps even obsessive-compulsive disorder.

"I think it's actually one of the biggest advances in psychiatry in a very long time," says Dr. Martin Teicher, an associate professor of psychiatry at Harvard Medical School and director of the Developmental Biopsychiatry Research Program at McLean Hospital.

Ketamine may also offer new hope for people like James who have symptoms of several different psychiatric disorders.

James had a happy childhood, he says. But his thoughts were out of control. "I always felt like I was crossing a freeway and my thoughts were just racing past me," he says.

He spent much of his childhood terrified of "an unknown, an ambiguous force out there." The fear was "overwhelming," he says. "I literally slept with the cover over my head with just room to breathe through my mouth until I went to college."

And there was something else about James: his body temperature.

"I overheated constantly," he says. "I would wear shorts all year long. In my 20s in my apartment I would sleep with the windows open in the middle of the winter."

In his late 20s, James saw a doctor who told him he had attention deficit hyperactivity disorder. So he started taking stimulants.

At first, the pills helped him focus. Then they didn't, no matter how many he took.

He'd done well as an idea guy in the advertising industry. But now James was trying to work at home, and it wasn't going well.

"ADHD pills will make you interested in anything," he says. "So I was putting the desk together and taking the desk apart. I was putting a laptop stand together and taking it apart. I was going in a massive downward spiral."

James had always suffered from mood swings. But now they were rapid and extreme. And he couldn't stop thinking about gruesome scenarios, like a murderer coming for his family.

"My wife took a summer off to be with me because she was scared of what was going to happen to me," he says. "She would go to work for a few hours, then rush home. There would be times I'd call her just screaming, 'Please come home. I can't get through another minute.' "

Eventually, James found his way to Dr. Demitri Papolos, an associate professor of clinical psychiatry at Albert Einstein College of Medicine.

"He was like a whirling dervish when he came into my office," Papolos says. "He was extremely fearful, scanning the environment all the time and he overheated at the drop of a hat."

Papolos diagnosed James with a variant of bipolar disorder he calls the "fear of harm phenotype." It typically appears in childhood and often doesn't respond to traditional psychiatric drugs.

But Papolos has found that the condition does respond to ketamine. "It's been transformational," he says.

In January, Papolos published a study of 45 children with the problem. They inhaled a nasal mist containing ketamine about twice a week. Nearly all got dramatically better.

Scientists still aren't sure why ketamine works, but there's evidence that it encourages the brain to rewire, to alter the connections between cells. That process has been linked to recovery from depression. And it may also explain why ketamine helps people who have symptoms associated with several different psychiatric disorders.

"I think it's having multiple effects, and that means it's probably useful for multiple different disorders," Teicher says.

One of those effects involves a part of the brain involved in temperature regulation. And that could explain why patients like James usually stop overheating once they are taking ketamine.

James started taking a ketamine nasal spray every other day. He says his response was dramatic.

"One day I turn to my wife and I'm like, 'I feel calm today. I don't know if it's the sun coming in, I don't know if it's just the way we're sitting here, but I feel like I could go and sit at the computer and work.' "

The next day, James did sit down at his computer. A month later, he was back at work.

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[mr peabody]

Psychedelic drugs and the future of mental health care

by Sean Illing | Vox | Mar 8, 2019

I had a close call on the second night of the ayahuasca ceremony.

I saw my teenage self melting into particles and eventually disappearing altogether. I pulled off my sleep mask and saw the people around me shape-shifting into shadows. I thought I was dying, or perhaps losing my grip on reality.

Suddenly, Kat, my guide, appeared and began singing to me. I couldn’t make out the words, but the cadence was soothing. After a minute or two, the dread washed away and I settled back into a peaceful half-sleep.

The 12 of us — nine women and three men — taking ayahuasca in a private home in San Diego were led by two trained guides: Kat and her partner, whom I’ll call Sarah since she requested anonymity due to legal concerns. Together they have more than 20 years of experience working with psychedelics, including ayahuasca, a plant concoction that contains the natural hallucinogen known as DMT.

Kat and Sarah work as a team serving psychedelic medicine every month or so in a different city. Their primary role is to create a space in which everyone feels secure enough to drop their emotional guards and open up to the drugs’ potential to change their attitudes, moods, and behaviors.

There’s a lot of unease heading into these ceremonies, especially for people who have never experimented with psychedelics. The fear of what you might see or feel can be overwhelming. But guides like Kat are your port in the storm. When things get turbulent, they respond with a steady, calm hand.

Though psychedelic drugs remain illegal, guided ceremonies, or sessions, are happening across the country, especially in major cities like New York, San Francisco, and Los Angeles. Guiding itself has become a viable profession, both underground and above, as more Americans seek out safe, structured environments to use psychedelics for spiritual growth and psychological healing. This new world of psychedelic-assisted therapy functions as a kind of parallel mental health service. Access to it remains limited, but it’s evolving quicker than you might expect.

But what would a world in which psychedelics are legal look like? And what sort of cultural structures would we need to ensure that these drugs are used responsibly?

Today, a renaissance is underway. At institutions like John Hopkins University and New York University, clinical trials exploring psilocybin as a therapy for treatment-resistant depression, drug addiction, and other anxiety disorders are yielding hopeful results.

In October, the Food and Drug Administration took the extraordinary step of granting psilocybin therapy for depression a “breakthrough therapy” designation. That means the treatment has demonstrated such potential that the FDA has decided to expedite its development and review process. It’s a sign of how far the research and the public perception of psychedelics have come.

It’s because of this progress that we have to think seriously about what comes next and how we would integrate psychedelics into the broader culture. I’ve spent the past three months talking with guides, researchers, and therapists who are training clinicians to do psychedelic-assisted therapy. I’ve participated in underground ceremonies, and I’ve spoken to people who claim to have conquered their drug addictions after a single psychedelic experience.

Our current laws sanction various poisons, including booze and cigarettes. These are drugs that destroy lives and feed addictions. And yet one of the most striking things about the recent (limited) psychedelic research is that the drugs do not appear to be addictive or have adverse effects when a guide is involved. Many researchers believe these drugs, when used under the supervision of trained professionals, could revolutionize mental health care.

Psychedelics are becoming tools of healing rather than a threat to the social order. And the scientists and organizations and training institutions leading the way are working within the system to reduce the potential for blowback. This is very different from the approach taken in the ’60s, and so far it’s been a success.

Your mind on psychedelics

Psilocybin is the drug of choice for most researchers in recent years for a variety of reasons. For one, it carries less cultural baggage than LSD, and so study participants are more willing to work with it. Psilocybin also has strong safety data based on studies conducted before prohibition, and so the FDA has allowed a small number of small clinical trials to move forward.

Although the most recent studies are still preliminary and the sample sizes fairly small, the results so far are compelling. In one 2014 Johns Hopkins study, 80 percent of the smokers who participated in psilocybin-assisted therapy remained fully abstinent six months after the trial. By way of comparison, smoking cessation trials using varenicline (a prescription medication for smoking addiction) has success rates around 35 percent.

In a separate 2016 study of cancer-related depression or anxiety, 83 percent of 51 participants reported significant increases in well-being or satisfaction six months after a single dose of psilocybin. (Sixty-seven percent said it was one of the most meaningful experiences of their lives.)

A typical psilocybin session lasts somewhere between four and six hours (compared with 12 hours with LSD), yet it produces enduring decreases in depression and anxiety for patients. Which is why researchers like Roland Griffiths at Johns Hopkins believe psychedelics represents an entirely new model for treating major psychiatric conditions. Conventional treatments like antidepressants don’t work for a lot of patients and can come with a host of side effects.

To understand the clinical side, I traveled to Johns Hopkins to sit down with Alan Davis, a clinical psychologist, and Mary Cosimano, a research coordinator and trained guide. Both help lead the psilocybin sessions at Hopkins.

Researchers at Hopkins have worked with a number of populations since they received approval from the FDA to study psilocybin in 2000 — healthy adults without any psychological issues, cancer patients suffering from anxiety and depression, smokers, and even seasoned meditators.

A key part of the process at Hopkins is what they call “life review.” Before they provide the drug, they want to know who you are, where you’re at in your life, and what kinds of emotional or psychological walls you’ve built up around yourself. The idea is to work with patients to determine what’s holding them back in their lives, and explore how they might overcome it.

Davis and Cosimano both say psilocybin has benefited every population they’ve worked with. “It’s not for everyone,” Cosimano told me, “but for the right person at the right time, it can be positively transformative.” (They don’t accept patients anywhere on the spectrum of psychosis — it’s just too dangerous.)

The psilocybin sessions are intense and, in some cases, last all day. The rooms they use are a curious blend of drab doctor’s office decor and New Age ornamentation. There’s a vanilla-colored couch covered with embroidered pillows and draped on both sides by South American art. Near the couch, on an end table, is a ceremonial cup and mini sculptures of magic mushrooms; it’s not quite an altar, but it may as well be.

The important thing, Cosimano and Davis say, is to make the patient as comfortable as possible. They even encourage people to bring personal artifacts with them, or letters from loved ones, or basically anything with deep emotional resonance. Much like the underground guides, researchers do everything they can to create a safe psychological space.

Sessions can unfold in multiple directions, depending on the depth of the experience (which is hard to predict) and the mental state of the individual. Mostly, patients are lying on the couch with a sleep mask covering their eyes. Cosimano, Davis, and other clinical guides act as lodestars — holding the patient’s hand and helping them process what they’re seeing and what it means. “I never get bored with this,” Cosimano told me. “Every single session is different, every experience is different, and I’m just blown away at being able to witness each person’s journey.”

Yet it’s not entirely clear to the scientists what it is about these experiences that produce such profound changes in attitude, mood, and behavior. Is it a sense of awe? Is it what the American philosopher William James called the “mystical experience,” something so overwhelming that it shatters the authority of everyday consciousness and alters our perception of the world? What’s clear in any case is that psychedelic trips are often beyond the bounds of language.

The best metaphor I’ve heard to describe what psychedelics does to the human mind comes from Robin Carhart-Harris, a psychedelic researcher at Imperial College in London. He said we should think of the mind as a ski slope. Every ski slope develops grooves as more and more people make their way down the hill. As those grooves deepen over time, it becomes harder to ski around them.

Like a ski slope, Carhart-Harris argues, our minds develop patterns as we navigate the world. These patterns harden as you get older. After a while, you stop realizing how conditioned you’ve become — you’re just responding to stimuli in predictable ways. Eventually, your brain becomes what Michael Pollan has aptly called an “uncertainty-reducing machine,” obsessed with securing the ego and locked in uncontrollable loops that reinforce self-destructive habits.

"Taking psychedelics is like shaking the snow globe," Carhart-Harris said. "It disrupts these patterns and explodes cognitive barriers. It also interacts with what’s called the default mode network (DMN), the part of the brain associated with mental chatter, self-absorption, memories, and emotions." Anytime you’re anxious about the future or fretting over the past, or engaged in compulsive self-reflection, this part of the brain lights up. When researchers looked at images of brains on psychedelics, they discovered that the DMN shuts down almost entirely."

Think of it this way: You spend your whole life in this body, and because you’re always at the center of your experience, you become trapped in your own drama, your own narrative. But if you pay close attention, say, in a deep meditation practice, you’ll discover that the experience of self is an illusion. Yet the sensation that there’s a “you” separate and apart from the world is very hard to shake; it’s as though we’re wired to see the world this way.

The only time I’ve ever been able to cut through this ego structure is under the influence of psychedelics. I was able to see myself from outside my self, to see the world from the perspective of nowhere and everywhere all at once, and suddenly this horror show of self-regard stopped. And I believe I learned something about the world that I could not have learned any other way, something that altered how I think about, well, everything.

At Johns Hopkins, the drug experience is only one part of the treatment. Equally important is the therapy that follows. People regularly tell researchers that the psilocybin session is the single most personally and spiritually significant experience of their lives, including childbirth and the loss of loved ones.

"But there’s a need," Davis said, “to make sense of these experiences and to bring them into your day-to-day life in a way that doesn’t discount the meaning. That doesn’t necessarily have to be therapy or one-on-one counseling with a guide, but it’s crucial to integrate the experience into your daily life, whether that’s taking up a new practice like yoga or meditation, spending more time in nature, or just cultivating new relationships."

The point is that’s it not enough to take the ride and move on; it’s about establishing new habits, new mental patterns, new ways of being. Psychedelics can kick-start this process, but for many people, at least, that’s all they can do.

When I returned from my first ayahuasca retreat, I struggled to process what had happened to me. I had no formal help, no instruction, no real support. It’s jarring to slide back into your routine after having your inner world turned upside down like that. I’ve adopted new practices (like meditation), and that has gone a long way in keeping me connected to that initial encounter with psychedelics, but there are limits to what you can do alone.

Recognizing the need for more integration, schools like the California Institute of Integral Studies and psychedelic researchers like NYU’s Elizabeth Nielson are focused on training professional therapists to work specifically with psychedelic users. Nielson is part of the Psychedelic Education and Continuing Care Program, which does not conduct psychotherapy but offers instruction to clinicians who want to learn about psychedelics.

“People who have used psychedelics, or will use psychedelics in the future, will need help integrating their experiences, and many will feel safest doing that in a therapist’s office,” she told me. “That means we’ll need more therapists who understand these experiences and know how to have these kinds of conversations with patients.”

So how do we integrate psychedelics into the culture?

For better or worse, psychedelics, like all drugs, are going to be used outside the safer contexts of research facilities or private sessions with experienced guides. According to Geoff Bathje, a psychologist at Adler University who works with high-trauma patients, the question is therefore, “What sort of harm reductions do we need to help protect people?”

Several people I spoke with pointed to the “harm reduction” model. Harm reduction focuses on reducing the risks associated with drug use, as opposed to punitive models aimed at eliminating use altogether. It’s a practical and humane approach that has worked well in places like Portugal, where all drugs for personal use have been decriminalized.

Although the harm reduction model isn’t typically associated with psychedelics, the principles apply all the same.

For Bathje, it’s about doing good drug education in the general population, “making sure people understand the risks involved with psychedelics — how they can be misused, how people can be exploited when under the influence, etc.” There are already national harm reduction groups like Zendo Project, which is sponsored by MAPS, that focus on peer-to-peer counseling for people experimenting with psychedelics.

Bathje and some of his colleagues have established a harm reduction group in Chicago called Psychedelic Safety Support and Integration. The goal is to promote safety and help people process their psychedelic experiences. It’s a critical container that brings in the community, spreads awareness of the risks associated with psychedelic drug use, and creates a space for connection.

At the moment, there’s a gap between the harm reduction movement and the psychedelic research community. “You go to a psychedelics conference and it’s focused on the science and the therapeutic potential,” Bathje said, “and the general assumption is that if we just produce good science, these drugs will get approved as medicines and everything will just fall into place.”

“If you attend a harm reduction conference,” he added, “it’s all about cultural change and how politicians don’t care about the science. The focus is much more on organizing and who has the power and how we can reduce risks and do things safely.” This is partly why the harm reduction movement can be useful to psychedelics. Science may be critical to legalization, but public health programs would also have to help integrate these drugs into the broader culture.

*From the article here :

The extraordinary therapeutic potential of psychedelic drugs, explained

I spent months talking to psychedelic guides and researchers. Here’s what I learned.

www.vox.com

 

[mr peabody]

Ketamine a breakthrough treatment for suicidal children

by Jack Turban | July 18, 2017

Initial research finds fast, dramatic benefits for a vulnerable population.

Fourteen-year-old Nicole, whose name I changed for her privacy, told her mother every day for years that she wanted to end her own life. Between suicide attempts were more psychiatric hospital visits than she or her mother could count. She refused to get out of bed, shower, or go to school, missing sixty school days in a single year. In one visit with her therapist, she admitted to praying every night that she would not wake up the next morning. After countless psychiatrists and psychotherapists were unable to improve her depression, her mother converted a bathroom cabinet into a locked safe, containing all of the sharp objects and pills in the house. Her parents were certain it was only a matter of time until Nicole killed herself.

Today, a now seventeen-year-old Nicole greets me with a big smile. Her blonde hair is pulled back into a ponytail to reveal her bright blue eyes. She tells me she hasn’t missed a day of school and is preparing for college. Blushing, she lets me know that her first date is coming up, a prom date to be precise. For the first time in years, she is happy and wants to live.

What happened to cause this dramatic change? In December, Nicole started infusions of a psychedelic drug called ketamine. Though she had failed to respond to endless medication trials for her depression (selective serotonin reuptake inhibitors, mirtazapine, topiramate, antipsychotics, and lithium to name just a few), ketamine cleared her depression within hours. The effect lasts about two weeks before she needs a new infusion.

Ketamine is a drug with many identities. For anesthesiologists, it’s a sedative for painful procedures. For partiers, it’s a fun way to hallucinate and have an out-of-body experience. For critics, it’s a dangerous addictive drug that can cause memory problems, bladder disease, and psychosis when abused. In the past few years, it has taken on a new identity: miracle psychiatric drug that works within hours. Its use as a psychiatric medication is relatively new, and it’s possible that regular infusions could cause significant long-term side effects. We currently lack the long-term data to know. Still, the National Institute of Mental Health has called it “the most important breakthrough in antidepressant treatment in decades.”

The ketamine for mental health story goes back as far as the 1980s, when neuroscientists examined the brains of people who had committed suicide. They found that suicide victims had structural abnormalities in a protein called NMDAR, a neurotransmitter receptor that is sprinkled throughout the brain. It also happens to be the receptor to which ketamine binds. Though some animal models suggested that ketamine improved depression in mice, it wasn’t until 2000 that researchers tried giving the drug to adults with depression. Surprisingly, many patients’ depression completely resolved within hours. The quick and dramatic result was unprecedented for an anti-depressant medication.

Since then, physicians have given the drug to thousands of depressed adults, including patients in eight successful clinical trials. But fewer have been willing to infuse the drug into the veins of minors. Yale School of Medicine is an exception, and I recently watched a few adolescents receive the infusions with Yale’s clinical trial team. It was less dramatic to watch than I expected, but the kids were definitely high. There was a lot of giggling involved, and they often said that they felt like time was changing and that their bodies felt ‘funny’ and sometimes numb. Nicole admitted, “I’m not gonna lie. I like the feeling of it.”

Perhaps more dramatic than the trips themselves, which happened in a carefully controlled procedure room with a psychiatrist and anesthesiologist ready to intervene if needed, were the interviews that came after. I could see the weight of depression lifted from these patients within hours. Adolescents who were previously ready to end their own lives became bright and hopeful. Psychiatry has never seen a drug intervention so powerful and fast acting. While most anti-depressants take weeks to work and offer modest improvement, ketamine offers dramatic improvement in less than a day.

Because of early success in adult patients, there has been explosion of ketamine clinical trails for adolescents. Frustrated by a lack of effective treatments for children experiencing severe, debilitating, psychiatric disease, doctors have new clinical trials underway for adolescents with depression, anxiety, obsessive-compulsive disorder, and even a rare autism-like condition called Rett’s syndrome. Dr. Gerard Sanacora at Yale School of Medicine explained it like this: “We know high blood pressure causes all kinds of things: heart attacks, strokes, vision problems, and kidney diseases. We treat all of those with blood pressure pills. Ketamine may be the blood pressure pill of psychiatry — altering basic physiology [of neuronal connections] and having a wide range of beneficial effects.”

But there is also reason to be concerned. Before now, ketamine has only been used as a one-time injection for anesthesia. The FDA approved the drug based on trials where the drug was given just once. For depression, however, it is given every few weeks with an unclear end point. Will repeated administration reveal new risks? Studies in adolescent mice show that ketamine can cause long-term cognitive problems. Ketamine-treated mice can also develop a schizophrenia-like illness, with a pattern of neuron loss in the brain that is similar to schizophrenia. However, it’s important to note that the majority of these studies use mice given ketamine doses equivalent to 10 times that which is given to patients.

Dr. Michael Bloch, Yale child psychiatrist and principal investigator of several controlled trials for ketamine for adolescents, points out that the drug is only used for select patients who have severe mental health problems that have not responded to other medications. The infusions are provided in a clinical trial setting, where doctors collect efficacy data and carefully watch for side effects. For each of his patients, the theoretical risks of ketamine are carefully weighed against the risk of suicide. For Nicole, who seemed likely to die from suicide, the calculus was not difficult.

Though Dwyer and Bloch stress that doctors need to be careful, they are also quick to point out the potential promise of this research. Dr. Bloch explains, “Suicide is the second leading cause of death in adolescents. 40% of depressed adolescents don’t respond to first-line treatments. Another half of those don’t respond to multiple trials of medication paired with psychotherapy. Other than electroconvulsive therapy, which carries its own risk of memory problems, doctors have almost no other choice.” Suicidal patients are also at a high risk for suicide after leaving the hospital. Existing anti-depressants like Prozac take weeks to work, while ketamine can take effect in less than 24 hours. This could decrease deaths from suicide after patients leave the hospital.

For Nicole, one of those suicidal teens, everyone involved seems convinced that ketamine saved her life. According to her, her family, and her doctors, the theoretical risk of long-term side effects was less frightening than what might happen in the face of chronic hopelessness and suicidality.

https://www.scientificamerican.com/article/the-ketamine-breakthrough-for-suicidal-children/\​

 

[mr peabody]

Exercise, the new primary prescription for those with mental health problems

Neuroscience News | May 23, 2019

Adding exercise as a treatment for patients in psychiatric care facilities has positive benefits and is proving to be more effective than medications or psychotherapy alone. Exercise helps reduce mental health disorder symptoms such as anxiety, depression, anger and psychomotor agitation. Researchers say exercise also helps to develop a more balanced and integrated sense of self for those with mental health disorders.

When it comes to inpatient treatment of a range of mental health and mood disorders — from anxiety and depression to schizophrenia, suicidality and acute psychotic episodes — a new study advocates for exercise, rather than psychotropic medications, as the primary prescription and method of intervention. Findings from the study reveal that physical exercise is so effective at alleviating patient symptoms that it could reduce patients’ time admitted to acute facilities and reliance on psychotropic medications.

“The general attitude of medicine is that you treat the primary problem first, and exercise was never considered to be a life or death treatment option. Now that we know it’s so effective, it can become as fundamental as pharmacological intervention,” explains David Tomasi, a lecturer at the University of Vermont, psychotherapist and inpatient psychiatry group therapist at the University of Vermont Medical Center and lead researcher of the study.

Practitioners at inpatient psychiatric facilities — often crowded, acute settings in which patients experience severe distress and discomfort — typically prescribe psychotropic medications first, rather than natural remedies like physical exercise, to alleviate patients’ symptoms such as anger, anxiety and depression. In fact, Tomasi estimates that only a handful of inpatient psychiatric hospitals in the U.S. provide psychotherapist-supported gym facilities exclusively for these patients. Instead, practitioners rely on classical psychotherapeutic and pharmacological frameworks to treat psychiatric symptoms, which they monitor to determine when a patient is ready to be discharged from the facility.

Tomasi, in collaboration with UVMMC’s Sheri Gates and Emily Reyns, built a gym exclusively for roughly 100 patients in the medical center’s inpatient psychiatry unit, and led and introduced 60-minute structured exercise and nutrition education programs into their treatment plans. The psychotherapists surveyed patients on their mood, self-esteem and self-image both before and after the exercise sessions to gauge the effects of exercise on psychiatric symptoms.

Patients reported lower levels of anger, anxiety and depression, higher self-esteem, and overall improved moods. Tomasi, Gates and Reyns found an average of 95 percent of patients reported that their moods improved after doing the structured exercises, while 63 percent of the patients reported being happy or very happy, as opposed to neutral, sad or very sad, after the exercises. An average of 91 percent of patients also reported that they were pleased with the way their bodies felt after doing the structured exercises.

“The fantastic thing about these results is that, if you’re in a psychotic state, you’re sort of limited with what you can do in terms of talk therapy or psychotherapy. It’s hard to receive a message through talk therapy in that state, whereas with exercise, you can use your body and not rely on emotional intelligence alone” explains Tomasi.

“The priority is to provide more natural strategies for the treatment of mood disorders, depression and anxiety,” he adds. “In practice, we hope that every psychiatric facility will include integrative therapies — in our case, exercise in particular — as the primary resource for their patients’ psycho-physical wellbeing.”

Exercise is the new primary prescription for those with mental health problems - Neuroscience News

Adding exercise as a treatment for patients in psychiatric care facilities has positive benefits and is proving to be more effective than medications or psychotherapy alone. Exercise helps reduce mental health disorder symptoms such as anxiety, depression, anger and psychomotor agitation...

neurosciencenews.com

​

 

[mr peabody]

LSD may offer viable treatment for certain mental disorders

McGill University | Neuroscience News | 6 Jan 2021

LSD increases social behaviors by activating 5-HTPA serotonin receptors and AMPA receptors in the prefrontal cortex, and the mTORC1 protein. Activating all three factors promoted social interactions. The findings suggest supervised LSD microdosing may help alleviate some of the social problems associated with ASD and other mental health disorders that impact social behaviors.

Researchers from McGill University have discovered, for the first time, one of the possible mechanisms that contributes to the ability of LSD to increase social interaction.

The findings, which could help unlock potential therapeutic applications in treating certain psychiatric diseases, including anxiety and alcohol use disorders, are published in the journal PNAS.

Psychedelic drugs, including LSD, were popular in the 1970s and have been gaining popularity over the past decade, with reports of young professionals claiming to regularly take small non-hallucinogenic micro-doses of LSD to boost their productivity and creativity and to increase their empathy. The mechanism of action of LSD on the brain, however, has remained a mystery.

Studies in mice provide clues

To conduct their study, the researchers administered a low dose of LSD to mice over a period of seven days, resulting in an observable increase in the sociability of the mice. “This increased sociability occurs because the LSD activates the serotonin 5-HT2A receptors and the AMPA receptors — which is a glutamate receptor, the main brain excitatory neurotransmitters — in the prefrontal cortex and also activates a cellular protein called mTORC 1,” explains Danilo De Gregorio, PharmD, PhD, who is a postdoctoral fellow in the Neurobiological Psychiatry Unit at McGill and the study’s first author.

“These three factors, taken together, promote social interaction in mice - the equivalent of empathy and social behaviour in humans.”

The researchers note that the main outcome of their study is the ability to describe, at least in rodents, the underlying mechanism for the behavioural effect that results in LSD increasing feelings of empathy, including a greater connection to the world and sense of being part of a large community.

“The fact that LSD binds the 5-HT2A receptor was previously known. The novelty of this research is to have identified that the prosocial effects of LSD activate the 5-HT2 receptors, which in-turn activate the excitatory synapses of the AMPA receptor as well as the protein complex mTORC1, which has been demonstrated to be dysregulated in diseases with social deficits such as autism spectrum disorder,” as specified by Prof. Nahum Sonenberg, Professor at the Department of Biochemistry of McGill University, world renowned expert in the molecular biology of diseases and co-lead author of the study.

Using the cutting-edge technique of optogenetics, a technique where genes for light-sensitive proteins are introduced into specific types of brain cells in order to monitor and control their activity precisely using light signals, the researchers observed that when the excitatory transmission in the prefrontal cortex is de-activated, the prosocial effect of LSD was nullified, highlighting the importance of this brain region on the modulation of the behavioural effects of LSD.

Moving forward to apply the findings to humans

Having found that LSD increases social interaction in mice, the researchers are hoping to continue their work and to test the ability of LSD to treat mutant mice displaying the behavioural deficits similar to those seen in human pathologies including autism spectrum disorders and social anxiety disorders. The hope is to eventually explore whether micro-doses of LSD or some novel derivates might have a similar effect in humans and whether it could also be a viable and safe therapeutic option.

“Social interaction is a fundamental characteristic of human behaviour,” notes the co-lead author Dr. Gabriella Gobbi, Professor in the Department of Psychiatry at McGill and psychiatrist at the McGill University Health Centre. “These psychedelic compounds, which, at low doses, are able to increase sociability may help to better understand the pharmacology and neurobiology of social behavior and, ultimately, to develop and discover novel and safer drugs for mental disorders.”

LSD May Offer Viable Treatment for Certain Mental Disorders - Neuroscience News

LSD increases social behaviors by activating 5-HTPA serotonin receptors and AMPA receptors in the prefrontal cortex, and the mTORC1 protein. Activating all three factors promoted social interactions. The findings suggest supervised LSD microdosing may help alleviate some of the social problems...

neurosciencenews.com

 

[mr peabody]

Broccoli sprouts may restore brain chemistry imbalance linked to schizophrenia

Johns Hopkins Medicine | May 8, 2019

In a series of recently published studies using animals and people, researchers say they have further characterized a set of chemical imbalances in the brains of people with schizophrenia related to the chemical glutamate. And they figured out how to tweak the level using a compound derived from broccoli sprouts.

In a series of recently published studies using animals and people, Johns Hopkins Medicine researchers say they have further characterized a set of chemical imbalances in the brains of people with schizophrenia related to the chemical glutamate. And they figured out how to tweak the level using a compound derived from broccoli sprouts.

They say the results advance the hope that supplementing with broccoli sprout extract, which contains high levels of the chemical sulforaphane, may someday provide a way to lower the doses of traditional antipsychotic medicines needed to manage schizophrenia symptoms, thus reducing unwanted side effects of the medicines.

"It's possible that future studies could show sulforaphane to be a safe supplement to give people at risk of developing schizophrenia as a way to prevent, delay or blunt the onset of symptoms," adds Akira Sawa, M.D., Ph.D., professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Schizophrenia Center.

Schizophrenia is marked by hallucinations, delusions and disordered thinking, feeling, behavior, perception and speaking. Drugs used to treat schizophrenia don't work completely for everyone, and they can cause a variety of undesirable side effects, including metabolic problems increasing cardiovascular risk, involuntary movements, restlessness, stiffness and "the shakes."

In a study described in the Jan. 9 edition of the journal JAMA Psychiatry, the researchers looked for differences in brain metabolism between people with schizophrenia and healthy controls. They recruited 81 people from the Johns Hopkins Schizophrenia Center within 24 months of their first psychosis episode, which can be a characteristic symptom of schizophrenia, as well as 91 healthy controls from the community. The participants were an average of 22 years old, and 58% were men.

The researchers used a powerful magnet to measure and compare five regions in the brain between the people with and without psychosis. A computer analysis of 7-Tesla magnetic resonance spectroscopy (MRS) data identified individual chemical metabolites and their quantities.

The researchers found on average 4% significantly lower levels of the brain chemical glutamate in the anterior cingulate cortex region of the brain in people with psychosis compared to healthy people.

Glutamate is known for its role in sending messages between brain cells, and has been linked to depression and schizophrenia, so these findings added to evidence that glutamate levels have a role in schizophrenia.

Additionally, the researchers found a significant reduction of 3% of the chemical glutathione in the brain's anterior cingulate cortex and 8% in the thalamus. Glutathione is made of three smaller molecules, and one of them is glutamate.

Next, the researchers asked how glutamate might be managed in the brain and whether that management is faulty in disease. They first looked at how it's stored. Because glutamate is a building block of glutathione, the researchers wondered if the brain might use glutathione as a way to store extra glutamate. And if so, the researchers questioned if they could use known drugs to shift this balance to either release glutamate from storage when there isn't enough, or send it into storage if there is too much.

In another study, described in the Feb. 12 issue of the journal PNAS, the team used the drug L-Buthionine sulfoximine in rat brain cells to block an enzyme that turns glutamate into glutathione, allowing it to be used up. The researchers found that theses nerves were more excited and fired faster, which means they were sending more messages to other brain cells. The researchers say shifting the balance this way is akin to shifting the brain cells to a pattern similar to one found in the brains of people with schizophrenia. Next, the researchers wanted to see if they could do the opposite and shift the balance to get more glutamate stored in the form of glutathione. They used the chemical sulforaphane found in broccoli sprouts, which is known to turn on a gene that makes more of the enzyme that sticks glutamate with another molecule to make glutathione. When they treated rat brain cells with glutathione, it slowed the speed at which the nerve cells fired, meaning they were sending fewer messages. The researchers say this pushed the brain cells to behave less like the pattern found in brains with schizophrenia.

"We are thinking of glutathione as glutamate stored in a gas tank," says Thomas Sedlak, M.D., Ph.D., assistant professor of psychiatry and behavioral sciences. "If you have a bigger gas tank, you have more leeway on how far you can drive, but as soon as you take the gas out of the tank it's burned up quickly. We can think of those with schizophrenia as having a smaller gas tank."

Because sulforaphane changed the glutamate imbalance in the rat brains and affected how messages were transmitted between the rat brain cells, the researchers wanted to test whether sulforaphane could change glutathione levels in healthy people's brains and see if this could eventually be a strategy for people with mental disorders. For their study, published in April 2018 in Molecular Neuropsychiatry, the researchers recruited nine healthy volunteers (four women, five men) to take two capsules with 100 micromoles daily of sulforaphane in the form of broccoli sprout extract for seven days.

The volunteers reported that a few of them were gassy and some had stomach upset when eating the capsules on an empty stomach, but overall the sulforaphane was relatively well tolerated.

The researchers used MRS again to monitor three brain regions for glutathione levels in the healthy volunteers before and after taking sulforaphane. They found that after seven days, there was about a 30% increase in average glutathione levels in the subjects' brains. For example, in the hippocampus, glutathione levels rose an average of 0.27 millimolar from a baseline of 1.1 millimolar after seven days of taking sulforaphane.

The scientists say further research is needed to learn whether sulforaphane can safely reduce symptoms of psychosis or hallucinations in people with schizophrenia. They would need to determine an optimal dose and see how long people must take it to observe an effect. The researchers caution that their studies don't justify or demonstrate the value of using commercially available sulforaphane supplements to treat or prevent schizophrenia, and patients should consult their physicians before trying any kind of over-the-counter supplement. Versions of sulforaphane supplementsare sold in health food stores and at vitamin counters, and aren't regulated by the U.S. Food and Drug Administration.

"For people predisposed to heart disease, we know that changes in diet and exercise can help stave off the disease, but there isn't anything like that for severe mental disorders yet," says Sedlak. "We are hoping that we will one day make some mental illness preventable to a certain extent."

Sulforaphane is found in a variety of cruciferous vegetables, and was first identified as a "chemoprotective" substance decades ago by Paul Talalay and Jed Fahey at Johns Hopkins.

According to the World Health Organization, schizophrenia affects about 21 million people worldwide.

Broccoli sprout compound may restore brain chemistry imbalance linked to schizophrenia

In a series of recently published studies using animals and people, researchers say they have further characterized a set of chemical imbalances in the brains of people with schizophrenia related to the chemical glutamate. And they figured out how to tweak the level using a compound derived from...

www.sciencedaily.com

 

[mr peabody]

Single dose of 5-MeO-DMT produces rapid improvements in psychopathological symptoms*

by Eric Dolan | PsyPost.org | Sep 18, 2019

A single inhalation of the psychedelic drug 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) is associated with sustained improvements in satisfaction with life, mindfulness, and a reduction of psychopathological symptoms, according to preliminary research published in Psychopharmacology.

“5-MeO-DMT is a lesser known psychedelic compared to, for example, ayahuasca and psilocybin — and thus very limited research exists,” explained study author Malin Uthaug (@malin.uthaug), a PhD candidate at Maastricht University in the Netherlands.

5-MeO-DMT occurs naturally in the venom of some toads and in a variety of plants species. It can also be produced synthetically.

“Essentially, I saw this as a niche area, and brought it upon myself to investigate its effect and therapeutic potential further as part of my doctorate work at Maastricht University. This specific article summarizes the first study I did on the topic, but there are more to come,” Uthaug said.

In the study, 42 participants completed a battery of psychology tests before inhaling vapor from dried toad secretion containing 5-MeO-DMT. The participants completed the tests again about 24 hours later and 24 participants completed the tests yet again at a 4-week follow-up assessment.

“This study was a so-called ‘naturalistic observational study.’ This means that as a researcher, I simply observed what was occurring at sessions where toad secretion containing 5-MeO-DMT was administered to participants by facilitators, and distributed questionnaires to the participants,” Uthaug explained.

“Although there are limitations with this design (no placebo-control, participant bias, etc), it has an advantage in the sense that it allows researchers to get a better look at drug effects than what the current legality status of psychedelics permit.”

The researchers found that subjective ratings of life satisfaction, depression, anxiety, and mindfulness improved on the day after the session, and this effect persisted for four weeks. The findings are in line with a previous survey of 362 adults, which found that approximately 80& of respondents reported improvements in anxiety and depression after using 5-MeO-DMT.

But there also does not appear to be anything particularly special about toad venom compared to synthetic 5-MeO-DMT.

“Another important take-away from the study is that 5-MeO-DMT is the main compound in the toad secretion as demonstrated by our lab-analysis,” Uthaug said.

“This finding, as well as the outlined ethical and ecological consideration of toad secretion use, make a clear and strong argument for the discontinuation of toad secretion as a means of obtaining and consuming 5-MeO-DMT. In other words, ‘save a toad – exploit a chemist.‘”

Previous research has indicated that 5-MeO-DMT has a relatively safe profile of use and is predominantly used for spiritual exploration. But there is still much to learn about the psychedelic drug.

“The results of the present study are in no way conclusive, and more research is warranted to investigate 5-MeO-DMT further. The rest of our studies on 5-MeO-DMT (from my dissertation as well as other collaborations) are yet to be published, and include one study outlining the effects of 5-MeO-DMT on biomarkers (salivary cortisol and IL-6), and another comparing the effects and experiences following vaporization or intramuscular injection,” Uthaug told PsyPost.

“These will all amplify the current literature, but future clinical research and safety assessment of 5-MeO-DMT, specifically through the intramuscular route, is highly warranted before a clinical trial can commence.”

Uthaug also noted that some facilitators of 5-MeO-DMT face serious allegations of malpractice.

“Additionally, none of the facilitators have the necessary expertise (clinical background) to properly hold a safe space where altered states of consciousness can be entered, nor to screen for contraindications in participants that are included in a session,” she said. “This is dangerous as it puts people at unnecessary risk for having an unpleasant and even traumatic experience, which can impact them as well as those around them negatively.”

*From the article here :

A single dose of 5-MeO-DMT produces rapid and persistent improvements in life satisfaction and psychopathological symptoms

A single inhalation of the psychedelic drug 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) is associated with sustained improvements in satisfaction with ...

www.psypost.org

 

[mr peabody]

These psychedelic drugs show promise for treating mental health disorders

by Rachael Rettner | Live Science | Aug 11, 2018

They aren't drugs you'd ever expect to see scribbled on a doctor's prescription pad: ecstasy, "magic" mushrooms, ayahuasca.

But in recent years, a number of small studies have explored the potential for psychedelic drugs to treat certain mental health conditions. And the results suggest that, along with talk therapy, the drugs may benefit some people.

"Combined with talk therapy, some psychedelic drugs like MDMA, psilocybin and ayahuasca may improve symptoms of anxiety, depression and PTSD," Cristina Magalhaes, an associate professor of clinical psychology at Alliant International University in Los Angeles, said in a statement. Magalhaes co-chaired a symposium on psychedelics and psychotherapy at the annual meeting of the American Psychological Association (APA) in San Francisco.

Still, more research and discussion are needed to better understand the possible benefits of the drugs, as well as the ethical and legal issues surrounding their use, Magalhaes said. Many psychedelic drugs, including the three addressed in the symposium, are illegal in the United States and are available only for patients in research studies.

Here's a look at why these three psychedelic drugs show promise for treating mental health conditions:

MDMA

Research will soon begin a large-scale study of MDMA, the active ingredient in the drug ecstasy, along with talk therapy, for the treatment of PTSD. The "Phase 3" study, which will include at least 230 people, is the final step needed before MDMA can be approved as a prescription drug, according to The New York Times.

The combination of this drug and talk therapy has already shown benefits in smaller studies of patients with PTSD who did not respond to other treatments.

Researchers think that MDMA may help people with PTSD by improving how they respond when they undergo talk therapy, Dr. Michael Mithoefer, a psychiatrist in private practice in South Carolina who has studied MDMA, told Live Science in a 2016 interview.

MDMA may also have benefits for some people with autism who also have social anxiety. In a very small study presented at the APA symposium, researchers examined the effect of two MDMA treatments, spaced a month apart, on 12 adults with autism and social anxiety. The subjects also received talk therapy. The researchers found that the patients experienced significant and long-lasting reductions in their social anxiety symptoms.

"Social anxiety is prevalent in adults with autism, and few treatment options have been shown to be effective," said Alicia Danforth, of the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center, who presented the study. "The positive effects of using MDMA and therapy lasted months, or even years, for most of the research volunteers."

Still, because the study was small, more research is needed to better understand how MDMA and talk therapy may treat social anxiety in adults with autism.

Psilocybin

Recent studies also suggest that psilocybin could benefit patients who have cancer-related psychological distress, or cancer patients with depression who haven't benefited from other treatments. For example, in 2016, two studies involving a total of 80 patients found that a single dose of psilocybin could considerably reduce the depression and anxiety felt by patients who had terminal or advanced cancer, compared with those who took a placebo. And the effect was long-lasting; up to 80 percent of participants saw their reductions in depression and anxiety last for six months.

In another study discussed at the APA symposium, 13 patients with life-threatening cancer who experienced anxiety and distress were treated with psilocybin combined with talk therapy. Results showed that the patients were better able to grapple with loss and existential distress, and many patients said they developed a new understanding of dying, according to the researchers.

"Participants made spiritual or religious interpretations of their experience, and the psilocybin treatment helped facilitate a reconnection to life [and] greater mindfulness and presence and gave them more confidence when faced with cancer recurrence," said Gabby Agin-Liebes, a doctoral candidate in psychology at Palo Alto University in California, who presented the study.

Ayahuasca

Ayahuasca is a drink made from plants that grow in the Amazon and that indigenous people in South America have traditionally used for spiritual ceremonies. It contains the psychedelic N,N-dimethyltryptamine, or DMT, as well as compounds that may have anti-depressive effects.

Indeed, preliminary research suggests that the drug may benefit people who have depression. In a small study in Brazil, researchers looked at the effects of ayahuasca in six people with depression who'd never taken the drug before. Within hours of taking ayahuasca, patients saw improvements in their symptoms, which lasted for the three-week study period, according to a 2015 article in the journal Nature. The researchers are now conducting larger studies of the drug.

As for how ayahuasca and other drugs help with psychiatric conditions, there are likely many factors involved. But one study suggests that feelings of spirituality, and how they related to people's ability to regulate their emotions, may play a role.

That study, also presented at the symposium, involved 159 participants who reported that they had taken a psychedelic at some point in their lives, such as psilocybin, ayahuasca or LSD.

Participants also reported on their levels of spirituality and their relationships with their emotions. The study found that use of psychedelics was linked with increased levels of spirituality, which in turn was tied to improved emotional stability and fewer symptoms of anxiety and depression.

"This study reinforces the need for the psychological field to consider a larger role for spirituality in the context of mainstream treatment, because spiritual growth and a connection to something greater than the self can be fostered," said Adele Lafrance, an associate professor of psychology at Laurentian University in Ontario, who presented the findings at the symposium.

These Psychedelic Drugs Show Promise for Treating Mental Health Disorders

In recent years, a number of small studies have explored the potential for psychedelic drugs to treat certain mental health conditions.

www.livescience.com

 

[mr peabody]

Are magic mushrooms the answer to depression?*

by Josh Jacobs | The Guardian | 10 Jun 2019

Lying on a bed in London’s Hammersmith hospital ingesting capsules of psilocybin, the active ingredient of magic mushrooms, Michael had little idea what would happen next. The 56-year-old part-time website developer from County Durham in northern England had battled depression for 30 years and had tried talking therapies and many types of antidepressant with no success. His mother’s death from cancer, followed by a friend’s suicide, had left him at one of his lowest points yet. Searching online to see if mushrooms sprouting in his yard were the hallucinogenic variety, he had come across a pioneering medical trial at Imperial College London.

Listening to music and surrounded by candles and flowers in the decorated clinical room, Michael anxiously waited for the drug to kick in. After 50 minutes, he saw bright lights leading into the distance and embarked on a five-hour journey into his own mind, where he would re-live a range of childhood memories and confront his grief. For the next three months, his depressive symptoms waned. He felt upbeat and accepting, enjoying pastimes he had come to feel apathetic about, such as walking through the Yorkshire countryside and taking photographs of nature.

“I became a different person,” says Michael. “I couldn’t wait to get dressed, get into the outside world, see people. I was supremely confident – more like I was when I was younger, before the depression started and got to its worst.”

The trial, finished in 2016, was the first modern study to target treatment-resistant depression with psilocybin, a psychedelic drug naturally occurring in around 200 species of mushroom. To varying degrees, Michael and all 18 other participants saw their symptoms reduce a week after two treatments, including a high, 25mg dose. Five weeks later, nine out of 19 patients found that their depression was still significantly reduced (by 50% or more) – results that largely held steady for three months. They had suffered from depression for an average of 18 years and all had tried other treatments. In January this year, the trial launched its second stage: an ambitious effort to test psilocybin on a larger group and with more scientific rigour (including a control group, which Michael’s study lacked), comparing the drug’s performance with escitalopram, a common antidepressant. The team has now treated about a third of the 60 patients and say that early results are promising for psilocybin.

Imperial’s current work is among a string of new studies that a group of professors, campaigners and investors hope will lead to psilocybin’s medical approval as a transformative treatment. Others soon to begin include an 80-person study run by Usona Institute, a Wisconsin-based medical non-profit, and a trial at King’s College London, as well as a 216-person trial that is already under way around the US, Europe and Canada, managed by the London-based life sciences company Compass Pathways. Robin Carhart-Harris, head of Imperial’s Centre for Psychedelic Research and a Compass scientific adviser, believes psilocybin could be a licensed medicine within five years, or potentially even sooner. “By about that point,” he says, “it would be like an irresistible force, and indefensible to ignore the weight of the evidence.”

For 48-year-old university design technician Kirk Rutter, this is why psilocybin seems to work – and why he hopes it will become medically available. He sees the drug not as a silver bullet but as a medicine that shows patients deep truths and requires them to apply teachings of this kind. Some other treatments, such as cognitive behavioural therapy, also seek to reshape thinking patterns, often in conjunction with antidepressants, but for many the current options fail to work. More than 300 million people suffer from depression globally, according to the World Health Organization, but researchers say that many of the most serious cases do not respond to antidepressants.

Rutter was in this group, having tried counselling and two prescription medicines in the five years before the Imperial trial, as his depression worsened following his mother’s death. After psilocybin, he began to break cycles of catastrophic thinking and had the confidence to make profound life changes, such as selling his house and moving away from abusive neighbours, reorganising his finances and travelling for enjoyment after years of not leaving the country. He says of psilocybin: “It removes any barriers and allows you to process what you need to in an almost seductive way. You are inevitably and irresistibly drawn into it.” One week after the treatment, he noticed a feeling of optimism come back to his life. “Hell,” he thought, “I haven’t had this for a long time.”

*From the article here :

'They broke my mental shackles': could magic mushrooms be the answer to depression?

New trials have shown the drug psilocybin to be highly effective in treating depression, with Oakland the latest US city to in effect decriminalise it last week. Some researchers say it could become ‘indefensible’ to ignore the evidence – but how would it work as a reliable treatment?

www.theguardian.com

 

[mr peabody]

Perth

Treating mental disorders with psychedelic psychotherapy*

by Cahli Samata | Medical Xpress | Oct 10 2018

Millions of Australians suffer from a myriad of mental health issues. Depression, PTSD and addiction to name a few. But what if psychedelics could help them?

Every day in Australia, more than eight people die by suicide. Millions more suffer mental health issues. We have treatments available, but in Australia, we're missing out on therapies that are showing great promise in other parts of the world.

Why? Because they use psychedelic drugs.

Psychedelic drugs and mental health issues may sound like a terrible combination—and it can be in the wrong setting.

But increasing evidence suggests that using controlled portions of these drugs with trained psychotherapists could help people overcome several mental health disorders.

Even healthy people might be able to benefit in the future.

Dr. Stephen Bright is Senior Lecturer of Addiction at Edith Cowan University (ECU) and Vice President of Psychedelic Research in Science and Medicine (PRISM). He's hoping to bust the myths about psychedelic drugs and push through the politics so that Australians may one day benefit from these potentially life-saving therapies.

What is psychedelic psychotherapy?

Psychedelic psychotherapy involves using small amounts of psychedelic drugs in a controlled, clinical setting with trained psychotherapists. There are different drugs used for different purposes, but some of the main ones are psilocybin, LSD and MDMA. The drugs used in this type of therapy aren't like ones you'll find on the street. They are pharmaceutical grade, meaning you know the exact dose and what's in it.

All psychotherapies aim to help patients overcome a problem or make a positive change to their life—usually by facing it head on.

Take post-traumatic stress disorder for example. Someone with PTSD may avoid thinking about the bad experience they had. In psychotherapy, the therapist will actually direct them towards facing that bad experience to help them to work through it.

Adding psychedelic drugs to the mix generally helps patients get there faster. The therapists 'hold the space', allowing the patient to mostly guide the session. The therapists will usually only need to intervene if the patient is avoiding facing their issues or bad feelings.

"It never fails to amaze me how much spontaneous insight people gain in the MDMA sessions. It would take 10+ weeks of normal psychotherapy to guide a person to the insights that the patient spontaneously come up with while on MDMA," Stephen said.

Stephen explains that this is a technique he often used while 'trip sitting' at festivals.

"The further they push against bad feelings, the worse their experience becomes. So we try to talk to them about what they're experiencing and allow them to approach it and work through it rather than avoid it, and doing so seems to have a therapeutic response."

But patients aren't thrown in the deep end like someone having a difficult trip at a festival. Psychedelic therapy involves planning and preparation.

The preparatory sessions are thorough, so the patient knows exactly what they need to do and therapists know how best to support them.

"The person is fully prepared beforehand for what they're going to experience, and they have some coping strategies."

A mystical experience

So what is it about psychedelic drugs that patients find therapeutic?

Neurologically, we're not sure. But Stephen said "The secret often lies in the mystical experience you can have on psychedelic drugs. It's difficult to explain, but it's a spiritual sense of oneness. Kind of like having an epiphany. The mystical experience usually happens more with psychedelic drugs like psilocybin, rather than MDMA."

A study at New York University found that patients with life-threatening cancer who had this mystical experience from psilocybin psychotherapy had improved quality of life and decreased depression and anxiety. This has huge implications for palliative care.

"That spiritual experience seems to be the catalyst in allowing them to come to terms with their situation," Stephen explains.

But this isn't exactly a new discovery. The co-founder of Alcoholics Anonymous, Bill Wilson, said the spiritual awakening he experienced on LSD is what started his own sobriety.

"The problem is spiritual experiences are hard to create but we know, with psychedelics, we can induce these mystical experiences in a clinical setting in the right context with the right trained therapists involved," said Stephen.

This is why research has also looked into psychedelic psychotherapy as a treatment for addictions like smoking. One study found that psilocybin psychotherapy helped people quit smoking, with 60% still smoking-abstinent after 12 months.

"That's remarkable when you consider Champix—which is the leading pharmacotherapy for nicotine cessation—that has a success rate of 21% at 12 months," said Stephen.

"Subjects in this study reported that this mystical experience that's induced by the psilocybin is ranked as one of the top five most significant experiences of their life."

Your brain on psychedelics

Not only has this therapy shown good results in PTSD, palliative care and addiction, it's also being looked at as a treatment for depression because of the effect it has on the brain.

"Another area that's in its infancy is psilocybin and depression. There's been an open label study published by Imperial College in London among people who hadn't responded to other treatments for depression. They found a number gained significant benefits from psilocybin-assisted psychotherapy."

In this study, they also took a look at what was going on in the brain of patients with neuroimaging. Using this, they found a change in the brain was linked to a reduction of depressive symptoms.

It turns out psilocybin can temporarily switch off a part of the brain called the default mode network, which correlated with patients having that mystical experience.

"The default mode network is a series of interconnected neural pathways. It's activated all the time when we're in a waking state. It allows you and me to have this conversation at the moment because we can concentrate on what we're doing," said Stephen.

"If we turn off the default mode network, we end up with a lot of cross-talk happening within the brain,"

"In the context of depression, perhaps having all those different interconnected pathways allows the person to see the world, themselves and others in a completely different perspective."

He likens the default mode network to a conductor in the brain. Turning off the default mode network with psychedelics is "like putting the conductor on paid service leave for 6 to 12 hours. Without the conductor, the orchestra starts playing all kinds of things."

"In that cacophony of noise comes epiphanies."

Inducing everyday epiphanies

If you're like me, by now you're probably thinking you could use an epiphany too. Surely this can't only be useful for mental health disorders?

I asked Stephen to play the hypothetical game of looking into the future and letting me know if there will ever be a day this could be accessed by anyone needing to make a big life decision, and he replied "People can go when they want to engage in some sort of spiritual contemplation or they're not sure about something in their life and they can utilise the psychedelic experience to help them with that."

But before we get there, we have some serious catching up to do.

What's stopping us?

You may have noticed that all the studies referenced in this article have been from the US and the UK. That's because Australia has been seriously lagging behind in psychedelic research.

Stephen said "there are a few reasons for this, namely academic conservatism," which is why I swell with uni pride when Stephen tells me my old stomping ground ECU has thrown their support behind psychedelic science.

"We've been banging our heads against the wall for about 8 or 9 years now, and things are really starting to look quite positive. I don't want to get too optimistic, but things are starting to look really positive," he said.

"The fact that ECU is supportive of it is fantastic."

Stephen's worked in both the policy and scientific spheres to try and get Australia to embrace and get involved in psychedelic research. In particular, he's been leading the charge for MDMA-assisted psychotherapy.

Right now, the MAPS is in the process of phase 3 trials for MDMA-assisted psychotherapy for PTSD, after phase 2 yielded promising results.

"What we're hoping in Australia, and what ECU's supporting, is that Perth will be a site for a phase 3 trial," said Stephen.

"If we can demonstrate we have the people and infrastructure to do MDMA-assisted psychotherapy, then we can come on board as a phase 3 site, and so all we need to do to demonstrate that is just run a very small pilot feasibility study. And so that's what we're working on at the moment."

Getting Australia on board means we will be able to access psychedelic psychotherapies and won't be left behind.

"Hundreds of thousands of Australians will no longer needlessly suffer from depression, post-traumatic stress disorder and anxiety associated with dying … we will see less suicides occurring among war veterans," said Stephen.

"Australians won't need to travel overseas to access these treatments because we will have clinics and trained therapists available in Australia who can provide these therapies."

So it's probably time that Australia had an epiphany and took psychedelic science a little more seriously.

*From the article here :

Treating mental disorders with psychedelic psychotherapy

Millions of Australians suffer from a myriad of mental health issues. Depression, PTSD and addiction to name a few. But what if we could help them by trying something a little trippy?

medicalxpress.com

 

[mr peabody]

The authors conclude that diagnostic labeling represents ‘a disingenuous categorical system.’

Study finds psychiatric diagnoses to be ‘scientifically meaningless’

Neuroscience News | July 8, 2019

A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless, as tools to identify discrete mental health disorders.

The study, led by researchers from the University of Liverpool, involved a detailed analysis of five key chapters of the latest edition of the widely used Diagnostic and Statistical Manual (DSM), on ‘schizophrenia’, ‘bipolar disorder’, ‘depressive disorders’, ‘anxiety disorders’ and ‘trauma-related disorders’.

Diagnostic manuals such as the DSM were created to provide a common diagnostic language for mental health professionals and attempt to provide a definitive list of mental health problems, including their symptoms.

The main findings of the research were:

- Psychiatric diagnoses all use different decision-making rules
- There is a huge amount of overlap in symptoms between diagnoses
- Almost all diagnoses mask the role of trauma and adverse events
- Diagnoses tell us little about the individual patient and what treatment they need

The authors conclude that diagnostic labeling represents ‘a disingenuous categorical system’.

Lead researcher Dr. Kate Allsopp, University of Liverpool, said: “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”

Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”

Professor John Read, University of East London, said: “Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”

Study finds psychiatric diagnosis to be 'scientifically meaningless' - Neuroscience News

Researchers conclude many psychiatric diagnoses are scientifically worthless as tools for identifying discrete mental health disorders.

neurosciencenews.com

 

[mr peabody]

Mental health is getting the psychedelic treatment

Rick Doblin wants to be a legally licensed psychedelic therapist. Learn about his work using MDMA, or ecstasy, to help people suffering from PTSD.

Rick Doblin is the executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS), which he founded in 1986 and grew into an international psychedelic pharmaceutical company. MAPS, which designs or sponsors psychedelic psychotherapy drug development research, received FDA Breakthrough Therapy Designation for MDMA-assisted psychotherapy for PTSD in 2017, with Phase 3 clinical trials underway and FDA approval anticipated in 2021. He will speak in the 2019 Aspen Ideas: Health program track Sex, Drugs, and Rock-and-Roll.

We caught up with him about advances in psychedelic therapy and the current culture around drugs in the United States.

You’ve been working to develop a new way to treat people suffering from Post Traumatic Stress Disorder using the psychedelic drug MDMA, or ecstasy. How can this drug help people with PTSD?

MDMA-assisted psychotherapy uses MDMA to improve the effectiveness of psychotherapy for PTSD. Significantly, the treatment involves only two or three administrations of MDMA in conjunction with psychotherapy in a controlled therapeutic setting, as part of a 12-week course of psychotherapy. In this treatment, MDMA is not the treatment by itself, but must be administered together with psychotherapy. Once approved, patients will not be able to take the MDMA home—patients won’t be filling their prescriptions at their local pharmacy. Instead, MDMA will only be available through a doctor and only in supervised therapeutic settings from certified clinicians.

MDMA is a synthetic compound first patented in 1912, and now off-patent, that is widely recognized for its ability to decrease fear and defensiveness while increasing trust and empathy. It may open a “window of tolerance” in patients undergoing psychotherapy for PTSD, enhancing the effectiveness of psychotherapy. MDMA directly reduces activity in the amygdala, a brain region that helps regulate fear and anger and which is often overactive in PTSD patients. By reducing this activity, MDMA may help people feel less afraid of their traumatic memories, and therefore to be able to share them more comfortably with their therapists. MDMA also stimulates the release of specific hormones, such as oxytocin and prolactin, which occur naturally in the human body and are associated with feelings of trust, bonding, and intimacy. Due to their trauma, PTSD sufferers often isolate themselves, or have difficulty trusting their therapists enough to adequately process their emotions. MDMA may facilitate the psychotherapeutic process by helping people feel safer and more connected to themselves and to their therapists. MDMA also enhances activity in the prefrontal cortex, facilitating memory and attention. This is related to MDMA’s effect of stimulating serotonin and dopamine release in the brain.

In MAPS’ completed Phase 2 trials with 103 participants, 56 percent no longer qualified for PTSD after treatment with MDMA-assisted psychotherapy, measured one to two months following treatment. At the 12-month follow-up, 68 percent no longer had PTSD. Most subjects received just 2-3 sessions of MDMA-assisted psychotherapy. All participants had chronic, treatment-resistant PTSD, and had suffered from PTSD for an average of 17.9 years. The combined analysis of all these Phase 2 results was published on May 7, 2019 in the peer-reviewed Journal of Psychopharmacology.

Why would someone choose to be treated for mental illness with psychedelics rather than other prescription medications?

To be clear, existing prescription treatments for PTSD can and do work at least a little bit for some people. It’s just that for many people, they don’t. The volunteers in our Phase 2 trials were all people with chronic, treatment-resistant PTSD, so they’d all tried existing treatments and they hadn’t worked for them. When MDMA-assisted psychotherapy is approved, however, it will be available for anyone for PTSD, not just for treatment-resistant patients.

I think that the main contribution that psychedelic therapy will make to psychiatric treatment is to provide an option for treating mental illness that only involves a very limited course of treatment, and a very limited number of administrations of the drug. Current psychiatric treatments for PTSD involve taking drugs every day, for months or years or forever, in order to keep the symptoms of the illness under control. PTSD sufferers often relive their traumatic experiences through nightmares and flashbacks, have difficulty sleeping, feel detached from daily life, have lower quality of life, and suffer from anxiety, depression, and suicidal thinking. Existing treatments just keep those symptoms in check, and patients have to deal with the side effects all the time. We’re seeing that MDMA-assisted psychotherapy, on the other hand, can get at the root of PTSD, allowing people to re-shape their relationship to their trauma at a deeper level.

More than three dozen states have legalized either medical or recreational marijuana. How is the increasing availability of marijuana affecting your work, if at all?

Legal and regulated availability of marijuana in the United States first appeared in 1996 with California passing Proposition 215, allowing medical use. At the time, public support for legalization was around 25 percent. With demonstrated therapeutic benefits and excellent safety profile observed in medical marijuana patients, public support started to trend upwards reaching majority in 2013, and was recorded at a record high of two-thirds in 2018. Ironically, marijuana is still classified as a Schedule 1 controlled substance by the US Drug Enforcement Administration (DEA), a category for drugs with no accepted medical use, lack of accepted safety use, and high potential for abuse. Since the 1980s, policies and rhetoric have vastly exaggerated many risks of recreational drugs, and minimized potential benefit with an abstinence-only education & policy approach, resulting in a lack of reliable information regarding safety and reducing potential harms, and barriers to conducting research including inadequate quality and supply of study drug as well as lack of funding for studies assessing therapeutic benefits. More research is needed to thoroughly explore the potential risks and benefits of marijuana and psychedelics. Public support for access to previously stigmatized therapeutic tools like marijuana and MDMA has increased drastically over the last decade as medical access and regulated clinical trials have been allowed to take place.

While marijuana is becoming legal, opioids are increasingly stigmatized. How would you characterize the current environment around drugs — socially and politically — in the United States? How does it impact the work you do?

The alarming rates of deaths related to opioid use is a crisis very much in the forefront of political discourse in the United States. Politicians and their constituents are realizing that the so-called "war on drugs" and its draconian, prohibition-based policies have failed to address the issues of unregulated drug trafficking and use, as they are not rooted in public health and safety. For example, psychedelics and marijuana are classified as Schedule 1 controlled substances as the result of explicit political efforts to target political opponents and racial and ethnic minorities. Stigma is one of the primary drivers of drug-related harms, so I am interested in moving away from prohibition-based policies towards more compassionate and human-centered drug policy that regulates and decriminalizes drugs, including psychedelics. When a prohibition-based, zero-tolerance position is taken with regards to drug policy, especially for substances that have the potential to cause physical or psychological harm when not used in the proper setting or with appropriate preparation and supervision, there is a heightened probability of associated harmful outcomes. Conversely, when a harm reduction, education-based position is taken with regards to drug policy, people are equipped to make informed decisions about when and how they use drugs, based on accurate information about the benefits and the risks associated with substance use.

You’d like to eventually become a legally licensed psychedelic therapist. What would need to change, legally, for you to step into such a role?

MAPS is currently working to make MDMA legally available for use in therapeutic settings. We are now conducting the clinical trials needed for the Food and Drug Administration (FDA) to approve the use of MDMA combined with psychotherapy for the treatment of PTSD. In November 2018, MAPS, through its wholly owned subsidiary MAPS Public Benefit Corporation, began Phase 3 clinical trials of MDMA-assisted psychotherapy for PTSD at 15 sites in the US, Canada, and Israel. Provided the results confirm the Phase 2 trial results, doctors may be able to legally prescribe MDMA for use in psychotherapy, not as a take-home drug but only for use in controlled therapeutic settings, by 2021. On August 16, 2017, the FDA granted Breakthrough Therapy Designation to MDMA for the treatment of PTSD. The FDA grants this designation for treatments that (1) are intended alone or in combination with one or more other drugs to treat a serious or life-threatening disease or condition; and (2) preliminary clinical evidence indicates may demonstrate substantial improvement over existing therapies. I am excited that after more than three decades of work towards this goal, it’s looking very hopeful that I’ll be able to fulfill my dream of becoming a legal psychedelic therapist—before I’m too old to change careers!

You will speak in the program track at Aspen Ideas: Health. Can you give us a brief idea of what you’ll focus on in Aspen?

In my talk in Aspen, I'll discuss the current state of the so-called psychedelic renaissance taking place across the globe and associated political and cultural influences so people can have an idea of the big picture of the potential these substances have for mental health care and beyond. Then, I'll discuss the FDA-regulated drug development process for MDMA-assisted psychotherapy for PTSD and the results of the clinical trials sponsored by MAPS, as well as the treatment approach and training program for providers. Finally, we'll turn towards the future and explore what regulation of MDMA-assisted psychotherapy might look like post-approval from the FDA, the availability of treatment in the US and globally, and my vision for a post-prohibition world.

Mental Health is Getting the Psychedelic Treatment | Aspen Ideas

Rick Doblin wants to be a legally licensed psychedelic therapist. Learn about his work using MDMA, or ecstasy, to help people suffering from PTSD.

www.aspenideas.org

 

[mr peabody]

From ketamine to cupboard therapy: the future of mental health treatment

by Kate Lyons | The Guardian

Once, the future of mental health treatment was drugs. The advent of Prozac and a whole class of similar medication gave doctors an easy option and big pharma easy money.

But 20 years on, the problems have not gone away. In fact, mental illness is much more pervasive, with depression now the world’s second biggest cause of disability.

Moreover, a dramatic reduction in drug research and development suggests pills will not be the only – or even the primary – answer to mental health problems in the long term.

But what will be?

The laboratory

One reason Sergiu Pasca, assistant professor at Stanford University, went into research after completing medical training was his frustration when he saw what oncologists could do for their patients and how limited he and his colleagues were in treating mental health problems.

This was partly to do with the difference in funding for cancer and mental health research. But there was also the question of access.

“For cancer you can remove the tumour, and we can grow these cancer cells in a dish. If you find a small molecule that stops uncontrolled proliferation of these cells, you have a potential drug for cancer,” said Pasca. “In contrast with that, we don’t have direct access to brain cells, you can’t do a brain biopsy. Therefore, in studying mental disorders, we look at postmortem brains. That’s a problem for me as a neuroscientist because these neurons can’t fire,” he said.

Sergiu Pasca MD has built small pieces of human cortex in his lab at Stanford.

Pasca’s laboratory has found a way to solve that problem, at least in part. Using stem cell technology, the team takes skin cells from living patients and from those develops a small spherical piece, up to 5mm in diameter, of functioning human cortical brain tissue. These small pieces, and there are thousands sitting in petri dishes in Pasca’s lab, have a structure very similar to the human cerebral cortex, the outer layer of the brain, and have neurons that fire.

Since these cultures have the DNA of whoever they are taken from, Pasca is able to compare brain tissue made from the cells of people with conditions such as autism and schizophrenia in the hope of working out how these conditions develop on a molecular level.

“It’s very likely that, as a community, we’re going to identify the causes, the mechanisms and probably specific therapies for particular forms of psychiatric disorders, pretty much like we’re doing for cancer today,” said Pasca.

The research is expensive and labour intensive, with each piece of brain tissue requiring about 20 weeks of almost daily cell culture work, but he believes it is likely to yield results, particularly for conditions that have a strong genetic component, such as autism, schizophrenia and forms of intellectual disability.

“In the next 10 years I think we’re going to understand more and more psychiatric disorders at the molecular level. I am convinced we’re going to witness a revolution in psychiatry,” he said.

The therapy

Dr Andrea Reinecke, clinical psychologist and researcher at Oxford University, is pioneering a new, and some might say tough, form of cognitive behavioural therapy (CBT). Her one-off sessions involve locking her patient in a cupboard so he or she can have, and get through, a panic attack.

In the first experimental study, which tested the impact of one-hour sessions of CBT on patients with panic disorders, all 30 patients showed improvement and one-third reported being completely free of symptoms a month later.

A second study combining the one-hour CBT with cicloserine, an antibiotic known to have a positive impact on neuro-plasticity, is about to be completed and looks set to report even better results.

The CBT session involves Reinecke talking to people with panic disorders about what prompts their panic attacks and about their coping strategies. Then Reinecke locks the patients in a cupboard, without access to any of these coping mechanisms, and let’s them go through a panic attack unaided.

This is important, according to Reinecke, because the brain starts to learn that it wasn’t the coping mechanism – breathing into a paper bag, calling a friend, or avoiding the situation – that prevented them from dying.

Teresa White, a carer from Oxfordshire, participated in the second trial, in March 2015. She had panic attacks for 20 years, which mean't she couldn’t travel alone or be in a lift by herself. Even deviating from her regular dog-walking route would bring on a panic attack.

“I always felt like something bad was going to happen,” said White. “I was going to have a heart attack, I was going to pass out or I was going to die. I’d never actually been on a train by myself either until I’d done the study.”

White says the one-hour CBT treatment has been life-changing. “I can walk the dog anywhere I like, I’ve just recently done my first long-haul flight to the Caribbean, I went snorkelling, which is a big thing for me because of having a mask over my face. I can go in a lift by myself,” said White.

"The speed and intensity of this treatment meant that not only was it cheaper, but also more patients saw it through," says Reinecke. "There is a high dropout rate for a typical 12-session course of CBT spread over six months."

“Whereas this goes for an hour, it’s one session where they have to push themselves, they can cry and scream and shout at me, but it’s going to work. It’s not only about cutting short but also about making things more effective,” said Reinecke.

So far, Reinecke is optimistic about the treatment’s effectiveness in the treatment of panic disorders, which affect 5% of the population. Her team is looking into whether it could also be used for other anxiety disorders and PTSD and within the next few years she will begin discussions with the NHS about running larger clinical trials in hospitals or at outpatient clinics.

The community

Five minutes’ walk from a tube station in east London, past an abandoned block of flats with broken windows, there is an unexpected three acres of calm.

Situated on a perfectly maintained park, where people sit reading on benches and a child kicks a ball with his grandfather, is the Bromley-by-Bow Centre.

“A visiting priest said we had all the characteristics of a monastery except one,” said Dan Hopewell, director of knowledge and innovation at the centre. “We’re missing beer brewing.”

The feeling of a sanctuary is unsurprising – the centre was originally a church, which in the 1980s had a priest with a vision for serving the community of Tower Hamlets. Now, the centre is run as a secular charity – though the church still meets there – and houses a cafe, GP clinic, studio space for artists, a nursery, exercise and art classes, English lessons, employment and housing advice, and mental health support groups; and it models a very different approach to mental health care.

It hinges on the view that people’s mental wellbeing and social situation – in particular their ability to have purpose, community and not live in poverty – are intertwined and that addressing the latter can help to fix problems with the former. “How we live our lives, what we eat, who we talk to, all of these contribute to how we feel,” said Alice Everett, the centre’s social prescribing coordinator.

Everett works alongside local GPs to help people struggling with housing, finances, isolation and unemployment, which in turn affect their mental health. She often recommends people join programmes run by the centre, one of which is therapeutic horticulture, a weekly gardening group for people with mental health and intellectual difficulties.

“The group is fantastic, everyone’s so friendly and it does pick you up,” said Bill, one of the group members. “It really is good for your mind. If you miss a week you really miss it mentally.”

Bill has discovered he has green fingers. The landing of his flat is covered with pot plants, including begonias, which he describes as “my little babies,” though to his frustration they keep flowering pink. “I want some orange and red ones.”

For Matt Griffin, the programme that helped him was a sports and employability course for 18-35-year-olds with mental health problems. “I’d been very unwell with quite serious depression for a good year and a half. Doing the course gave me confidence,” said Griffin. “Coming in, interacting with people on a weekly basis made me feel more welcome, more able to do things.”

Since completing the programme early last year, Griffin has been employed part-time by the Bromley-by-Bow centre as a peer support worker.

These are just two examples of programmes the centre runs – “I work here and I still don’t know half the things we do!” said Griffin – but it is the ethos of the centre that marks it out.

“Our modern urban lifestyles are deeply unhealthy, not just because we don’t get any exercise, also because we don’t talk to anyone,” said Hopewell. “We’d say in deprived communities you don’t need a health centre that sits on its own, you need cafes, walking groups, art groups, things that bring people together.”

The Bromley-by-Bow approach is of interest to health professionals and governments around the world, attracting 1,500 visitors each year. The centre is advising the Well North programme, which is looking to introduce similar community centres across the north of England.

“It doesn’t matter if people are coming from Australia, Japan, Holland or Oldham, the issues are identical, their health services are under strain. Solutions don’t come out of consulting rooms, and don’t come out of hospitals, they come out of communities.”

The pharmacology

Even if the drugs pipeline is rather empty and big pharma is largely withdrawing, drugs will continue to play a role in treating mental illness.

Selective serotonin reuptake inhibitors (SSRIs) such as Prozac were in a sense a chance discovery, and the latest breakthroughs have also had an element of serendipity about them, the result of academic rather than industry experimentation.

The problem for drug makers is that the disorders are very complex, requiring much bigger trials than drugs for other illnesses, and have much higher failure rates.

And yet there are prospects. The pharma giant Allergan is to conduct phase III trials on a ketamine-like antidepressant that it says has rapid effect on major depressive disorder.

The Lancet recently reported that a small study found people with stubborn depression responded favourably to doses of psilocybin, an active ingredient in magic mushrooms. Another study found that the hallucinogenic substance ayahuasca helped alleviate symptoms in depression sufferers.

“Ketamine was pioneered by academics in New York, we’ve done magic mushrooms,” said Prof David Nutt from Imperial College London, referring to two recreational drugs found to have some success in treating depression. “These are small-scale experimental studies, but if we hit on something, Pharma might come back. Pharma are great at making drugs, we’ve to give them targets.”

From ketamine to cupboard therapy: the future of mental health treatment

With big pharma short on solutions, we talk to people pioneering new ways to beat conditions including anxiety, depression and schizophrenia

www.theguardian.com

 

[mr peabody]

Psychedelics and their role in treating mental health disorders

Psychedelics such as LSD, magic mushrooms, mescaline etc. have garnered renewed interest in the scientific world because of the possible role they could play in mental health problems. Ketamine remains the only psychedelic at present that is used clinically as an anesthetic agent. The others are all classified under banned drugs.

There have been numerous studies recently where these drugs have been tried in treatment of mental health disorders such as addictions, depression and post-traumatic stress disorder etc. These agents have shown promise in persons in whom most of the conventional therapy has failed.

Researchers at Imperial College London are now all set to start major clinical trials to see if any of these psychedelics can be actually helpful in treatment of depression when compared to a standard drug used for treatment of depression. In their trial the team of researchers would compare magic mushroom compound psilocybin and a SSRI (selective serotonin re-uptake inhibitors) antidepressant, escitalopram. The trial is expected to run for at least 2 years. Dr Robin Carhart-Harris, study leader said that there is a “revolutionary potential” of these psychedelic drugs and this is not an exaggeration.

The team of researchers explains that these psychedelic drugs have been in scientific interest for the last few decades. They were initially used in the 1950s and 60s for some of the mental health problems before they fell into disrepute mainly because of the abuse liability, recreational use and risk of dependence and addiction. Over a thousand studies had been conducted during that time. Soon fear of moral degeneration and overdosage related risks took over and these drugs were made illegal in America in 1968. The United Nations too convened on the status on 1971 that stopped scientific research on these drugs. Member states made these drugs illegal and classified them as Schedule 1 drugs or drugs that have no known medicinal benefits. This sealed their fates even in scientific research. Next few decades saw no research on these drugs. It is only recently that there is renewal of interest in the psychedelics especially in PTSD and depression that is refractory to standard treatments.

In the mid-2000s these drugs underwent a “scientific renaissance” after Johns Hopkins University in the US started work on them. Psilocybin was being studied in 1990s mainly because laws governing its use in research were not as stringent as with others. Psilocybin showed that there was a reduction in symptoms of depression in 80 percent of the patients with terminal cancers who suffered from depression. This agent could also help people quit smoking more effectively than currently used therapy. Dr Carhart-Harris has been working with psychedelics for the last five decades and more and he and his team last year found that psilocybin can help “reset” the brains of people with depression and help cases of “untreatable depression”. His paper published in the journal Scientific Reports showed that two areas of the brain including the amygdala and a network of neurons are affected. The amygdala helps an individual to process emotions and feelings while the network of neurons help coordinate different parts of the brain. Dr Carhart-Harris says that it could be that the psilocybin can “heat up” and “reset” the brain to remove the rigidly held “self destructive patterns of thought”. Along with cognitive behavioral therapy, he explained, the brain could be “recalibrated”.

Some of the problems with the use of psychedelics are the fear and anxiety bad trips may cause. There may be a sense of losing control that might trigger anxiety and even psychotic breaks, warn experts. During the trials pure, medical-grade drugs would be used under strict medical supervision and support and it is hoped that the negative effects may be lesser. One of the major problems with the use of these drugs is the temporary nature of their efficacy. They seem to lose their ability to provide relief after continued use say experts.

Until now the studies conducted pitted the effects of psychedelics against placebo. This latest trial would be the first to try it against an established antidepressant, say researchers. Dr James Rucker, a clinical lecturer at the Institute of Psychiatry at King's College London, is soon to start his study to establish the safety of psilocybin. Once the drug is established to be safe, it could go on to become licensed and finally be prescribed by doctors. According to Dr. Rucker, this could take at least five years or longer to happen.

https://www.news-medical.net/news/20...disorders.aspx​