Exploring the Role of Psychedelic Drugs in Medicine

Dr. Alexandra LaStella, PharmD, RPh
Jul 20, 2024
5 min read

Author Note:

As part of an advanced placement practice experience in psychiatry, I was granted the opportunity to analyze any study that I found interesting (pertaining to psychopharmacology). I chose a small trial which assessed the clinical utility of MDMA (a.k.a "Ecstasy"/"Molly") for the treatment of social anxiety in severely autistic adults. This was the first scholarly experience I had with psychedelics, and I found it fascinating. It turns out, the study used a dosage of MDMA that was not far off from what is used recreationally. One result I noted, in particular, is that none of the adults who received the first round of treatment refused to come back for their second treatment; In other words, none of the study subjects had a poor experience. The results, regardless of the small study size, showed clinical benefit in social anxiety symptoms 6 months after MDMA therapy in social anxiety symptoms. In this article, we explore which psychedelics are being used/undergoing studies in medicine today, and their associated indications.

Introduction: Psychedelic Medicine

Psychedelic-assisted psychotherapy has garnered enormous attention in the last decade or so, often being advertised in healthcare media as somewhat of a miracle solution. Contrary to the therapeutic potential of psychedelic drugs, our society is significantly more familiar with their potential to cause harm. However, much of this stigmatization is due to public familiarity with cases where psychedelic drugs are used recreationally in uncontrolled, non-medical contexts, and are often combined with other substances.

Along with a plethora of anti-drug initiatives of the 1970s-1980s, research into psychedelics was entirely halted by federal legislation. 20 years passed before the laws had been reversed to allow for clinical study of psychedelics. Within the past decade, researchers have been vigorously investigating the therapeutic potential of psychedelic drugs with a renewed passion.

Uniquely, psychedelic drugs demonstrate rapid and profound symptomatic improvement of various psychological disorders. This intensity of clinical improvement appears related to substantial changes in perspective which may occur during the psychedelic experience. These significant symptomatic improvements and changes in mindframe, alternatively, are not seen in the currently available psychiatric toolkit. As investigators learn more and more about the therapeutic potential of psychedelic drugs, we certainly will continue to hear about these new developments. If you believe you may be eligible to participate in a psychedelic trial, or would like to learn more about psychedelic treatments, we recommend asking your doctor or psychiatrist.

"Psychedelic psychotherapy, a unique remarriage of biological therapy and psychotherapy, has the potential to transform mental health care."

-Barber,G and Aaronson,S (5)

MDMA ("Ecstasy/Molly")

Chemical Name: 3,4-methylenedioxymethamphetamine
Drug Class: synthetic amphetamine derivative
Neurotransmitter Activity: serotonin, dopamine and noradrenaline
Systemic Effects: euphoria, arousal, altered perception, enhanced empathy and sociability (sometimes referred to as an "empathogen")
Toxicity: serotonin syndrome, cardiac events leading to death are possible (dose-dependent). With illegally manufactured "party drugs" like MDMA there is particular risk of contamination with other substances - drug quality and purity is not guaranteed.
Clinical Potential: PTSD (post-traumatic stress disorder) is the focus of most studies, but MDMA has potential to treat anxiety, treatment-resistant depression, and more.
Other: first clinical trial published in 2008. May cause temporary depression following treatment.

Psilocybin ("Magic Mushrooms")

Drug Class: classical psychedelic
Neurotransmitter Activity: serotonin (5HT-2a)
Systemic Effects: altered consciousness (ex: hallucinations), altered mood/mood swings (happy, sad, fearful, irritable), distorted sense of time and space.
Toxicity: classic psychedelics are generally safe and well tolerated. Anxiety and dysphoria are possible. Major adverse events rarely observed.
Clinical Potential: addiction (tobacco, alcohol), anxiety associated with terminal illness, PTSD, treatment-resistant depression, and social anxiety among autistic adults. Investigations ongoing re: bipolar depression, suicidal ideation, depression associated with early Alzheimer’s disease, anorexia nervosa, and mood disorders in early-stage cancer patients.

LSD

Chemical Name: lysergic acid diethylamide
Drug Class: classical psychedelic
Neurotransmitter Activity: serotonin (5HT-2a)
Systemic Effects: altered consciousness (ex: hallucinations), altered mood/mood swings (happy, sad, fearful, irritable), distorted sense of time and space.
Toxicity: classic psychedelics are generally safe and well tolerated. Anxiety and dysphoria are possible. Major adverse events rarely observed.
Clinical Potential: anxiety associated with terminal illness, PTSD, treatment-resistant depression, and social anxiety among autistic adults.

Ayahuasca

Chemical Name: a combination of N,N-dimethyltryptamine and harmala monoamine oxidase inhibitor alkaloids
Drug Class: classic psychedelic
Neurotransmitter Activity: serotonin (5HT-2a)
Systemic Effects: altered consciousness (ex: hallucinations), altered mood/mood swings (happy, sad, fearful, irritable), distorted sense of time and space.
Toxicity: classic psychedelics are generally safe and well tolerated. Anxiety and dysphoria are possible.
Clinical Potential: anxiety associated with terminal illness, PTSD, treatment-resistant depression, and social anxiety among autistic adults.

Mescaline

Drug Class: classic psychedelic
Neurotransmitter Activity: serotonin (5HT-2a)
Systemic Effects: altered consciousness (ex: hallucinations), altered mood/mood swings (happy, sad, fearful, irritable), distorted sense of time and space.
Toxicity: classic psychedelics are generally safe and well tolerated. Anxiety and dysphoria are possible.
Clinical Potential: anxiety associated with terminal illness, PTSD, treatment-resistant depression, and social anxiety among autistic adults.

Conclusion: The Future of Psychedelic Medicine

In the grand scheme of things, we have hardly scratched the surface of the clinical utility of psychedelic medicines. We've discussed the ability of a variety of taboo/controversial drugs to treat symptoms of extremely troublesome neuropsychiatric disorders.

"The new age of psychiatry Psychedelic-assisted psychotherapy offers the hope of a new treatment whose rapid onset and enduring efficacy could outpace that of other psychiatric treatments."

This promise, combined with psychedelics’ taboo and controversial culture and history, has led psychedelic therapies to garner huge amounts of attention for a treatment that remains in an investigational stage.

Overall, psychedelic drugs are (without any shred of doubt) clinically useful. Results of a large scale meta-analysis of multiple psychedelic studies which provides continued and unwavering support for ongoing research on psychedelic-assisted psychotherapy. The analyzed studies were high-quality, and notably lack serious adverse events in participants. It is important to understand that traditional psychiatric medications do not have this marked effect size; the significant improvement in participants' symptoms is practically unheard of in the field of psychopharmacology. Despite having shortcomings such as small sample size, the data overwhelmingly illustrates the potential for psychedelic drugs in psychiatry. As researchers continue to investigate psychedelics, we are confident that there will be infinitely more on the horizon.

...Groovy!

Resources:

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