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Are psychedelics the next frontier of mental health medicine?

An illustration of a hand reaching for a pair of colourful mushrooms

News analysis by Susannah Hollywood

Is Australia's approval of psychedelics for treating PTSD and depression the start of a medicinal revolution in mental health management?

Psychedelics are a class of psychoactive substances which can produce mind-altering effects. Also known as hallucinogens, these drugs can change an individual’s perception of reality, influencing thoughts, moods and emotions, skewing sensory perceptions and even causing hallucinations – seeing or hearing things that don’t exist or are distortions of reality.

Although illegal in the UK, these drugs are taken recreationally for the positive effects that these altered states of consciousness can induce. Sensory and visual distortions can make the environment appear vividly coloured, recognisable shapes and meaning may be found in everyday objects, and a kaleidoscope of moving patterns and warped sensory input can be enjoyed. Feelings of relaxation, increased empathy and heightened connection with others are also commonly experienced.

In many traditional and indigenous cultures, these compounds are also well established for their therapeutic benefits. Thought to induce healing and bring spiritual enlightenment, hallucinogens are deeply embedded in many cultural rituals, strongly associated with shamanism, mysticism and spirituality.

Within mainstream medicine in countries such as the UK, however, psychedelics remain classed as an illegal drug. Research began to delve into their potential for use as treatments in psychiatric conditions in the 1950s and 60s, and a series of clinical studies were carried out. However, as political and societal opinion turned against them, the focus on this area fell away. Since then, these substances have been illegal for any use in the UK, either recreational or therapeutic.

In recent years, with mental ill-health on the rise and its impact on society escalating, there is now a rekindled interest in this area. The need to think outside the box to find solutions is driving innovation, and scientists are again exploring the potential of psychedelics to alter our minds in beneficial ways.

Psychopharmacology researchers in several countries have found that hallucinogens can enhance the neuroplasticity of the brain – its ability to re-organise its structure, form new connections, and re-wire existing pathways. Essentially, these compounds can make the brain more impressionable and more receptive to change. This has significant potential within the field of mental health.

In conditions in which thought patterns have become hard-wired and inflexible, and perspectives narrowed, taking a psychedelic drug may be a disruptor, opening cognitive pathways and allowing past experiences to be re-framed. This process has been likened to ‘shaking a snow globe’. Conditions which may respond include post-traumatic stress disorder (PTSD), depression, obsessions, and eating disorders.

Many of the studies carried out in this area to date have evaluated a combination of psychedelic drug treatment with psychotherapy. The administration of the drug makes neural pathways more malleable, and the psychotherapy input ensures the re-establishment of new, positive patterns. The controlled re-shaping of pathways and connections is fundamental to the success of the treatment, and the two components must be seen as a package of intervention.

Australia has recently become the first country in the world to pass legislation allowing psychedelic treatments for certain mental health conditions. PTSD can now be treated with MDMA (also known as ecstasy) and treatment-resistant depression with psilocybin (the psychoactive compound found in magic mushrooms). Both must be prescribed by an approved psychiatrist, and the process closely supervised.

Splitting the field

This ground-breaking move has been met with a mixed reaction by experts in the field. Some, such as Professor David Nutt, head of Neuropsychopharmacology at Imperial College London, see this as an important step forward. Professor Nutt praised Australia for “leading the world in this vital innovation.”

However, others are warning that research in this area is still in its infancy, and that not enough is yet known about risks, side-effects and long-term outcomes.

Professor Richard Harvey, chair of the Royal Australian and New Zealand College of Psychiatrists’ Psychedelic-Assisted Therapy Steering Group warns of the potential “fear, panic and re-traumatisation” that can be brought on by use of these psychedelic substances.

A ‘bad trip’, in which an adverse reaction to a hallucinogenic drug is experienced, can induce acute anxiety, agitation, terrifying hallucinations and a sense of doom. Physical effects can include vomiting, sweating, dizziness and changes to heartrate. This experience could be particularly traumatic for people with existing mental health conditions.

Experts agree that it is essential for measured doses of these substances to be given under supervised and structured conditions, by a trained health professional. Self-administration is not advised and remains illegal in the UK. Opinion leaders in this field are keen to stress that these treatments should not be seen as a miracle cure and must be used cautiously and in a controlled manner.

Research is ongoing and psychedelics are not yet likely to be widely available as a mental health treatment. However, they are certainly showing potential in an area where there is still considerable unmet need. All eyes will be on Australia as they take this bold and progressive step.


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