Health Science Reviews

Psychedelic-assisted Therapy: Emerging treatment in Mental Health Disorders

by Sanelisiwe Fourteen 

“Nineteen-year-old Alice returns to the magical world from her childhood adventure, where she reunites with her old friends and learns of her true destiny.”

It’s not new that kids novels are centred around fantasies and mysteries, however they always seem to convey a valuable lesson at the end. After being one of the most successful novels written by Lewis Carrol in 1865, a lot of psychoanalytic papers have been written about this fantasy novel to examine the psychedelic undertones. The plot of the story has always been linked to being “disjointed in reality”. This is because Alice encounters a magic mushroom that can make her change in size. The “magical” properties of this mushroom are said to have been inspired by the hallucinogenic effect of the Amanita Muscaria, popularly known as the  fly agaric mushroom.

The correlation of Alice’s “trip” to  Wonderland and hallucinogenic drugs has been debated by many, but many psychedelic influences have been pointed out in the book.

“You are off on a trip . . . with no baggage, no destination, and no compass.”

Psychedelics, known as hallucinogens are psychoactive substances thought to “expand consciousness”, they improve mood in psychiatric conditions . They wield a  range of neurochemical and neuromodulatory, effects on the brain. Psychedelics include plant/fungi derivatives psilocybin, ayahuasca, peyote, iboga and  laboratory synthesized  LSD (ergot fungi) and 3,4-methylenedioxymethamphetamine (MDMA).

Subjective effects of psychedelics may include the following:

Open- or closed-eye imagery.

Acute emotional experiences.

Anti-amnesic effects.

Although psychedelics are not yet approved by the U.S. Food and Drug Administration (FDA), over 70 clinical trials are currently being conducted across the globe using psychedelic-based therapies for mood disorders. Hard-to-treat psychiatric conditions like severe depression, anxiety, alcohol and nicotine dependence and OCD (obsessive compulsive disorder) have been the target for most psychedelic-assisted therapy. Particularly for individuals that have found other treatments ineffective.

Psilocybin being the centre of most research, is a naturally occurring psychedelic prodrug compound found in over 200 species of fungi. It is structurally similar to serotonin; a human neurotransmitter that regulates mood, cognition and perception. Psilocybin was granted breakthrough therapy status by the FDA for treatment-resistant depression in 2018 and for major depressive disorder (MDD) in 2019.

MDMA is currently in a phase 3 clinical trial as an adjunct to psychotherapy for posttraumatic stress disorder (PTSD). A randomized controlled trial pooled analysis showcased that 54.2% of patients treated with MDMA-assisted psychotherapy for PTSD no longer met the diagnostic criteria for PTSD. It allowed patients with PTSD to better tolerate the examination of traumatic material in therapy, anxiety, fatigue, headache and loss of appetite; which are the most common adverse effects of PTSD.

The greatest concern and the  reason why psychedelic studies were halted in the past is because of the 1970 Controlled Substances Act where psychedelics were considered drugs of abuse than potential therapies. However, in an Australian Drug Harms Ranking Study(2019), they identified psilocybin and MDMA as two of the five least harmful drugs out of 22 investigated drugs, scoring 5 and 7, respectively. Alcohol was found to be the most harmful scoring 71. The negative outcomes reported with recreational use have not been observed in any therapeutic study.

When administered in clinical settings with psychological support (nurses), early clinical trials have shown that psychedelics may be a safe and effective treatment for many mental health disorders. Some experiences are quite intense hence nurses play a critical role in this healing process. The knowledge, skills and values nurses bring to patient care in psychedelic-assisted psychotherapy is critical and is well translated. They bring in the physical, emotional, mental and even spiritual levels of support whilst patients undergo therapeutic psychedelic experiences; they take the patients through the “trip”.

Figure 1. MDMA therapy session is conducted by researchers Marcela Ot’alora, MA, LPC, and Bruce Poulter, MPH, RN (Multidisciplinary Association for Psychedelic Studies)

Psychedelics have deep effects on understanding of self and the world around us, demonstrating enhanced insight and personal growth. Psychedelic-assisted therapy offers a great potential to relieve suffering and encourage healing and peace amidst illness when used in a clinical setting.

References

1. Penn, Andrew MS, NP, PMHNP-BC; Dorsen, Caroline G. PhD, FNP-BC; Hope, Stephanie DNP, RN, NC-BC; Rosa, William E. PhD, MBE, AGPCNP-BC, FAANP, FAAN. CE: Psychedelic-Assisted Therapy. AJN, American Journal of Nursing: June 2021 – Volume 121 – Issue 6 – p 34-40
2. Sarris, J., Pinzon Rubiano, D., Day, K., Galvão-Coelho, N. L., & Perkins, D. (2022). Psychedelic medicines for mood disorders: current evidence and clinical considerations. Current opinion in psychiatry, 35(1), 22–29.