He was a 38-year-old veteran officer with the New York Police Department responding to a call one morning when the building he had just exited suddenly exploded, injuring him, civilians, other officers and killing one first responder. The devoted husband and father was diagnosed with a traumatic brain injury and was gripped by anxiety, depression and post-traumatic stress disorder, which drastically changed his life. I recently met him through a colleague and his story resonated as it sounded like many of the patients I had cared for over the years.
He was placed on one medication after another with no clear benefit but lots of side effects. Finally in 2020, four years after his accident, he stopped all his medications cold turkey and decided to try something different. He joined the over 7 million Americans who used psychedelics and other hallucinogens that year.
Psychedelics have the potential to treat post-traumatic stress disorder, anxiety, substance use disorders, depression and other psychiatric conditions. “In our newly established Interventional Psychiatry program, where we aim to treat depression, post-traumatic stress, and other disorders that have not responded to traditional treatments, we anticipate that the use of Ketamine, psilocybin, MDMA and other medications will provide much-needed alternatives for our patients,” said my colleague Dr. Stephen Ferrando, Professor and Chair of Psychiatry at New York Medical College as well as Director of Psychiatry at WMCHealth.
There have been hundreds of clinical trials evaluating psilocybin, LSD, ibogaine as well as other hallucinogens like MDMA and ketamine. This includes phase3 clinical trials like the one at the University of California San Francisco that showed psychedelic-assisted therapy reduced PTSD symptoms and functional impairment in a diverse population with moderate to severe PTSD. Results like these have led to increased excitement about psychedelics and contributed to researchers speculating that positive clinical trial results could lead to FDA approval within a year. This is a big deal. Here’s why we should care about this.
An estimated 22% of adults in the U.S. are living with mental illness, including one-third of young adults aged 18 to 25. Unfortunately, a large portion of them continue to suffer with anxiety, depression and other symptoms despite using the available behavioral and pharmacologic treatments, and many may go so far as to attempt or even complete suicide.
Psychedelics may offer hope for these patients. They’ve been around for centuries and have previously been used for spiritual, religious and recreational uses as well as exploration of consciousness. They have also been used as a therapeutic tool for healing purposes by Indigenous people from South and Central America.
Many war veterans have found that the treatments offered for PTSD have not been adequate, so they have pursued treatment with psychedelics like Ayahuasca and psilocybin. The Veterans Administration has indicated that it is open to safely exploring the possibility of psychedelics in treatment of PTSD, and the FDA has provided guidance to sponsors developing psychedelic drugs for treatment of psychiatric conditions.
Modern Era Of Psychedelics
Dr. Albert Hofmann first synthesized lysergic acid diethylamide, more commonly known as LSD, in 1938. Five years later, in 1943, he became the first person to try it. Classic psychedelics like psilocybin (or magic mushrooms), mescaline, LSD and DMT have been classified as Schedule 1 substances, which means they have no therapeutic benefit, by the U.S. Drug Enforcement Agency since 1970. MDMA, the synthetic psychedelic also known as ecstasy, was added to the list in 1987. In the 1980s and 1990s, psychedelics were popular with adolescents given that they looked like stickers and candy, which increased their appeal to this age group.
In 2019, John Hopkins researchers received $17 million in funding to start a center for psychedelic and consciousness research, and last month Harvard University was awarded a grant by the Chicago-based Gracias Family Foundation to use an interdisciplinary approach to study psychedelics in society and culture. Other institutions studying psychedelics include Yale University, Stanford University, and Washington University, among many others.
Impact Of Psychedelics
The word psychedelic is derived from the Greek words meaning “mind manifesting.” Psychedelics result in changes in perception, which include altered states of awareness or focused consciousness, altered thought patterns, trance, mystical and hypnotic states. This may be related to effects on the brain’s sensory relay station, known as the thalamus, and its connection to the cerebral cortex, which mediates higher-order intellectual functioning. These alterations could result in people using psychedelics also getting hallucinations or even synesthesias, a phenomenon in which you experience more than one sense simultaneously.
Some people experience a different level of self-perception and may come to a better understanding about themselves, others and the world, which is precisely what the NYPD officer experienced.
“Before I tried psilocybin, the door was closed to all emotions, but now I can experience good and bad emotions, and I’m okay with them.” Six hours after he had his first dose of psilocybin, he wanted to go home to be with his family.
He has had additional doses of psilocybin since the first trial in 2020 but he has identified people closer to him who can guide him through the therapy so he no longer has to travel thousands of miles to get his treatment. He hopes that through legalization and FDA approval, the psychedelics could become more widely available to others suffering from PTSD and other psychiatric disorders, particularly his fellow first responders. While waiting for FDA approval, there are numerous organizations, like the Casey Skudin 343 Fund, that provide financial support to help first responders access these treatments.
Notwithstanding the potential benefits of psychedelics, it is important to keep in mind that independent and personal use of these agents remain illegal in all 50 states. However, Oregon and Colorado have fully legalized the supervised adult use of psilocybin, and the VISIONS Act of 2023 is a Congressional bill that aims to prohibit the use of federal funds from preventing a state from implementing its own laws with respect to psilocybin. That may help clear the way for more research to be conducted on the safety and efficacy of psilocybin and other psychedelics in treating mental health conditions.
Despite all the buzz around psychedelics, it is important to keep in mind that these drugs have limitations and potential side effects. Patients who have experienced psychosis and severe dissociation are generally not considered appropriate for these treatments. Dr. Ferrando adds “along with the potentially pleasant effects of transcendence, feelings of oceanic oneness, and reduced defensiveness, all of which can facilitate psychotherapy, the drugs themselves can produce unpleasant side effects.” These can include acute dysphoria, the so-called “bad trip,” feelings of disconnectedness or disassociation, as well as physical symptoms, such as heart racing and changes in blood pressure. All of these require close monitoring according to FDA guidelines, including the presence of therapists and monitors in the room with the patient during the drug experience, as well as regular checks of vital signs.
Dr. Ferrando indicates, “However, despite these limitations, when used properly and under the appropriate therapeutic conditions, we anticipate that these drugs will be safe and provide much-needed alternatives for those who have not responded to other treatments.”
With so many academic centers researching these agents, the increased funding and the positive clinical trial results, the body of evidence is gradually becoming more substantive, and now many scientists believe FDA approval may not be far. However, it is important that we continue to approach these substances responsibly and with scientific rigor. A great deal of thought will have to go into regulating these substances, especially given their already widespread use despite still being illegal here in the U.S. Many physicians and scientists now have good reason to be cautiously optimistic about the role psychedelics may play in the future.