Psychedelic Medicine: the Future of Therapy or a Hippie Pipe-Dream?
WRITTEN BY REECE JONES
ILLUSTRATION BY ELLEN LAN
Hated for their implications, praised for their powers, and steadily gaining fame among the masses. It sounds like a description of a budding religious icon. In reality, it’s a portrayal of illicit compounds like LSD and magic mushrooms: psychedelics.
Under the influence of a psychedelic, users may become extremely suggestible, but in the long term, experience an enhancement to a neuronal process called synaptic plasticity. The dendrites or “wires” between neurons grow in length, number, and size, allowing for new connections to form. Ideally, this brain malleability can be harnessed to reinforce positive thought patterns and eliminate negative ones.
In recent years there’s been a shift in attention towards the therapeutic potential of psychedelics. Therapy under the influence of a psychedelic drug has yielded favorable results in addiction treatment, treatment-resistant depression (TRD), anxiety, PTSD, and other psychological conditions. Such promising results have garnered excitement around their utility. But realistically, will these drugs ever enter the pharmaceutical market?
“Yes,” says Dr. Greg Fonzo, an assistant professor at UT Austin’s Dell Medical School and co-director of the school’s Center for Psychedelic Research and Therapy. But despite expert endorsement, obstacles remain on the path to approval. As Dr. Fonzo explains, “The FDA Psychopharmacologic Drugs advisory committee recently recommended against the approval of MDMA-assisted therapy in the treatment of PTSD. The official ruling from the FDA is still to come but even if MDMA is not approved at this point, I still believe that one or more psychedelic compounds will become approved eventually.” UT and institutions across the nation are contributing to clinical trials for the FDA approval of therapy using psilocybin, the compound within magic mushrooms. Currently, psilocybin-assisted therapy is in phase III clinical trials for the treatment of TRD, and phase II trials for the treatment of anorexia nervosa. Although treatment of these conditions has proven effective, there are still several questions to be answered.
“One is safety. There are case reports of recreational use having very negative outcomes, like mania or psychosis,” says Fonzo. It’s imperative to consider these risks and acknowledge recreational users’ lack of supervision within such cases. The other is longevity – how durable are these changes? Some conditions such as TRD show positive treatment outcomes initially, but as Fonzo says, “you start to see symptoms creep back up and people relapse.” Finally, there’s scalability. Psychedelic pills won’t be available for pick up at a local Walgreens. These treatments must be delivered in a very specific, boutique clinical setting with constant supervision. With such preparations, treatment sessions will be expensive, likely costing thousands.
Currently, Dr. Fonzo and his lab are performing observational studies and randomized clinical trials to measure the therapeutic effects of psychedelics. Brain imaging of patients before and after treatment will help researchers “understand what changes in the brain relate to improvement symptoms,” says Fonzo. Additionally, Fonzo’s team is testing a combination treatment using a technique called repetitive transcranial magnetic stimulation (TMS). TMS uses an electromagnetic coil to stimulate nerve cells in the brain. In depression, the areas of the brain involved in mood control are believed to have decreased activity and decreased communication with other areas of the brain. Externally stimulating these lesser-used regions seeks to restore or normalize their activity and communication with other parts of the brain. TMS, combined with the neuronal malleability promoted by psychedelics, may make integrating those lesser-used brain regions significantly easier. As seen with TMS, a myriad of other psychological treatments may benefit from being paired with psychedelic administration.
The therapeutic potential of psychedelic-assisted therapy and its benefits will continue to be exploited, especially in a time of rapidly rising cases of mental illness. However, it’s essential to not fall victim to hype. “We’re in a phase where there is more hype than evidence regarding what psychedelics might be useful for while downplaying some of the risks involved,” says Fonzo. “There’s this conception that they’re miracle drugs that will cure mental illness, but it’s not true.”
As psychedelic-assisted therapy becomes a readily prescribed practice, the treatment will hopefully leave the realm of mysticism and enter one of normality. Simultaneously, data reporting effective treatment will aid in dismantling the stigmatizations that have plagued this class of compounds for half a century. In a much nearer future than anticipated, people will start to see that psychedelics are neither gateway drugs nor miracle cures, but rather, as Fonzo says, “just one tool that we have in the arsenal.”
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