Psychedelic therapy
Psychedelic therapy is an innovative approach in psychotherapy where patients take controlled doses of consciousness-altering substances to address various mental health issues, including trauma, addiction, depression, and PTSD. This therapeutic method has gained traction among researchers and practitioners due to a growing body of clinical evidence that suggests these substances can provide significant psychological benefits. Historically, many cultures have utilized psychoactive substances in ritualistic contexts for thousands of years, but the modern application of these substances in therapy began in the 1930s with the synthesis of LSD.
The resurgence of interest in psychedelic therapy occurred in the 1990s, leading to renewed scientific studies on substances like MDMA and psilocybin. Despite the promising results, the legality of these substances often limits research and clinical use, leading to informal practices in some settings. Recent advancements have seen some psychedelics recognized by regulatory bodies, with the FDA granting breakthrough designations for specific therapies using substances like MDMA and ketamine. However, critics of psychedelic therapy often point to methodological concerns in studies, including small sample sizes and reliance on anecdotal evidence. Overall, while the potential for psychedelic therapy is increasingly acknowledged, it continues to navigate a complex landscape of legal and scientific challenges.
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Psychedelic therapy
Psychedelic therapy is an unconventional psychotherapeutic technique in which a patient ingests controlled doses of consciousness-altering substances to help process traumatic events, reach profound personal or existential insights, or overcome addictions. Clinical evidence supports the idea that many psychedelic and psychoactive substances are therapeutically valuable. Psychedelic therapy, which clinicians commonly refer to as psychedelic-assisted therapy, has gained increased attention from the scientific community as a possible adjunct treatment for substance abuse, depression, post-traumatic stress disorder (PTSD), existential anxiety triggered by terminal illness, and other mental health conditions.
Because most jurisdictions currently classify the substances used in psychedelic therapy as illegal drugs, the technique remains controversial. Legal concerns frequently result in psychedelic-assisted therapy being conducted in unofficial, informal, or underground settings.
Brief History
Many ancient and traditional cultures have used forms of psychedelic therapy over the course of history. Fossil evidence shows that humans have used naturally occurring psychoactive substances as part of ritual ceremonies for at least ten thousand years, particularly in Africa and the Americas. Some experts even believe that psychedelics played an important role in the evolution and expansion of human consciousness, generating profound impacts on the development of human culture and society.
The ritual use of psychedelic substances by Indigenous peoples waned significantly as European Christian missionaries established their presence throughout the world during the colonial era. Missionaries considered such practices pagan and heretical, leading to their active suppression.
Psychedelic therapy’s modern beginnings can be traced to the late 1930s when the Swiss chemist Albert Hofmann (1906–2008) first synthesized LSD while attempting to create a stimulant for the circulatory system. Hofmann discovered the drug’s psychedelic properties in 1943 when he accidentally absorbed some through his skin during a research procedure. He concluded that the drug had significant psychotherapeutic potential, and by the 1950s, scientists around the world were investigating LSD’s effects on neurochemistry. Other psychedelics, including mescaline and psilocybin ("magic" mushrooms), were similarly studied during the era.
Though this early wave of research produced encouraging results, it was undermined by a sharp rise in the recreational use of psychedelic drugs during the 1960s. This social trend, which was closely associated with Western counterculture, resulted in LSD, psilocybin, and similar substances being reclassified as drugs of abuse.
Psychedelic and hallucinogenic drugs staged a comeback in the research community during the 1990s, partly due to the increased popularity of MDMA (ecstasy) as a recreational drug and accompanying anecdotal evidence of its therapeutic benefits. Scientists have since reconsidered the psychedelic therapy research performed during the 1950s and 1960s and have secured the necessary authorizations to launch new studies into the psychotherapeutic value of legacy psychedelics like LSD, mescaline, and psilocybin as well as previously overlooked substances such as DMT, ibogaine, ketamine, MDMA, and salvia.
Psychedelic Therapy Today
Sanctioned research into the potential therapeutic applications of psychedelic drugs has been limited because many of the substances under investigation are illegal. Studies are typically conducted by a few scientists and test subjects, who work with low, controlled doses in highly regulated and carefully monitored environments. In the United States, the Food and Drug Administration (FDA) authorizes such studies through a rigorous application process, and the agency maintained extremely tight restrictions when psychedelic drug research made its initial comeback during the 1990s and 2000s. However, by the late 2000s, the FDA loosened certain constraints for LSD and MDMA research, citing their “breakthrough therapy” potential for serious mental health conditions that can be difficult to treat using conventional methods. These policy changes were informed by a growing body of international research that pointed to the therapeutic value of these drugs as potentially effective alternative treatments.
Since the 1990s, the scientific consensus has generally shifted in favor of psychedelic therapy as a legitimate option for patients whose conditions do not respond to frontline interventions. However, the mainstream adoption of psychedelic drugs as medicines has continued to face legal obstacles and reasonable objections, given their demonstrated abuse potential.
Psychiatric research on psilocybin has been prevalent in the 2010s and 2020s. Studies have found strong evidence that it may be effective in relieving symptoms of alcohol use disorder and treatment-resistant depression. By 2022, it was legal or decriminalized for therapeutic use in six states and Washington, DC.
In 2017, the FDA granted Lykos Therapeutics a breakthrough therapy designation for midomafetamine, a synthetic drug related to MDMA, as a treatment, in combination with psychological interventions such as psychotherapy, for post-traumatic stress disorder in adults. By 2024, Lykos had conducted a phase 3 clinical trial for midomafetamine-assisted therapy as part of its new drug application to the FDA. That August, the FDA rejected Lykos's new drug application, however, stating that further phase 3 trials of midomafetamine-assisted therapy were needed. Lykos representatives said that another phase 3 trial would take several years to conduct.
With established medical uses as an anesthetic, ketamine is a Schedule III drug in the United States, and its abuse for recreational purposes remains illegal. Ketamine became legal in the US for medical and therapeutic use in 2019, when the FDA approved a ketamine nasal spray, Esketamine, to treat treatment-resistant depression. In 2022, the FDA also approved the use of ketamine in clinical trials for mental health treatments. Researchers have investigated its potential as a treatment for a range of conditions including depression, alcoholism, cocaine addiction, obsessive-compulsive disorder (OCD), PTSD, and suicidal thoughts.
Studies also show that lesser-known, naturally occurring psychedelics such as DMT and salvia appear to relieve self-reported levels of depression and anxiety in some patients. Ibogaine, a natural psychedelic alkaloid, began gaining traction as an alternative treatment for opioid abuse during the 2010s, when the opioid crisis swept across North America and other regions of the world. Strong anecdotal evidence and a growing body of peer-reviewed studies seem to indicate that large doses of ibogaine dramatically reduce the physical effects of opioid withdrawal and provide temporary but extended relief of post-withdrawal cravings. However, its continued classification by the FDA and other international agencies as a drug with high abuse potential and no recognized medical applications has forced patients to seek treatment in underground settings.
While mainstream medical opinion of psychedelic therapy continues to grow more favorable, the concept also has its critics. Many studies have been negatively evaluated because they use overly small sample sizes, selectively promote supportive data while omitting unsupportive data, and rely heavily on the anecdotal nature of patient experience rather than clinically demonstrable, objective results.
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