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Insight & Intelligence : Mar 25, 2014
Psychedelics Shown to Relieve Anxiety
Studies find LSD and other psychedelic drugs could treat PTSD and substance abuse.!--h2>
Timothy Leary had the counterculture, not medicine, in mind when he titled his 1966 album, “Turn On, Tune In, Drop Out.” Surely if slowly, though, researchers are discovering that LSD and other psychedelic drugs long banned for their harm when abused can benefit some people under controlled circumstances.
In a widely publicized study released earlier this month, a Swiss research team led by Peter Gasser, M.D., of the Medical Office for Psychiatry and Psychotherapy in Solothurn, Switzerland, found that of 12 patients with life-threatening illnesses, all eight receiving the drug showed statistically significant reductions in standard anxiety measures. The study, published March 4 in The Journal of Nervous and Mental Disease, was the first published in some 40 years that evaluated LSD’s safety and efficacy as an adjunct to psychotherapy.
“When administered safely in a methodologically rigorous medically supervised psychotherapeutic setting, LSD can reduce anxiety, suggesting that larger controlled studies are warranted,” Dr. Gasser and colleagues concluded.
Before treatment, patients received two preparatory psychotherapy sessions allowing for discussion of their health, history, mindset, personality, and social and emotional situations. “This is an absolute important part of the treatment,” Dr. Gasser told GEN. “Building up a confidential relationship is the basis of therapy—also psychedelic therapy—and it is one of the important factors for a safe trip.”
Four patients taking much weaker LSD dosages showed about the same anxiety levels, though Dr. Gasser cautioned the sample size was too small for generalization.
“What the minimum dosage for psychotherapeutic effectiveness is we don’t know exactly. The threshold dose is between 20 and 50 mcg, and I guess that the minimum dose for psychotherapy is about 100 mcg. 200 mcg, the dose of our study, is supposed to be a medium-high dose,” Dr. Gasser said.
A follow-up study assessing interviews and anxiety testing after 12 months will soon be published, he added.
Brad Burge, a spokesman for the Multidisciplinary Association for Psychedelic Studies (MAPS), told GEN the study not only shattered a longstanding taboo but launched a new era of research into LSD-assisted psychotherapy.
“The breakthrough is that this is the first double-blind, placebo-controlled study administering LSD in humans,” Burge said. “This is the first completed study of LSD that was explicitly designed to help develop LSD into a legal prescription treatment.”
Looking Beyond LSD
Dr. Gasser’s study isn’t the first to link LSD to a medical benefit. Two years ago Teri S. Krebs, Ph.D., and Pål-Ørjan Johanssen, Ph.D., both of the Norwegian University of Science and Technology, concluded a single dose of LSD helped reduce alcohol abuse as early as one month afterward, and most often two and six months afterward. The findings, published in the Journal of Psychopharmacology, followed a review of six clinical trials with a combined 536 participants.
“We need further data on whether subgroups of individuals exist for whom LSD presents an increased beneficial effect or risk for adverse events. Future clinical trials could combine a range of doses of LSD with current evidence-based alcohol relapse prevention treatments,” Drs. Krebs and Johanssen concluded in the study. “As an alternative to LSD, it may be worthwhile to evaluate shorter-acting psychedelics, such as mescaline, psilocybin, or dimethyltryptamine.”
Psilocybin has come under review in a handful of studies for its benefits in calming users—especially military members with post-traumatic stress disorder (PTSD).
Last year in the Journal of Experimental Brain Research, researchers observed that mice injected with a range of psilocybin doses acquired a robust conditioned fear response—while mice with lower doses extinguished their conditioning significantly faster than mice treated with higher doses or saline.
The study noted that psilocybin’s ability to extinguish fear conditioning may be affected by its actions at sites other than the hippocampus—such as the amygdala, known to mediate the perception of fear. Also, psilocybin is not purely selective for 5-HT2A receptors.
Healing and Horror
Psilocybin and LSD are among psychedelic drugs under study in recent years for possible medical benefits. Another is ayahuasca, a medicinal brew in which the ayahuasca vine (banisteriopsis caapi) is cooked, usually with other plants, to produce a brown liquid consumed in healing ceremonies by Amazon spirit healers.
In healing ceremonies by the Uniao Do Vegetal and other Brazilian ayahuasca religions with syncretic spiritual practices, the brew has not been linked to the horrible side effects highlighted in news and magazine reports. These range from nausea and vomiting to anxiety, hypertension, dizziness, and even death.
“The Brazilian syncretic churches had a very tight system of screening people who are interested in helping them integrate the experience. They kept very good records on how people fared,” Charles S. Grob, M.D., professor of psychiatry and pediatrics at Harbor-University of California, Los Angeles Medical Center, told GEN.
Problems arose, he said, when affluent Westerners fall prey to fake healers at retreats outside Brazil: “In Brazil, you have to go through the churches, and that’s not an easy process, necessarily. In Peru, you’re just getting more and more westerners going down there in search of experience. Some have marvelous, life-changing, positive transformative experiences. But you’ve got a smaller percent who are likely very vulnerable to begin with, but who also end up working with facilitators who don’t have the necessary knowledge, training, and even ethics.”
Dr. Grob was among eight researchers who in 2012 signed a statement supporting ayahuasca legalization published in the International Journal of Drug Discovery. They urged regulators worldwide “to demonstrate tolerance and grant these groups the necessary degree of legal freedom and respectful engagement for them to continue evolving into safe and responsible contributors to today's multicultural and globalizing society.”
The statement offers a paradigm for permitting ayahuasca: Since 1951, when researchers defended peyote consumption by Native Americans through a statement in the journal Science, the U.S. government reversed its ban on the spineless cactus in 1976 and recognizes Native American Church peyote ceremonies as an effective and reimbursable substance abuse treatment.
For psychedelic drugs to gain mainstream acceptance, they will need to show much more definitive correlations with improvements against diseases and disorders that are likely to emerge only after several years of clinical trials.
It’s too soon to say if the drugs will also need to show success against a variety of conditions. Of the recent studies exploring medically beneficial uses for LSD and other psychedelic drugs, many focus on two indications—reducing anxiety and inhibiting substance abuse.
“We don't know if the conditions we’re exploring are the optimal uses of LSD and other psychedelic drugs, since there hasn’t been enough research yet,” Burge said. “We do know that LSD and other psychedelics can work well for anxiety-related conditions, including addiction and PTSD, based on published case reports, so that’s why we’re exploring those conditions first.”
Burge added that the ongoing wars in Iraq and Afghanistan, and the numbers of veterans who have returned from service with PTSD, have contributed significantly to overall public and political attention on the need for more effective treatments.
MAPS’ highest priority is obtaining funding to launch clinical trials of 3,4-methylenedioxymethamphetamine (MDMA) plus psychotherapy to treat PTSD. The group cites preliminary studies that have shown that the combination can help people overcome PTSD and possibly other disorders.
Following the Money
Studies of psychedelic drugs face one key hurdle: They aren’t funded by NIH or the Department of Defense since they involve illegal drugs.
“Every dollar of the over $17 million we have spent on scientific research and public education has come from private contributions, both individual donors and small family foundations,” Burge said. “That's been enough to get us this far, though we're going to need to take our fundraising to the next level in order to develop our research programs and make these treatments available for those who need them.”
Another private funder, The Heffter Research Institute, has provided more than $4 million since it was established in 1993. Among studies funded was one by Dr. Grob, an institute co-founder, examining psilocybin in a controlled setting to reduce the psychospiritual anxiety, depression, and physical pain of terminal cancer patients: “My hope is that more established investigators will identify that his is an important and neglected area, and deserves more formal approved research.”
As with much of science, the pace of future studies hinges on finding money to fund them. Dr. Grob has good reason for optimism, simply by comparing the present day—when the controlled use of medical marijuana is a reality underpinned by years of research—to the backlash against countercultural drug abuse that led investigators to stop studying the good that psychedelic drugs can do within limits.
“Everything was shut down by the late ‘60s and early ‘70s, and it took decades for research to open up on any level,” Dr. Grob recalled. “We’ve come a long way. That should be acknowledged.”
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