Can psychedelics cure mental illness? This question is now under vigorous investigation at research centers across the world and is the subject of a Nova documentary that premieres Wednesday night on PBS.
People who take psychedelic substances have reported powerful mystical experiences that are often characterized by a sense of unity or oneness with other things, a profoundly positive mood and transcendence of time and space.
These mind-altering substances have been used by humans for thousands of years in ritual settings. In the 1950s, some researchers demonstrated their promise as therapies for certain mental illnesses. But this research abruptly came to an end as authorities cracked down on psychedelics after they rose to prominence in the 1960s counterculture. The U.S. government criminalized the possession of psychedelics in 1968.
Only in the past few years has the stigma surrounding psychedelics started to fade. Now, scientists from institutions around the worldincluding prestigious centers like Johns Hopkins University and Imperial College Londonare carrying out pioneering research into these substances.
Some research groups have demonstrated that psychedelics combined with therapy sessions show promise for the treatment of a range of mental health conditions, such as post-traumatic stress disorder (PTSD), addiction and depression.
One group featured in the Nova film received psilocybin-assisted therapy as part of a limited clinical trial. Some of the members showed a 50 percent reduction in drinking, compared with a group treated with psychotherapy alone, and some patients experienced remarkable recoveries.
Another group from a different trial featured in the film involved cancer patients with major depressive disorders. Significant improvements were seen in the majority of participants.
And MDMA-assisted therapy for PTSD is now in the final stages of the Food and Drug Administration's (FDA) approval process, while psilocybin-assisted therapies for depression, among others, are also being examined by the agency.
A neuroscientist featured in the Nova documentary, Yasmin Hurd, who is director of the Addiction Institute at the Mount Sinai Behavioral Health System, told Newsweek one of the things we know is that psychedelics work on the neurotransmitter serotonin, which is involved with disorders related to depression and anxiety. This may explain some of their therapeutic effects, although more research needs to be done to understand the biological mechanisms at play.
"These psychedelics impact on the serotonergic system, and they work also in changing the plasticity of neurons, meaning that they can change the structure of them," Hurd said.
"In a number of substance use disordersnot allthe neurons retract, they have lost their spines. And we've seen that a lot of these psychedelic drugs actually cause the spines to grow again. That's one of the ways in which many people feel that psychedelics may be working."
Studies have looked at the serotonergic system in humans, and researchers have been able to correlate psilocybin-induced changes in the brain with improved outcomes for emotional states and cognition.
"Also, when you look in the human brain, you can see that the psychedelics change the connectivity between brain regions. For example, if we think about a brain region like the amygdala[it] is really critical for emotional regulation and [is] highly sensitized to negative memories," Hurd said.
In PTSD, for example, the amygdala is highly active, but psychedelics appear to reduce the activity of these amygdala networks.
"We still don't know completely how the psychedelics may be reducing depression or anxiety and PTSD, but those are some of the things that we've seen," Hurd said.
She also said there are still many unknowns when it comes to psychedelic therapies and their effectiveness. "The dosing is still really challenging to know. The type of disorder and who [these treatments] might be better suited forthose are things that are still being investigated."
Hurd said it is important people realize that the therapies being investigated do not simply involve people being given a pill. An important aspect of these potential treatments is the associated behavioral therapy.
"The field is still trying to understand what component of behavioral therapy that's needed," Hurd said.
Another challenge with the research into psychedelic therapies is that there tends to be no placebo control.
"Normally, when you run clinical studies to see if something works, you have to make sure that it [doesn't just work] because somebody wants it to work. That may ultimately be the biggest challenge with psychedelics," Hurd said.
The use of psychedelics also comes with risks and ethical concerns. Psychedelic experiences can have negative outcomes if an individual is not in the right frame of mind or environment when taking them. Scientists stress the importance of administering them in a therapeutic setting when mental health conditions are treated.
"Psychedelics are very different from all other medications," Hurd said. "You need to be in a particular environmentNative peoples, when they have used these psychedelics, it was in a group setting. So for these particular medications, there needs to be extremely controlled settings."
She continued: "The more studies that are done, hopefully, we'll be able to understand which particular individuals can benefit from it in combination with therapy...and who may be at risk. There's no medication that's going to work on everyone."
Certain groups of people should also avoid taking psychedelics, such as people with a personal or family history of schizophrenia or bipolar disorder who are at risk of experiencing negative psychotic states.
As for the future, psychedelic therapies may be available as FDA-approved medications where the dosing and side effects are known and the drug is administered by a physician.
Despite the risks and remaining unknowns, Hurd said psychedelics have the potential to upend how we currently treat mental health conditions.
"You have to be brave enough to be open to [the fact that psychedelics] can revolutionize [treatment] for people whose lives are destroyed by their addiction, the craving that they can't stop no matter how much they want to. Anything to me that can help people get their lives back I think can be extremely powerful."
She continued: "In the United States, we have millions of people with a substance use disorder. Addiction has a huge cost to our society. [Psychedelics could] be extremely powerful in helping us to have healthy adults. But at the same time, we don't want to exacerbate and worsen people's outcomes.
"So I'm cautiously optimistic, but I like to see data. Hopefully, now with more clinical trials being supported by the National Institutes of Health and clinical trials going through the FDA channels, we will be able to get much better insights," Hurd said.
Can Psychedelics Cure? premieres Wednesday at 9 p.m. EDT/8 p.m. CDT on PBS. The film will also be available for streaming at PBS.org/nova, Nova on YouTube and via the PBS Video app.
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