The (Re)Emerging Field of Psychedelic Psychiatry

Presented at the International Congress on Naturopathic Medicine - 2019

Definitions

  • Psychotomimetic: Outdated term used to describe substances that mimic psychosis

  • Hallucinogen: A substance that generates hallucinations (does not accurately describe psychedelic experience)

  • Psychedelic: an experience in which the mind (soul) is fully manifested

  • Entheogen: a psychedelic substance specifically used for spiritual practice

  • Microdosing: the practice of using sub-psychedelic doses (5-25% of a full dose) for enhancement of mood, creativity, and energy

Recreational versus Therapeutic Use

  • These substances enhance sensory experiences and opens one to new ways of being in the present moment

  • Intention makes the experience what it is

  • We refer to this as Set and Setting

  • Mindset: what is your present mental and emotional state? What do you want from this experience?

  • Setting: Where are you? Do you feel safe? Supported?

  • Harm reduction is a safer approach than prohibition

Classic Psychedelics

  • Tryptamines

  • LSD

  • Psilocybin

  • DMT (ayahuasca)

What do they treat?

  • Cancer related anxiety and depression

  • Treatment-resistant depression

  • Addiction

  • In smoking cessation clinical trial at 12 month follow up 67% of participants were abstinent (compare to varenicline at <31%)

  • Migraines and cluster headaches

  • PTSD

  • “the betterment of well people”

  • It is also enhancing our neurobiological understanding of consciousness

LSD

  • 25-Lysergic Acid Diethylamide or “acid”

  • A synthetic product of lysergic acid, which is naturally occurring in the parasitic rye fungus, Claviceps purpurea

  • An ergoline tryptamine with a rigid structure

  • Very potent with only 75-150 µg p.o. to illicit a psychedelic effect

  • Peaf effect in 1-2.5 hours

  • Total duration is 8-12 hours

  • 〖5-HT〗_2A and 〖5-HT〗_1A Agonist

  • Also interacts with dopamine and glutamate pathways

Psilocybin

Magic Mushrooms

Ayahuasca

  • “Vine of the sould”

  • A shamanic tradition originating in the Amazon region of South America

  • A tea brewed from the vine of Banisteriopsis caapi  which contains β-carbolines which act as monoamine oxidase type-A inhibitors, and the leaves from the bush Psychotria viridis which is rich in dimethyltryptamine (DMT)

  • DMT can be smoked or intravenously injected for a 10-20 minute psychedelic experience, but it is not orally active. The MAO-I allows the DMT to reach the brain where it agonizes 〖5-HT〗_2A receptors producing a 4-6 hour experience.

  • When asked how they knew to combine these two plants, the indigenous people will say that the plants themselves guided them

  • The practice of ceremonially ingesting ayahuasca is protected as a religious sacrament in many parts of the world

  • Nausea and vomiting are common

MDMA

  • 3,4-methylenedioxymethamphetamine

  • Not a classic psychedelic because it does not produce vivid mystical experiences

  • Classified as an entactogen or empathogen

  • WARNING: Most classes of antidepressants lower the effects of MDMA and increase the risk of serotonin syndrome

  • Affects Alpha-2 receptors impairing thermoregulation, but also enhancing relaxation

  • Causes a release of oxytocin which suppresses amygdala activation and enhances feelings of closeness and empathy

  • Animals studies have shown elevated BDNF in the amygdala may account for the fear extinction that allows for safe recall of emotionally painful memories.

  • How MDMA-Assisted Therapy Is Done

    • Done in a comfortable home-like setting

    • Most studies used male-female dyad of therapists. This is not always necessary.

    • 1-3 one hour sessions are done to establish therapeutic relationship before a drug session is conducted

    • Sessions are patient driven rather than guided by the therapists

    • Eye shades, headphones, and music are often used

    • Follow up integration sessions are crucial

The Entropic Brain

  • Entropy describes a measure of uncertainty or randomness within a system. Applied to the brain, this concept provides a framework for describing both mechanistic and qualitative properties to states of consciousness.

  • The DMN has been called the physical counterpart of the narrative-self or ego

  • It coordinates sensory input to create a coherent reality that optimizes survival

  • It is associated with unconscious thought, self reflection, and mental time travel

  • Depression, addiction, OCD and other states of rigid thinking are associated with increased activity of the DMN

  • fMRI and MEG studies of the brain at baseline and after psilocybin administration demonstrate suppression of the DMN

  • This causes other regions of the brain to connect in ways that is normally does not, particularly the visual cortex

  • This psychedelic state is a form of primary consciousness similar to infancy, dreaming, and early psychosis

The Mystical Experience

  • The experience of reverence for and unity with all things accompanied by a sense of authoritative truth.

  • Accompanied with feeling of tranquility, ecstasy, transcendence of space and time, and ineffability.

  • Positive results from psychedelic clinical trials strongly correlate with mystical experience

Currently these substances are illegal to possess or administer outside of sanctioned research environments, however…

MDMA

  • Likely to be legal treatment for PTSD by 2021 by the FDA and EMA

  • Currently being researched for:

    • Alcohol addiction

    • Social anxiety in autism

    • Couple’s therapy

    • Mood disorders

Psilocybin

  • Cities of Denver, Colorado and Oakland, California have decriminalized possession

  • State of Oregon will vote in 2020 to create legal service centers where the public can come for a guided session with a professional

  • Research for the treatment of depression is currently in phase 2 clinical trials

Disclaimer: topics discussed on the podcast are for educational purposes only and should not be construed as medical advice. Consult with your medical provider about the appropriateness of these interventions in your individual case.

Music credit: American Vernacular by RAGE

Matthew Hicks