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Expert Q&A: Psychedelic Drugs and Mental Health

Psychiatry Chair Discusses Potential Uses and Drawbacks of Mind-Altering Substances

California’s attorney general recently approved signature gathering for a proposed ballot initiative that seeks to decriminalize psilocybin, the active ingredient in so-called “magic mushrooms,” and to authorize research into the medical use of the compound.

Psilocybin has been making headlines lately as researchers around the world discover potential uses for the mind-altering hallucinogenic substance in treating depression and other psychiatric disorders. It’s what Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai, calls a "second wave" of research.

"In the 1950s, there was a large wave of research that occurred on psychedelics, trying to evaluate their impact on a range of conditions," Danovitch said. "But as part of the war on drugs, and other factors, most psychedelics were outlawed, and it wasn't until more recently that researchers started to have the capability and capacity to study these drugs again."

While Danovitch is not leading any research study on psilocybin, he is monitoring the landscape closely.

"There's an effort to understand for what health problems are specific psychedelic agents most effective," he said.

For instance, there is evidence that certain psychedelic compounds can be helpful in the treatment of depression, eating disorders, anxiety, post-traumatic stress disorder, and substance use. However, according to Danovitch, there is a need for more rigorous studies to better establish which of these drugs are most effective, how they should be administered, and who is most likely to benefit.

What Are Psychedelic Drugs?

"Psychedelic drugs or psychedelic compounds are a large category that affect the mind," Danovitch said. "The term 'psychedelic,' actually means ‘mind manifesting.’"

Some of the compounds can be found in nature–in plants, fungi and even secreted by animals–while others, like the LSD that was popular in the 1960s and 1970s, are created in a laboratory.

Each of the compounds works in a different way to alter an individual's sense of reality.

"Some of these compounds, like psilocybin, alter the neural networks in our mind that help us to create a sense of order," Danovitch said.

These substances may act as sort of a "reset button," which may help those with internalizing disorders like anxiety and depression.

"It may be that the experience of having our sense of reality changed so dramatically helps us recognize that our view of reality is only one of several different perspectives," Danovitch said.

Other substances, like MDMA (also known as ecstasy), can create a sense of empathy and connectedness.

"It's thought that one of the ways MDMA may be helpful with a condition like PTSD, for example, or for people that have had a lot of trauma, is that it may help facilitate a deep sense of compassion—compassion for the self, compassion for others, and compassion in a way that makes it possible to reflect on really painful memories with a sort of healing awareness," Danovitch said.

But Danovitch stressed that researchers are still working to identify exactly how each of these substances works, and that most of the early evidence suggests that these drugs are only effective for mental health conditions when taken in conjunction with the correct therapy methods.

"When it comes to psychedelics, these are powerful substances, and they need to be handled with care and with humility," he said. “As a clinical intervention, psychedelic medications should always be paired with therapy. Therapy helps people prepare, process, integrate, and respond to the insights that psychedelics stimulate.”

Bad Trips and Other Side Effects

While psychedelics can facilitate therapeutic experiences, they can also produce negative experiences, or "bad trips," filled with fear and anxiety, or cause a user with an altered sense of reality to put themselves in harm's way. Further, these unregulated substances may be impure or "cut" with other substances that can cause additional damage to the mind or body.

Danovitch said that patients with a clinical condition like PTSD or depression might be even more vulnerable than others to experiencing a traumatic experience in the absence of a licensed therapist.

'It's really important that anybody using psychedelics for a health condition do so under the guidance of a health professional," Danovitch said. "If you're struggling with a health condition, and you're seeking treatment, you should talk to your doctor or a mental health provider."

Danovitch said that investigators are proceeding carefully in researching these substances, to fully understand both the therapeutic benefits and potential drawbacks.

"It's likely that down the line, we are going to see approved and available treatments that are based on these compounds," he said. “There has been a groundswell of innovation and research in this area, and we want to ensure that by the time these interventions reach patients their safety and efficacy is well-established.”

Read more on the Cedars-Sinai Blog: PTSD from COVID-19? What You Should Know