Psychiatry and psychedelia

Timothy Leary, the influential psychologist who popularized the use of LSD in the 1960s, is a polarizing figure in the debate on psychiatry and psychedelic drugs. While revered by some as the father of psychedelic research, he is reviled by others for his unconventional research methods, which culminated in Leary's lab, the Harvard Psiloybin Project, being shut down by the University in 1963. Following this set back, Leary established a private laboratory in a mansion in upstate New York where he continued conducting studies on his friends and followers. Leary's previously unseen recordings and notes from this period have recently been purchased and published by the New York Public Library, for the first time allowing us insight into the ground-breaking work done with these then novel substances. The backlash to Leary and his colleagues' extremist views regarding drug use, religion and politics (Richard Nixon at one point called Leary "the most dangerous man in America") potentially discredited any real benefits psychedelics may have in therapy for over 40 years. Experimentation and research with LSD, psilocybin (commonly known as hallucinogenic or "magic" mushrooms) and other psychedelic substances has been highly stigmatized and virtually impossible to conduct in a responsible laboratory setting. However, the restrictions against such research have gradually been lifted, and new studies are cautiously popping up heralding the clinical benefits of drugs like psilocybin and MDMA, or ecstasy.  These drugs are thought to help individuals who suffer from severe anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD) and depression when paired with talk therapy methods. The effectiveness of these drugs is thought to lie in their ability to engender feelings of empathy, love and connectedness, fostering a sense of unity and compassion for oneself and fellow man. These feelings may potentially create an easier, more open environment for patients to discuss their concerns in, while safely being guided by clinicians on a therapeutic trip.

Some of the most notable research coming out of this renaissance is being conducted at John's Hopkins University, led by Dr. Roland Griffiths. Griffiths has shown that psilocybin can be used to effectively reduce levels of depression and anxiety in terminally ill cancer patients, anecdotally helping some patients to accept and come to terms with their approaching mortality.

Another influential use for this type of research is in patients with PTSD. With the recent announcement that antipsychotic drugs, frequently prescribed to help treat PTSD in combat veterans, are no more successful than placebos at improving symptoms, it seems that a new method is needed to help those suffering from severe trauma. Antidepressants are already known to be ineffective at treating PTSD, and doctors were hoping that antipsychotic medication, a stronger mood affecter, would be more successful at treating the associated symptoms, such as flashbacks, memory suppression, outbursts of anger, anxiety, anhedonia and depression. However, after six months of treatment only 5% of patients who received the drug had recovered, a number that was statistically negligible and not significantly different from those who had received a placebo.

Some researchers are now looking at more unconventional methods, such as psychedelics, as potential treatments for PTSD. Clinical researchers both in the US and in the Netherlands have shown that MDMA can be effective at reducing PTSD symptoms in survivors of rape or other traumatic events. Neurologically, MDMA stimulates serotonin in the brain, a neurochemical linked to feelings of  happiness and whose depletion is commonly attributed to depression. This activation takes place throughout the brain, but much of it is focused in the dorsal lateral prefrontal cortex (dlPFC), a region involved in higher order cognition, memory and associative learning. Simultaneously, there seems to be a decrease in amygdala activity, an area involved in fear and emotion. Taken together, these two changes in neural activity are thought to increase memory and rational, cognitive coping of the traumatic event, while down-playing the aversive negative emotions connected to it. Therefore, an individual would be able to replay the more painful details of a memory and rationally analyze and come to terms with them, facilitated by a boost in mood from serotonin and disconnected from the typical painful affective responses. This could potentially help a patient "relearn" their associations with this memory, thus allowing them to lose the negative and recreate positive affective associations for these recalled experiences.

However, just as there are side effects with any drug, so there are too with MDMA. The most notable and potentially harmful one is a resulting decrease in serotonin after the high has worn off. When the brain is flooded with a neurochemical it regulates itself to become less receptive to this neurotransmitter, adapting to re-obtain homeostasis in the chemical levels in the brain. The brain therefore becomes relatively depleted of serotonin over the next few days after taking MDMA, and after multiple uses (or abuses) of the drug this effect can become pervasive and long-lasting. While the amounts of depletion are not particularly severe after minimal use, in a patient who is already struggling with depression or anxiety this temporary loss could be potentially devastating.

Banning potentially valuable clinical research because of social concerns and constraints only hurts scientific progression and the community at large. However it is important to keep in mind that these psychedelic substances are powerful drugs with potentially very severe consequences. They should be investigated as their benefits to clinical populations could be immense, but they should still be used carefully as much is still unknown (just as much as unknown about most drugs, prescription or otherwise) about their mechanisms and effects. Responsible research is the best way to investigate the therapeutic possibilities of these drugs, and the existence of methodical record taking like Leary's can only help us in our quest to understand these substances and their effects on the mind.

Dana Smith

PhD student in Experimental Psychology at the University of Cambridge