When thinking of psychedelics, the first thing that comes to mind isn’t normally that they could be used in a scientific manner to heal individuals. These drugs are more likely to be associated with hippies and the 60s than the possibility of resetting the brain’s composure for individuals with untreatable depression, or with PTSD.Studies for psychedelics to help combat mental illness started well before the stigma of psychedelics formed. In the 1950s and the early 60s, psychedelics were considered to be a promising treatment for a large array of mental health disorders (Therrien, 2018). Scientists took on more than 1,000 studies, to understand these drugs and how to use them medically (Therrien, 2018). The drugs, however, became very controversial. As musicians began to popularize the drugs as a ‘fun’ recreational activity, they became increasingly associated with the countercultural movement. The drugs were beginning to be seen as morally degenerate, as the negatives were more announced then even the possibilities of the benefits. As fear grew about the safety of people, psychedelics were made illegal in the United States in 1968. Shortly after in 1971, the UN Convention on Drugs effectively decided to end scientific research for psychedelics. It was not until the mid-2000s that the drugs underwent a scientific renaissance. Scientist began to look at these drugs, such as MDMA and Psilocybin once more. This paper will look at each drug and breakdown
MDMA
MDMA, or more commonly known as ecstasy, is a psychoactive drug primarily used as a recreational drug. This drug targets the brain by causing a big increase in the levels of several different neurotransmitters. Most predominantly it causes the release of large amounts of serotonin, which is contributed to the feeling of well-being and happiness. This drug also increases levels of oxytocin and prolactin. Oxytocin is known to increase affiliative behaviors (Miller, 2016). It has also been shown to affect how people respond to certain facial expressions (Miller 2016). While prolactin can cause a ‘post-orgasmic state’, making individuals feel more relaxed while increasing their sense of satisfaction (Miller 2016).
PTSD
With this, research has looked at MDMA specifically in relation to PTSD. People who suffer from PTSD are experiencing severe anxiety disorder resulting from exposure to a traumatic event. These individuals tend to be in the exhaustion stage of the Selye’s General Adaptation Syndrome (King, class discussion). This stage, although also known as the burnout stage, leaves people depleted. For individuals suffering from PTSD, however, elicits a more hyper-aroused composure leaving individuals flooded with anxiety and emotions (King, class discussion). This level of fear in everyday life causes a more active amygdala (Mithoefer et al, 2011). Medically prescribed drugs for patients with PTSD are for specifically targeted symptoms that come with PTSD. Talk therapy seems to be the most beneficial support for people with PTSD, however, can be difficult to achieve a state where the patient feels able to articulate their anxiety (Mithoefer et al, 2016). Some individuals respond to antidepressants such as sertraline or paroxetine, while some respond to specific types of psychotherapies. Nevertheless, these treatments do not substantially help many individuals suffering from moderate to severe symptoms of PTSD (Mithoefer, 2011).
PTSD and MDMA
This is where MDMA comes in. In a recent double-blind study, Mithoefer and colleagues reported that MDMA, when combined with psychotherapy in a controlled setting, was effective in reducing symptoms in individuals struggling with PTSD (Mithoefer et al, 2016). This study was done on 26 military personnel and emergency first responders as these occupations tend to have the most rates of PTSD. The participants were randomly assigned to receive one of three doses. Seven participants received 30 mg that was considered to be an active control group. While another seven received 75 mg and the remaining 12 participants got 125 mg. These doses were administered on two occasions separated by three to five weeks and were paired with time-intensive therapy (Mithoefer et al, 2016). The administration of the MDMA was accompanied by an 8-hour session of client-directed psychotherapy, followed by a week of daily phone contact and two 90-minutes sessions, “that aimed at integrating the experience” (Mithoefer et al, 2016). The results of the study showed that PTSD symptoms were substantially diminished and psychological functions substantially improved in those receiving 75 and 125 mg compared to the ‘control’ group receiving 30 mg (Mithoefer et al, 2016). Results from 75 mg were similar as 125 mg, showing that dosage does not matter. Many other small-scaled studies were done highlighting similar results. A new study, however, has just been accepted by the FDA, for a larger scale study, that combines both MDMA along with talking therapy for the treatment of PTSD, to show the validity of the smaller studies on a larger scale.
Implications of MDMA
MDMA is seen to ease symptoms of PTSD in many ways. It’s important to note that it’s not the specific actions of MDMA in the brain that appears to treat PTSD, but rather that it seems to make psychotherapy more effective as it is able to elicit a more ‘open’ individual. As stated earlier, people with PTSD are generally in an active emotional state. MDMA decreases activity in the amygdala which is beneficial for individuals suffering from PTSD as they have stronger reactions due to their heightened amygdala responses (Thal, 2018). The drug also seems to put patients in what researchers call an ‘optimal arousal zone’ which can place them in a perfect open mindset where therapy can come in and help (Mithoefer et al, 2016). Patients need to be open and willing to speak about their trauma’s, and with a little help of MDMA, the patient can be in the “sweet spot” for therapeutic change to happen (Mithoefer et al, 2016).
In multiple studies, it has been seen to increase feelings of trust, empathy, and bonding towards individuals psychotherapist. This allows the patient to overcome feelings of anger, emotional numbness, and anxiety during the treatment (Heifets and Malenka, 2016). MDMA fosters the feeling of closeness and empathy for individuals struggling with PTSD, it is given the classification as an “empathogen” as it offers a powerful prosocial action (Heifets and Malenka, 2016).
Results from the testing, show that the MDMA could foster a sense of control, something that most individuals struggling with PTSD find hard to obtain. Research has shown that having a sense of control, is a key component to finding balance and to be able to cope with stressors. According to the Approach Coping of Stressors, having a perceived feeling of control can give a sense of competence that translates to positive emotions (King, class discussion). As well as coping, having social support and emotional expression is part of successful coping. Emotional expression or disclosure is an adaptive strategy in which a person describes their feelings about a stressful or traumatic experience. This can reduce negative emotions, however, individuals need to be in the mind frame to work through things. It could be said that MDMA is a stepping stone for successful coping in the debilitating illness of PTSD.
It is important to note, that going through MDMA treatment for patients with PTSD isn’t a quick fix, as it can be a hard and painful experience as they have to almost relive their trauma (Miller, 2016). The drug, however, seems to help them feel like they can go through the process without feeling overwhelmed. If MDMA were to get approved, it would not be a drug you could pick up from the pharmacy. It would be administered at a specialized clinic under supervision (Miller, 2016). For example, in Mithoefer trial, when the patients took MDMA, they did it under the supervision of a therapist who spent an 8 hour time period with the patients where they were guided through talk therapy (Mithoefer et al, 2016). The patients spent the night at the clinic and were then in touch with the therapist every day for the following week (Mithoefer et al, 2016). The therapist met with the patient several more times before the following MDMA session. Taking the drug in a controlled environment with a specialist guiding the treatment is essential for the individual to be able to fully benefit from the brain alteration the MDMA is providing. Scientifically is and will not be used the same way that it has been popularized for. However, the feeling of complete openness that people seek out MDMA for are controlled for in the medical setting and could significantly alter the quality of life of individuals that suffer from PTSD.
Psilocybin
Recent studies have also suggested that psilocybin could benefit patients who have cancer-related psychological distress such as depression or anxiety of death (Griffiths et al, 2016). Psilocybin is a naturally occurring psychedelic compound that is found in more than 200 species of mushrooms (Griffiths et al, 2016). Psilocybin has been used in Mesoamerica in spiritual and religious ceremonies. A typical trip on a moderate dose of magic mushrooms (1-2g) brings the individual into an increased intensity of emotional experiences (Griffiths et al, 2016). Psilocybin also increases introspection and creates psychological functioning. Based off on brain imaging, studies show that a mushroom trip is neurologically similar to dreaming (Sample, 2017). If paired with talk therapy, this dreamlike induced state would be a perfect situation for a specialist to step in and work through emotions while trying to get patients to connect to a greater meaning.
Cancer and Psilocybin
For people suffering from life-threatening cancer, psilocybin may provide significant and lasting decreases in anxiety and distress. Patients with this kind of existential anxiety often feel hopeless and are worried about the meaning of life and what happens upon death (Griffiths et al, 2016). According to the National Comprehensive Cancer Network, 30-40% of people with cancer suffer from a mood disorder (McMains, 2017). Cancer patients’ feelings of personal control decline after diagnosis. As well as, those who have high levels of hopelessness and depression tend to survive for a shorter period of time after diagnosis then others do (McMains, 2017).
Cancer and Psilocybin Research
In the 1990s, researchers found that psychosocial interaction could improve survival rates of cancer patients. Patients attended group meetings and had therapy, where they were free to discuss their emotions and coping strategies. A follow up 10 years later showed that patients who received this treatment lived roughly 18 months longer than those in the control group (Spiegel et al., 1989). Being able to help these patients’ cope with these feelings and enhance the quality of life is what researchers studying psychedelics are trying to achieve.
In 2016, two studies involving a total of 80 patients found that a single dose could considerably reduce the depression and anxiety felt by patients who had terminal or advanced cancer, compared to those who took a placebo (Griffiths et al, 2016). The effects were also documented as long-lasting, as up to 80% of the participants saw their reductions last for a minimum of six months (Griffiths et al, 2016). In another study, 13 patients with life-threatening cancer who experienced anxiety and distress were treated with psilocybin combined with talk therapy.
Cancer Depression and Spirituality with Psilocybin
The depression that comes with a cancer diagnosis is understandable and can be seen as ‘normal’ as patients’ are going through an extremely stressful period (King, class discussion). The most common treatment for depression is cognitive behavioral therapy (CBT) and antidepressants. However, depression due to a cancer diagnosis is a challenging one to battle as the patient may not have the time for intervention. This depression can almost become treatment-resistant, a very disabling condition. As medical practitioners want to offer the best care for cancer patients, this depression and anxiety can come in the way of success. A study tested twelve patients with treatment-resistant depression and terminal cancer (Mithoefer et al, 2016). All twelve patients had two unsuccessful courses of antidepressants and some form of psychotherapy prior to the study. They found that psilocybin was safe and well-tolerated when given alongside supportive therapy (Mithoefer et al, 2016). The drug helped reduce 80% of the patient's symptoms of depression. In a small double-blind study at John Hopkins, researchers studied people suffering from cancer-related anxiety or depression. They found considerable relief for up to six months with just a single dose of psilocybin (Griffiths et al., 2016). The drug helped the decrease of depressed mood, anxiety, and death anxiety. The drug was also helpful in increasing the quality of life in patients, understanding their life meaning and becoming more optimistic. Six months post treatment, 80% of participants continued to show clinically significant decreases in depression and anxiety, while 83% reported increases in well-being or life satisfaction (Griffiths et al, 2016). Interestingly, 67 percent of participants reported the experience as one of the top five meaningful experiences in their lives and about 70 percent reported the experience as one of the top five spiritually significant lifetime events (Griffiths et al, 2016).
According to Kubler-Ross, reaching the acceptance stage is an important process in the stages of dying as the aspect of mortality is embraced (King, Class Discussion). Arriving at this stage, patients have been able to accept death, are no longer in denial and are true to themselves. The acceptance of death is important as it can relieve stress. As Weisman and Hackett describe in their main requirements for the patient, being compatible with the ego ideal is important (King, Class Discussion). This means that patients should be living in line with their authentic self. Evidence from the study with the 13 participants suggests that the psychedelic experience can truly be transformative as it is able to put patients in a deeper connection with not only themselves but with the world around them. It also helped the participants reconcile their feelings about death as nearly all participants reported that they developed a new understanding of dying. Psilocybin can help individuals move through the stages of grief and reach acceptance.
According to the researchers, many cancer patients said they developed a new understanding of death after taking mushrooms. The dreamlike state that psilocybin elicits is able to place the individual in a guided autobiography. This reconstruction of the past integrates itself with the present. Guided autobiography can open up the potential for a deeper understanding of one's purpose (King, Class Discussion). When approaching death, people try to make sense of the world around them. Finding meaning at the end of life can be a challenging process, however, the willingness to completely let go is the ultimate end goal. Patients also make a spiritual interpretation of their experiences and the treatment helped them facilitate a connection to life and the greater mindfulness. Psychological health can increase with spirituality methods of finding meaning at the end of life (Bieber, 2010). It could be said that psilocybin is the catalyst or the push patients need to begin the spiritual journey to understanding death. Death acceptance is very important for patients with terminal illness. This personal quest, guided by psilocybin, can help individuals understand the ultimate questions about life and death. This sense of spirituality can help patients enjoy life despite symptoms (Bieber, 2010).
The results from John Hopkins study are remarkable as a single dose can have a huge impact. Traditional psychotherapy is generally offered to people with cancer as well as CBT and antidepressants but can take weeks or even months and sometimes is not even effective. With psilocybin, however, results are in almost instantaneous. Psilocybin could be a game changer for terminally ill patients in being able to battle depression and anxiety while improving their quality of life.