Friday, April 2, 2021

Podcast: ‘Mainstreaming’ Psychedelic Drugs

David Nutt: In a space of 10 years, we’ve gone from pictures in a brain image to kind of revolution in psychiatry. And that is a, that is a powerful example of how medicine and science should work together.

Bradley van Paridon: That’s David Nutt, a psychiatrist and professor of neuropsychopharmacology at Imperial College London. He and his colleagues at The Center for Psychedelic Research at Imperial College are among a growing number of therapists and academics who believe that psychedelic drugs are a potential new treatment option for mental health conditions like depression.

David Nutt: The big challenge now is to roll it out so that all the millions of patients around the world who might benefit will get it.

Bradley van Paridon: The details however, of exactly if, when, where, and how this roll out will take place remain to be seen.

Lydia Chain
: This is the Undark Podcast, I’m Lydia Chain.

Research into using psychedelic drugs like LSD and psilocybin to treat mental health conditions is rapidly advancing, with a dozen clinical trials in 2021 alone. Paired with the movement to decriminalize or legalize these substances in many places, most recently in Oregon, the idea of bringing psychedelic drugs into the therapist’s office is becoming more mainstream.

But there’s still a lot for researchers and mental health practitioners to figure out, from finding the most effective ways to run a psychedelic-assisted therapy session, to navigating regulatory approval and insurance barriers, to actually recruiting and training therapists in the new methods. Bradley van Paridon has the story.

Nicolas Langlitz: There was a pretty significant amount of psychedelic research in the 1950s, which were also known as the golden age of psychopharmacology.

Bradley van Paridon: That’s Nicolas Langlitz. He studies the anthropology of science and medicine at the New School for Social Research in New York, including the history of research with psychedelic drugs. He says back in the early 60s that research was drastically curbed by new regulations surrounding the use of experimental drugs.

Nicolas Langlitz: The first step towards a more strict regulation had a lot to do with, in my eyes, very legitimate concerns about the way in which drugs, all sorts of drugs, were used by doctors and pharmaceutical industry.

Bradley van Paridon: This led to countries establishing frameworks whereby drug manufacturers are required to prove scientifically that medications are both safe and effective.

Nicolas Langlitz: And then at the end of the 1960s, there was a second more severe crackdown on psychedelic research associated with the prohibition of psychedelics. That really killed off work on human subjects.

Bradley van Paridon: But since the 90s, he says a combination of factors have reopened the conversation. One of them is a leap in basic neuroscience research about the brain and consciousness.

Nicolas Langlitz: The neurosciences are making a lot of headway now. So here are these drugs and we can use them to better understand the brain. And you know, there, there was some red tape of course, but by and large, regulators were willing to listen.

Bradley van Paridon: Decreases in social stigma helped, too. There’s also been a rise in mental health conditions such as depression and post-traumatic stress disorder and new conversations about the limitations of conventional treatment.

Andrea Jungaberle: We really have a worldwide mental health emergency and blunt tools. What we’re working with in psychiatry and psychosomatic medicine and psychotherapy is not working for everybody. So, we need new therapies.

Bradley van Paridon: That’s Andrea Jungaberle, the medical director of OVID Health Systems, a clinic in Berlin offering medical training and ketamine-assisted psychotherapy. It’s also part of a network of academics and doctors performing research and clinical trials in psychedelic-assisted therapy. Many experts agree traditional therapy doesn’t work for everyone. Plus, the discovery of new pharmaceuticals to treat conditions like depression has stalled.

Nicolas Langlitz: You know, if you look at the substances that have come out since the 1980s or even 1970s, most of them were me-too drugs. There were no major breakthroughs.

Bradley van Paridon: Me-too drugs are copies of existing drugs that are slightly altered chemically but still achieve the same effect. Today, there are many versions of selective serotonin reuptake inhibitors, commonly known as SSRIs, and they are the main class of drug prescribed to treat depression. These, like other anti-depressants or anti-psychotic medications, work via their chemical interaction with the brain. To relieve symptoms, a patient takes it routinely.

Nicolas Langlitz: So, if you have a depression, you take an antidepressant and you take it every day. Uh, if you suffer from schizophrenia, you take an anti-psychotic and you take it every day over a very long period, potentially over your lifetime. So, so these are really drugs for life.

Bradley van Paridon: He says this is quite different from how psychedelics are used. Instead, patients take the psychedelic in order to open them up to other types of psychological therapy. Here again is David Nutt.

David Nutt: It’s not just therapy and it’s not just the drug. We think it’s the two together produce that sort of optimal cocktail of, um, of change and facilitation of insights, which lead to improvements in the long-term. 

by Bradley van Paridon and Lydia Chain, Undark |  Read more:
Image: Photo by Cole Burston / Getty Images. Microscope image of neurons by MR McGill / Flickr. Illustration by Undark
[ed. For a good understanding of current depression treatments (via SSRIs), see: SSRIs: Much more than you wanted to know (SSC); Which SSRI is the best? (Lorien); and, Oh, The Places You'll Go When Trying To Figure Out The Right Dose Of Escitalopram (Astral Codex).]