Psychedelic drugs and psychiatric disorders

In February of this year, a CBS News article touted an exciting new potential treatment for mental illness: psychedelic drugs. More surprising, however, is how little we know about the treatment potential, despite the concept of psychedelic substance-turned-pharmacotherapy in the world of psychiatry since the 1950s.

Experiments using LSD and MDMA, among other psychoactive drugs, began to show some real benefits for treating alcoholism until the budding research was halted following a 1970 federal ban on the use of psychedelics. The scientific community had to halt their promising research due to the restrictions. The FDA has now started to allow some research groups to pursue potential therapy effects in patients with mental illness and life-threatening conditions. One pilot study at Harbor-UCLA Medical Center measured an improvement in “mood and outlook” in terminally ill patients for up to six months after being given a single dose of psilocybin, the active component of so-called magic mushrooms.

Scientifically speaking, we know so little about these drugs that these studies may sound alarming. Researchers explain that the substances being used are not chemically addictive and are administered under close supervision. Psychoactive drugs are being tested for efficacy in improving depression, anxiety, PTSD and other mood disorders as well as substance addiction and psychological symptoms associated with terminal diagnoses. Preliminary data show significant positive changes for many of these disorders. A review article published in February 2017 in Clinical Pharmacology and Therapeutics by Nichols, et al. describes effects that can be as strong or even stronger than conventional treatments, with greatly reduced side effects.

Expanding into further realms of research, a September 2017 article published in the Journal of Psychoactive Drugs described a study on the effects of ayahuasca, a South American psychoactive substance, in patients with eating disorders. The Nichols, et al. article also touts psychedelics as possible anti-inflammatory medications due to their effects on the central nervous system. The authors hypothesize that psychedelics work by “acutely destabilizing local brain network hubs and global network connectivity via amplification of neuronal avalanches, providing the occasion for brain network ‘resetting’ after the acute effects have resolved.” This phenomenon could be responsible for the long-lasting effects that have been seen in various studies.

Nichols, et al. also explain some of the hurdles facing researchers. Most obviously, these drugs are still difficult to obtain because they are not commercially legal. But all of these studies have been conducted in controlled, supervised settings. The notion of patients self-medicating and self-monitoring at home may mean the therapeutic effects could be altered, and the patients may be putting themselves in danger without proper supervision (not to mention that most of these substances are still illegal).

As dental professionals, our goal is to treat the whole patient. Many of our patients suffer from mental illness, so the therapeutic potential of these drugs should intrigue us. The implications for care should also be a topic of discussion. How will they affect the delivery of care? In my home state of Nevada, we’re just now learning to navigate the topic with patients who use recently-legalized marijuana. Perhaps the next challenge for patient management will open our minds in ways we never thought possible.

~Rachel Bush, Las Vegas ’18, national electronic editor