Gibson: Opening minds to a new kind of therapy

Psychedelic microdosing may have future in mental therapy.

Do banned psychedelic drugs like LSD and ecstasy have a place in the treatment of serious mental illness? This unexpected question is being evaluated by a growing number of researchers.

Guest Writer

Guest writer Scott Gibson M.D. M.D. has been practicing medicine in his hometown of McMinnville for 30 years. He has an enduring interest in science, which has expanded from the medical core disciplines of biology and chemistry to encompass physics, astronomy, geology and others. He served on the McMinnville School Board from 2011 to 2017, when he and his wife, Melody, moved to Amity to open a bed and breakfast.

Spoiler alert. The end of this article is going to say we don’t have enough information to make firm conclusions and that more studies are needed. We doctors can never have enough studies.

But don’t worry. This is an opinion article. So I will go out on a limb and offer some opinions, despite the fact that we don’t have as much information as we need.

Tremendous strides have been made in the application of medical and counseling therapy to mental illnesses in recent decades. But despite the new drugs and new approaches, including cognitive-behavioral therapy, many people achieve only partial improvement from debilitating conditions like depression, anxiety, schizophrenia and post-traumatic stress disorder.

Researchers have increasingly been turning in recent years to psychedelic drugs in the search for more effective therapies for those suffering from mental illness.

The attractiveness of these drugs as therapy comes from the very aspect that makes them dangerous — they make us feel better, sometimes a lot better. As a result, these drugs can be addictive, and in large doses, can foster irrational and self-destructive behavior.

The theory is that in controlled doses and restricted clinical settings, the positive emotional effects of psychedelic drugs can aid patients in distancing themselves mentally from traumatic experiences.

Veterans with PTSD, for example, have been given LSD in small doses, usually 1/10th to 1/20th the recreational dose, during therapy sessions where they are asked to recall wartime events triggering nightmares and suicidal thoughts. Some seem to benefit from this therapy, making them able to face their memories with less fear and anxiety.

John Lubecky, an Iraq War veteran suffering from PTSD, underwent psychotherapy while using a microdose of the drug MDMA, commonly called ecstasy. He described the experience this way:

“The adrenaline kick didn’t happen. The hair didn’t stand up on my neck. It’s like doing therapy while being hugged by everyone who loves you (while) in a bathtub full of puppies licking your face.”

This is the sort of anecdotal experience that has some researchers eager to see if these results are common, provide sustained benefits and can be achieved without precipitating addiction. To that end, the FDA has provided Breakthrough Therapy Designation to MDMA and psilocybin, the active chemical agent in so-called “magic mushrooms.”

An early study conducted at Yale University found that patients randomized into MDMA-assisted psychotherapy showed significantly more benefit for persistent PTSD than counterparts in the control group. Given that more than 3 million Americans suffer from PTSD, which carries a greater than one in four risk of suicide or suicide attempt, the need for better therapy can scarcely be overstated.

Observational studies involving depression have also shown promise, though high-quality randomized trials have yet to be conducted and analyzed. Severe anxiety and schizophrenia are other debilitating diseases being considered for psychedelic microdose intervention.

One thing observational studies have not found so far is evidence these drugs enhance cognitive function or decisionmaking. They may enhance creativity, which songs written by rock stars from the 1970s attest to. For those who fell into addiction, though, that creativity too often came at too great a price.

These drugs are incredibly powerful, and the devastating consequences of unregulated use are well known. But they do hold promise for people with severe mental health conditions who live with risk every day.

We have experience with powerful drugs that offer benefits when administered in limited doses. Opioids are the most obvious example.

Due to lax prescribing constraints and a broad black market availability, an estimated 2 million Americans are now addicted to opioids, many with life-damaging results.

Yet opioids are uniquely effective in controlling intense pain, including that stemming from trauma, surgery and cancer. Eliminating all opioids from medical use would result in severe suffering for huge numbers of people.

The answer must be better medical management, not elimination of this class of drugs. We can manage dangerous medication with vigilance.

It is very likely, in my opinion, that psychedelics are similar to opioids in that they can provide important benefits, but must be used with strict oversight and careful management. Given the ability of these drugs to make people feel good even in very stressful life situations, it seems only reasonable that in qualified hands, they could produce positive outcomes.

Since the 1960s, psychedelics have been branded as Schedule 1 drugs by the Food and Drug Administration, meaning the FDA considers them devoid of therapeutic benefit. As such, they have been almost impossible to study.

That is now starting to change, and the sooner, the better.

I believe, although with scant evidence, that psychedelics will become an important part of treatment for medical illness in the future. I am guardedly optimistic many people with severe PTSD and mood disorders will benefit from use of microdosed psychedelics to enhance counseling therapy.

It may be that microdosing psychedelics will benefit only a small segment of those with mental illnesses, or that they may have surprisingly broad application.

I will let the researchers probe those important questions. As I said at the beginning, we desperately need more high-quality studies.

Some enthusiasts think psychedelics will spell the end of depression, ADHD, anxiety, personality disorders, even hair loss.

I seriously doubt that. If these drugs are like almost every other therapy in medicine, they will work great for some, just OK for many, not at all for quite a few.

Some people won't be able to tolerate them. And no one will have hair magically growing back.

The government should continue to relax restrictions on studying these agents, and should fund studies to move our understanding forward. Lives are on the line with severe mental illness.

We need new, better therapies, and these drugs are already within our reach. It’s time we found out what they might be capable of.