If you have any interest in new treatments for mental health conditions, you cannot escape being bombarded by the hype around psychedelic medicines. Until recently, this class of compounds were shunned by the medical community as dangerous, unpredictable, and abusable. Psychedelics include psilocybin/major mushrooms, LSD, MDMA, ayawaska, ibogaine, DMT, and even cannabis derivatives. Now they are being promoted as the soon -to -come, cure-all for just about everything. You probably think, based on the title of this blog, that I am going to be critical of these cutting edge potential therapies. Maybe I have some new information about their safety or effectiveness to report? Or perhaps I’m one of those old school psychiatrists/researchers pushing back on the inevitable psychedelic revolution that will soon be at our clinic’s doorstep? The reality is none of the above. I have concerns and cautions but they aren’t what you might think.
As a psychiatrist who has been an early advocate and prescriber of ketamine for treatment resistant mood and anxiety disorders, I plan to be at the forefront of administering these therapies when they are available. I have seen the life changing effects of ketamine first hand for my long suffering patients. Our research program is actively involved in the development of a number of these psychedelic medications.
So what are the concerns and cautions? It is around the message being communicated about what benefits psychedelics will deliver. Unfortunately, it is a similar message, the pharmaceutical companies send regarding traditional antidepressants. That a pill will fix your problems. The pharmaceutical industry tells us that a pill will make your depression go away. That treating mood and anxiety disorders is a passive process that swallowing their medicine will solve. In reality, antidepressants (or psychedelics when available) are, or will be, just one component-a very important component- of what is needed to truly overcome mental health disorders.
What antidepressants, or in this case psychedelics, can do is to give someone with debilitating depression or anxiety the ability to do the things they need to do that will truly make them better. This may be engaging in therapy/counseling, reconnecting in relationships, getting back to work or school, exercising, eating properly, stopping self medication with drugs and alcohol, and the list goes on.
I worry that those suffering from depression and anxiety and have not responded to traditional therapies will see psychedelics making everything better without the burden of personal responsibility or including having to make the hard lifestyle changes needed. In fact,one of the unique attributes of psychedelic medicines is that the dissociative or hallucinogenic experience that comes along with them can give patients a unique insight into their psychic roadblocks and come up with possible solutions.
So let's continue to study psychedelic medicines and learn for whom they can help, for what conditions, and make sure they are safe both in the short and long term. But let’s reinforce that treating mental health conditions involves a holistic approach in which medicines, or psychedelics, are one piece along with the personal work that comes along with it. In other words, ask not what psychedelic medicine can do for you but what you can do with your psychedelic medicine.