When it comes to the future of treating mental health, there’s one question that’s sparked the attention of many medical professionals – do psychedelic treatments for depression work?
Mental ill health is the single largest cause of disability in the UK, and depression has been estimated to cost the NHS and the wider economy more than £7 billion every year. In any given week, around eight in every hundred people will be suffering from anxiety and/or depression, and, while the severity can vary, severe depression can be extremely debilitating.
It’s in everyone’s interest to work on effective treatments for depression, and psychedelics is one very promising area of research. Kate Bingham, who chaired UK’s Covid vaccine taskforce, recently called the use of psychedelics to treat depression an “area of real excitement”. A group of psychiatrists and mental health charities have also written to the government calling for a change in legislation regarding psilocybin – the active compound in magic mushrooms.
But what do we know about psychedelic therapy, and do psychedelic treatments for depression work? Keep reading to find out more.
Psychedelics Therapy and Treatment
Psychedelics are a class of psychoactive substances or drugs that produce changes in perception, mood and thought. They can affect the senses, emotions and cognitive processes and can also cause hallucinations. The effect of taking psychedelics is generally referred to as a trip. Frequently used psychedelics include psilocybin (the active ingredient in magic mushrooms), lysergic acid diethylamide (commonly known as LSD or acid) and mescaline. MDMA (ecstasy) produces both a stimulant and a psychedelic effect.
Psychedelics are controlled substances, meaning they cannot be legally used for recreational purposes in the UK. Over recent years, however, research has suggested that some psychedelics – particularly psilocybin but also MDMA – have been used as a treatment option for depression and post-traumatic stress disorder (PTSD). Results have been promising in cases of severe depression in which traditional treatments, such as cognitive behavioural therapy or antidepressants, have not proven effective.
So, how do psychedelics work? Well, the answer isn’t so straightforward. Not yet, anyway. Scientists still don’t fully understand how these drugs affect the brain, but it’s believed that ‘classic’ psychedelics like psilocybin and LSD work by binding to the serotonin 2a receptor – one of a number of receptor molecules the serotonin system uses to coordinate brain activity. While MDMA also seems to affect the serotonin system, there are a number of other neurotransmitters and hormones involved.
In terms of psychedelic treatment for depression, it is currently believed that psychedelics can help by encouraging the growth of new connections between neurons in the brain – a process or ability known as plasticity. It’s not currently known exactly how this works in mechanical terms, but it could involve binding to a particular receptor in the brain known as 5-HT2AR.
Current Research in Psychedelic Treatment for Depression
LSD was first synthesised in 1938 by Swiss pharmacist Albert Hoffman. Over the next couple of decades, the drug was the subject of more than a thousand articles in scientific and medical publications as its potential benefits and applications were explored. Early studies found that it had some success in treating alcohol addiction, as well as treating trauma, when combined with psychotherapy. It also had the potential for abuse, however, and could also trigger some mental health conditions, especially when used in a less controlled manner. By the 1960s, research came crashing to a halt as the drug was increasingly associated with the ‘counterculture’ and criminalised.
It is only relatively recently that research has resumed into the potential of psychedelic-assisted psychotherapy and other techniques. In Australia, psychiatrists are now able to prescribe MDMA for post-traumatic stress disorder (PTSD) and psilocybin for depression which has proven resistant to other treatments.
In the UK, however, these substances currently have a Schedule 1 classification – more restrictive than drugs such as cocaine and heroin, as the psychedelics are not officially considered to have medical applications. This makes producing and using the substances for research complicated and expensive.
David Nutt, professor of neuropsychopharmacology at Imperial College London, told Chemistry World: “In 2014, my group published the first study of psilocybin for treatment-resistant depression – it was a revolutionary treatment [but] we’ve been hardly able to do any research since because it’s been very difficult and very expensive.”
There have been a number of studies undertaken in the UK and internationally over the past 20 or so years, however. One such major trial, headed by researchers from the UK and carried out with 233 people from 10 countries in Europe and North America, delivered different doses of psilocybin to people who had mostly been severely depressed for over a year. With one 25mg dose and psychotherapy, one in three was no longer diagnosed as depressed at three weeks, and one in five saw a significant improvement at 12 weeks.
Potential Benefits of Psychedelic Therapy for Depression
Psychedelic drugs’ therapeutic benefits are still very much open to question, but more and more evidence is being built up. Another recent study by Johns Hopkins Medicine researchers in the US found that psilocybin-assisted therapy (when provided in a carefully controlled manner with supportive psychotherapy) could relieve major depressive disorder symptoms in adults for up to a year.
While the mechanics behind these improvements are not fully understood, it comes back again to plasticity and restoring connections in the brain. Connectivity between the brain’s various networks is typically reduced in people with severe depression. Another study – this one a double-blind, randomised controlled trial that compared the effect of psilocybin with the existing antidepressant drug escitalopram – used brain scans and found that connections had improved in those patients given psilocybin.
So, Do Psychedelic Treatments for Depression Work?
There is still a lot more research to be done, but a number of studies do seem to show that the controlled use of psychedelic drugs for depression can have a positive effect on some people. Psychedelics are, however, still strictly regulated in the UK. Trials are sometimes carried out, but the routine availability of any type of psychedelic-assisted therapy appears to be some way off yet.