There is a change happening for how certain drugs are seen in the United States. Over the last 20 years, nearly half of all states have made recreational marijuana legal. More people are showing their support for making other substances legal such as psychedelics or hallucinogens for mental health.
Research is underway to determine if some substances with hallucinogenic properties might have benefits for patients undergoing mental health treatment.
Neil Harjai, DO, PY3, is a psychiatrist at Genesee Mental Health Center and provides insight into some of the research happening around hallucinogens and mental health treatment.
Hallucinogens are substances developed from plants or fungi or created synthetically – both of which contain ingredients that can affect our moods and senses in different ways. When consumed, these drugs can cause hallucinations – experiences with sound, touch, sight, and smell that are caused without external influence.
Until the late 1990s, scientific studies into how hallucinogens affect conditions like anxiety and depression was stopped due to social stigma and laws like the United States Controlled Substances Act. However, changing attitudes on drugs and other substances led researchers to gradually resume studying hallucinogens and their effects over the last two decades.
Currently the primary substances being studied are:
“These are listed as currently Schedule I controlled substances,” Dr. Harjai said. “Only in very specific circumstances are researchers getting permission to move these studies along.”
With all of the studies being done, scientists are concentrating on how the substances can be used together with psychotherapy – not simply using the substances in an uncontrolled setting.
“These substances, while most are relatively non-addictive, do carry a risk of psychological distress,” Dr. Harjai said. “People may engage in reckless behavior, meaning any use of hallucinogens should be done in a pre-determined supervised setting.”
Most of the research currently underway focuses on how these substances affect people who are living with depression, social anxiety, bipolar disorder, and post-traumatic stress disorder (PTSD).
These studies typically follow four stages:
Assessment: Confirming a patient’s diagnosis (anxiety, PTSD, etc.) to rule out certain health conditions that may not be treatable using hallucinogens
Preparation: Discussing which substances will be used and any potential psychological discomfort a patient might experience
Experience: Using the substance in a controlled setting with a trained guide who verbally engages with the patient as needed
Integration: Talking with the patient and trained guide to discuss the experience after the effects of the drug wear off
MDMA is used to boost levels of neurotransmitters (dopamine, norepinephrine, epinephrine, dopamine) in the brain. After those levels increase, the patient’s brain is able to confront issues linked to their mental health disorder and help change their behavior.
Psilocybin unlocks similar means of increasing the release of neurotransmitters in a patient’s brain to help them better deal with symptoms of depression or PTSD.
Ketamine affects the glutamate system – which helps to regulate communication, learning, and memory in the brain. Studies are showing evidence that ketamine providing an increase in glutamate can help areas of the brain communicate more broadly, which might shed some light on how the drug can help reduce symptoms of depression.
“The focus of most research at this time appears to be focusing on how we can best use these substances to treat patients with specific mental health conditions – but only together with psychotherapy,” Dr. Harjai said.
As research with hallucinogens and mental health treatment moves forward, the scientific community seems hopeful that the results of these studies can be used to better treat people.
Most of the medications used to treat depression were created decades ago, so studying substances such as ketamine and MDMA could unlock the potential for new types of treatment. With depression being one of the most common mental health conditions in the U.S., doing more research to help patients in new ways is important.
As these treatments are studied, safeguards will need to be developed to prevent substances from being misused. Providers will need to learn best practices for treating patients and securing the substances when they are not in use.
“Over the next 10-20 years, substances such as psilocybin and MDMA could be more mainstream as treatment options than they are now,” Dr. Harjai said. “With these potential changes, we are hopeful that the stigma linked to mental health will continue to be reduced.”
