GDS2019: Would you take a trip to help heal your mind? Psychedelics in psychiatry

Professor Adam R Winstock, Dr Rupert McShane, Dr Ben Sessa & Associate Professor Matt Johnson

Between us we’ve been practicing psychiatry and psychology for over 75 years. We’ve prescribed and overseen research administering mountains of pills, capsule and liquids to thousands of people. Sometimes we know it’s a placebo or a prescription to address our own incompetence, other times we genuinely believe they might make a difference.

For some people the subtle rebalancing of brain chemicals can help an individual pull back the curtains that drape their mood in darkness. For some, the glimmer of light might allow them to see what lies outside and that they can start to feel brighter and reconnect with a different self. Antidepressants help maybe 6-7 out of every 10 people who have been appropriately prescribed them.

But for many they don’t work, or they don’t do enough. When they don’t work it’s often due to an incorrect diagnosis, inappropriate prescribing, poor compliance or the use of alcohol and other drugs. The trappings of socioeconomic deprivation, marginalisation and stigma among the most vulnerable also limit their potential efficacy in many. Then there’s side effects, withdrawal symptoms, overdose and cost. And there’s also the issue of self-efficacy. By this we mean when antidepressants appear to work, often individuals understand little about how the change has come about and take little ownership over that change. This might explain why relapse rates after stopping antidepressants is higher than for talking therapies where new ways of understanding and thinking can provide longer term strategies to sustain improved mental health.

In summary the tools psychiatrists have at present are limited in their effectiveness and acceptability. Psychiatry has long needed some new tools in its armoury.

Through the work of psychedelic pioneering groups like MAPS and Heffter Research Institute, and respected universities like Johns Hopkins and Imperial Collage, psychiatrists and more importantly their patients, might soon be getting a huge boost – with research indicating potential efficacy of psilocybin, LSD, MDMA and ketamine among others in the treatment of common psychiatric disorders such as depression and PTSD.

While one of us (Adam Winstock) spends his time helping people with serious drug problems and tries to improve their health and reduce the harms associated with their drug use, the other 3 (Rupert McShane, Matt Johnson and Ben Sessa) are currently involved in giving ketamine, psilocybin or MDMA to people with the aim of improving their mental health or their addictive use of other drugs.

So, drugs (‘medicines’) historically demonised by the press and psychiatry and the focus of law enforcement are now being sourced from legitimate providers and being investigated for their potential to heal minds and help people stop using drugs instead of being used by people to get high, with promising results.

GDS was keen to support the work of these clinical trial groups and others around the world. After discussion with an amazing group of active psychedelics researchers we came up with the idea of exploring how acceptable different types of psychedelic therapies might be compared to traditional interventions. To this end we have created a hypothetical scenario that requires participants to indicate how likely it would be that they would accept a range of different psychedelic interventions (each of which is briefly described) and the reasons for such a choice. The options include ceremonial versus medical ayahuasca, high and lower dose interventions with ketamine, LSD and psilocybin as well as MDMA.

To our knowledge this will be the largest study of the acceptability of these new therapies among a large international non-treatment seeking sample. We’ll be able to see what types of treatments are attractive to different groups and explore how a person’s past mental health and drug use history impacts on their choices.

So if you’re interested in helping understand how psychedelics can be part of psychiatry’s future, please share your thoughts and take part in the world’s largest drug survey : GDS2019

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