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    433. How Are Psychedelics and Other Party Drugs Changing Psychiatry?

    en-usOctober 01, 2020

    Podcast Summary

    • The Resurgence of Psychedelic Drugs in MedicinePsychedelic drugs, once considered wonder drugs for treating mental illnesses, were banned due to government regulation. However, due to shifts in cultural attitudes and public policy, researchers are once again studying these drugs for potential treatments for maladies like depression, addiction, and PTSD.

      Psychedelic drugs have been used for centuries for various purposes, including medicinal, religious, social, and recreational. The first synthetic hallucinogenic molecule, LSD, was discovered in 1938 and was considered a wonder drug that could treat mental illness. However, the U.S. government's war on drugs effectively killed off research on psychedelic drugs, causing widespread collateral damage in treatments undiscovered and scientific knowledge unattained. But things are changing, as cultural attitudes have shifted, public policy has started to move, and scientists are once again looking at these drugs for new mental illness, addiction, PTSD, and other malady treatments. Three medical researchers from the Mount Sinai Health System are at the forefront of this work. James Murrough, the director of a clinical research program focused on finding causes and treatments for depression, is among them, and he has been studying ketamine's rapid antidepressant effects for over 10 years.

    • The Dual Uses of Ketamine and MDMAAlthough Ketamine and MDMA are known as party drugs, they also have potential therapeutic benefits. Ketamine is the only dissociative anesthetic approved by the FDA, while MDMA is being researched as a possible therapy for PTSD.

      Ketamine was synthesized and approved as an anesthetic, but it is also popular as a party drug. It causes a unique altered state of mind and is the only 'dissociative anesthetic' approved by the FDA. MDMA is known for recreational use, but it is being researched as a possible therapy for PTSD, and the Multidisciplinary Association for Psychedelic Studies is largely responsible for its progress. Yasmin Hurd directs the Addiction Institute at Mount Sinai, which treats over 6,000 people with opiate-use disorder.

    • Alternative Approaches to Substance Use and Mental HealthWhile early cannabis use may increase the risk of substance-use and psychiatric disorders later in life, researchers are exploring alternative cannabinoids and substances such as CBD and ketamine for potential therapeutic benefits.

      Early cannabis use is strongly linked to an increased risk of developing substance-use and certain psychiatric disorders later in life, as confirmed by neurobiological studies on animal models. However, researchers have found an alternative cannabinoid, cannabidiol (CBD), which has been shown to reduce heroin-seeking behavior in rat models and is being tested in human subjects. Another key substance, ketamine, acts uniquely as an antidepressant by interfering with signaling in a specific receptor in the brain important for learning and memory. It appears to help brain circuits adapt to the environment, disrupting consciousness at high doses, making it useful as an anesthetic.

    • Using Ketamine for Treating DepressionKetamine, and its derivative esketamine, can provide temporary relief from depression for those who do not respond to traditional methods. However, it should only be administered under medical supervision and its effects are not permanent.

      Ketamine, a powerful anesthetic drug, can temporarily alter consciousness and lift depression at low doses. While it doesn't induce sleep, it triggers a disconnection state. A ketamine-derived drug called esketamine has been approved as an antidepressant and affects the glutamate system rather than serotonin like other antidepressants. The population for whom this drug is most successful are those with treatment-resistant depression, who don't respond to psychotherapy or conventional antidepressants. The drug is administered medicinally twice a week without psychotherapy attached. The effects of the drug are temporary and last a few days to a week.

    • MDMA in Psychotherapy: A Promising Alternative to Traditional Mental Health MedicineMDMA in psychotherapy is being studied as a potential way to increase empathy, connectedness, and prosocial behavior. Unlike traditional medications, it aims to put patients in a specific state to catalyze a therapeutic process and process traumatic memories.

      While traditional medicine for mental health is often trial-and-error, the use of MDMA in psychotherapy shows promise to increase empathy, connectedness, and prosocial behavior. MDMA was initially synthesized for a different purpose and was used clinically before it became illegal. Unlike ketamine, the treatment with MDMA aims to put patients in a specific state to catalyze a therapeutic process and process traumatic memories. The use of psychedelics is compared to telescopes and microscopes, allowing patients to see their minds in a new way and catalyzing self-discovery.

    • MDMA-assisted Psychotherapy for Treating PTSDMDMA-assisted psychotherapy provides a safe and supportive environment for trauma survivors to process their experiences. This therapy is a process and not a quick fix, with preparation sessions, an eight-hour uninterrupted session, and integration sessions to give patients a tool to see and address their trauma.

      MDMA-assisted psychotherapy offers trauma survivors with PTSD an opportunity to process their traumatic experiences in a safe and supportive environment. With an eight-hour uninterrupted session, the patient has more time to reflect and is not rushed out when they're getting to the good stuff. This therapy is not a quick fix, and two co-therapists are present throughout three preparation sessions, the eight-hour MDMA session, and three integration sessions. By allowing the patient to have a tool to really see things that are there but aren't obvious or cannot be looked at in any other way, MDMA therapy offers something necessary to treat PTSD. Rachel Yehuda, a scholar and researcher on PTSD, has received FDA approval to study the potential uses of MDMA to treat other maladies.

    • MDMA and CBD in PsychotherapyMDMA can help treat PTSD and has potential for other conditions, while CBD shows promising results in reducing anxiety, psychosis, and addiction cravings. THC levels have been selectively bred to increase.

      MDMA-assisted psychotherapy has been designated breakthrough treatment for PTSD, but it has potential to foster psychotherapy for almost any condition. THC, the cannabinoid inducing high, has been selectively bred to increase concentrations, while CBD, the non-psychoactive cannabidiol, has decreased in concentration. CBD shows promising effects in reducing anxiety, psychosis and cravings, especially in our first clinical studies on addiction.

    • CBD as a Non-Addictive Therapy for AddictionCBD shows promising results in reducing craving and anxiety in heroin-use disorder patients. It can offer a new therapy for addiction without the risks of addiction posed by traditional treatments like Buprenorphine and Methadone. Additionally, researchers are exploring the clinical uses of recreational drugs like ketamine and MDMA to treat severe depression and PTSD.

      CBD has shown promising results in reducing cue-induced craving and anxiety in people with heroin-use disorder, offering a non-addictive new therapy for addiction. While substances like Buprenorphine and Methadone have saved millions of lives, they come with their own set of problems and need to be monitored carefully. Researchers like James Murrough, Rachel Yehuda, and Yasmin Hurd are exploring clinical uses of drugs that have long been associated with recreational use, such as ketamine and MDMA, to treat severe depression and PTSD. Despite skepticism surrounding the use of ketamine, it offers a unique alternative to traditional antidepressants that take weeks or months to work.

    • The Potential Therapeutic Benefits and Risks of Psychedelic DrugsWhile multiple doses of ketamine have shown promise in treating depression, recreational use at high doses can lead to significant problems. As we consider the approval and use of MDMA and other psychedelic drugs, caution and consideration for potential risks and benefits are necessary.

      Despite initial skepticism, multiple doses of ketamine were found to be effective in treating depression in controlled settings and have paved the way for continued research into the potential therapeutic benefits of psychedelic drugs. However, it's important to remember that dose matters and recreationally using these drugs at high doses can lead to significant problems. When considering the potential approval and use of drugs like MDMA, we must learn from our complicated history with drugs that are both allowed and disallowed and approach with caution and consideration for the potential risks and benefits.

    • Psychedelics for Healing PTSD: Understanding Set and SettingPsychedelic drugs like MDMA can be effective in treating PTSD but must be used with proper guidance in a therapeutic setting. Understanding the intention and environment of consumption is crucial for its healing benefits. Proper regulation and distinguishing from dangerous compounds is necessary. Recreational use poses potential harm.

      Psychedelic drugs like MDMA can be safe and effective in healing PTSD if used with the proper guidance and in a therapeutic setting. The reason for exploring these treatments is because current treatments for PTSD do not always provide long-term relief. Understanding the 'set and setting' of psychedelic use, or the intention and environment in which it's consumed, is crucial in ensuring its healing benefits. While all drugs, including psychedelics, can be abused, proper regulation and guidance can limit potential harm. It's important to distinguish psychedelic drugs from highly dangerous compounds like cocaine and opioids. Recreational use of psychedelics also carries potential danger as unregulated substances could be mixed with harmful compounds.

    • The Importance of Proper Regulation and Scientific Collaboration in Providing Safe ProductsRegulations and scientific collaboration are important in ensuring safe and reliable products for consumers. The rapid pace of research should not compromise safety, and legal channels should be followed to ensure proper regulation.

      Regulation can often be a positive tool in protecting citizens and minimizing adverse events, as seen with the proposed legalization of MDMA. However, it is essential to work with scientists and ensure that products are safe, as seen with the widespread availability of CBD, which may contain harmful elements. Rapid acceleration in research, such as in the search for a Covid vaccine, may lead to a change in the mindset of speed of approval. Overall, proper regulation through legal channels and science-based information is crucial to provide people with safe and reliable options.

    • The Pros and Cons of Ketamine and MDMA as Therapeutic DrugsKetamine and MDMA are potential alternatives to traditional antidepressants and PTSD treatments. However, ketamine has addictive properties and questions surrounding its long term effects, while MDMA is only used for patients with no other options. Continuation of medication is important for optimal treatment.

      Ketamine, a recently approved antidepressant drug has raised questions due to its addictive nature and long term effects. The drug was often administered at so-called ketamine clinics run by psychiatrists and anesthesiologists. Even though it was fast-tracked, evidence suggests that ketamine does work as an alternative to traditional antidepressants. Patients are often curious about the duration of this treatment and how long they will have to take the medication. Similar to traditional antidepressants, studies suggest that if a patient responds to the medication and then stops, their risk of relapse is higher than if they stay on the medication. MDMA, on the other hand, is a medically-aided therapeutic drug that is used to treat PTSD for patients with no other options.

    • Exploring the Potential of Psychedelics and Cannabis for Psychological HealingMDMA and cannabis may aid in psychological healing, but careful consideration and screening is necessary for those interested. Medicine should focus on understanding the root of symptoms rather than simply treating them. Addressing barriers and fears of diverse populations is crucial.

      The use of MDMA or other psychedelics is proposed as a breakthrough to overcome recurring blockages in psychological processes, with the ability to make progress up to the individual. However, careful screening and consideration of contraindications are necessary for participants in the studies. In terms of efficacy to alleviate PTSD symptoms, cannabis has shown to help cope with the day-to-day, but not necessarily a cure. It's important to re-examine medication approaches in psychiatry to understand the root of symptoms, instead of just reducing them. MDMA experiences can bring both connections and difficulties, and it's crucial to address the barriers, expectations, and fears of diverse and underrepresented populations who might benefit from these treatments.

    • Ongoing Research on the Benefits of CBD and the Developing Interest in Glutamate-targeting DrugsCBD may have long-lasting effects and doesn't need to be taken daily. Research is also underway for drugs targeting the glutamate system to treat severe depression while minimizing unwanted side effects.

      Research on the use of CBD for treating addiction, anxiety and psychosis is ongoing, with large-scale phase II studies underway to determine the appropriate dosage and duration of treatment. CBD has shown long-lasting effects even after weeks of administration, meaning that it need not be taken daily. Meanwhile, the approval of ketamine for depression has spurred interest in developing drugs that target the glutamate system for rapid therapeutic effects without addictive potential or unwanted side effects. Current research aims to develop new treatments for severe depression and suicidality while minimizing the acute confusion, sedation, and dissociation that accompanies ketamine administration.

    • Ketamine and CBD as Potential Treatments for Depression and Various DisordersKetamine may provide short-term relief for treatment-resistant depression, while also having potential in psychotherapy for trauma recovery. CBD is being studied for a variety of disorders, including anxiety, pain, and Parkinson's disease.

      Ketamine, while initially numbing out the patient, has been found to have a significant positive effect on depression, with the largest effect occurring around 72 hours post-treatment. The drug's short half-life means that it is no longer in the body by the time the patient's mood is measured, making it an effective treatment for treatment-resistant depression. Ketamine may even have potential in ketamine-assisted psychotherapy, allowing patients to recover traumatic memories and potentially extending the time between infusions by dealing with the psychological processes driving the depression. Furthermore, CBD is being studied for a wide range of disorders, including schizophrenia, anxiety, pain, inflammation, and even Parkinson's disease.

    • Experts discuss the potential benefits and drawbacks of CBD and MDMA for mental health, and their use under clinical conditions.While promising, caution is advised when using CBD and MDMA outside of clinical settings. Further research is needed to determine their efficacy in treating mental health issues during the pandemic. Successful treatment can lead to greater self-awareness and healthier relationships.

      CBD has medicinal potential but overuse and off-label usage can minimize its potential benefits under strict clinical conditions. Research needs to be conducted on how past MDMA trials could benefit mental health during the COVID-19 pandemic. Successful treatment helps individuals approach future events with compassion and understanding, leading to improved relationships and self-awareness. These topics were discussed by experts Rachel Yehuda, Yasmin Hurd, and James Murrough on a recent live Zoom event in collaboration with WNYC and The Greene Space.

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