Friday, August 19, 2016

Should Getting High be a Possible Treatment for Depression?

By Maria Paula Martinez

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

Maria Paula Martinez is a student of a joint degree program majoring in Neuroscience and Behavioral Biology at Emory University and Biomedical Engineering at Georgia Institute of Technology. She is 20 years old and originally from Bogota, Colombia.

What if instead of the traditional and usually ineffective serotonin-reuptake inhibitors (SSRIs) used to treat depression, we could provide patients with a drug that directly mimics the effects of serotonin, the “happiness neurotransmitter”? Not only have such compounds been around for over a millennium, but they are the active ingredients in psychedelic drugs such as magic mushrooms. A scientific paper released in The Lancet Psychiatry this past May opened the possibility for compounds like psilocybin, the active ingredient of “shrooms”, to potentially treat depression. A group of researchers in the Imperial College of London were able to give psilocybin to 12 patients with depression who had unsuccessfully tried at least two different treatment types and had suffered from depression for an average of 17.8 years. The results of this preliminary study were astonishing. Not only did all patients show significant improvements after a single week of treatment, but the remission rate was double that of patients given SSRIs in a three-month treatment period (Cormier, 2016). Even though these are only preliminary results, it seems there is little control over how the media decides to portray these results, and what is likely to happen when these news articles reach the hands of patients with depression is not promising. “Magic-mushroom drug lifts depression in first human trial” and “How Magic Mushrooms Could Treat Depression” are only two of the titles of the news articles about this study. Both in prestigious journals, Nature News and Time, respectively, they portray an erroneous view of how this hallucinogen can be used as a treatment for depression and make the line between illicit drug and therapy a blur.

Psilocybin is a psychedelic drug of abuse that causes hallucinations and reduces inhibition (Park, 2016). Even though psilocybin itself does not cause physical dependence, the tolerance level of the drug can increase rapidly and withdrawal symptoms are observed when its use is stopped. According to the US Department of Justice, psilocybin is illegal because of the potential for negative physical and psychological effects under its use. Aside from producing hallucinations and impairing the ability to discern reality from fantasy, panic reactions and psychosis may also result from its consumption (Baumeister et al. 2014). The most common side effects include anxiety, paranoia, depersonalization and “bad trips,” but these vary based on personal predispositions (Tyl et al. 2014).

Psilocybe mexicana, image courtesy of Wikipedia.
In the Lancet study, researchers used a very controlled environment to ensure the safety of the patients. All of the subjects received two doses of psilocybin, 7 days apart from each other, in a dark room with psychological support present. Support was also provided before and after each session and patients were assessed periodically up to 3 months after the treatment to ensure that no psychotic symptoms developed (Carhart-Harris et al., 2016). The authors of the study claim that there is much to consider before psilocybin becomes a viable treatment option, but the results do suggest that psilocybin could be a possible treatment in the future (Cormier, 2016). However, if you had a condition that compromised your quality of life dramatically—to the point that you consider ending your own life— wouldn’t you take the risk of self-medicating with psilocybin, even if it is illegal?

The problem with research on such controversial topics is that it will reach most of its audience through a media that tends to misinform people and give them a false sense of hope. People suffering from depression who, based on studies like this, decide to use “shrooms” for the purpose of getting better could be at risk. One could argue, like the authors of the study do, that serotonin receptor agonists like psilocybin do not have the negative psychological effects that were previously thought. After all, recent studies have shown that this compound helps stabilize hyperactivity in the medial frontal cortex, which is directly associated with depression (Carhart-Harris et al., 2012); reduces anxiety (Gasser et al., 2014); lessens depressive and obsessive compulsive symptoms (Ballenger et al., 2008); and reduces addictive behaviors in tobacco users (Johnson et al., 2014). All of this evidence suggests that the label, rather than the effects, is what makes this drug illegal, but such conclusions were drawn from studies like the recently published Lancet study that were conducted in safe and controlled environments. This would not be the case if a patient with depression decided to self-administer psilocybin as treatment to improve her mood. Due to the perceptual alterations and heightening of emotions associated with the drug, dangerous behaviors could occur when not taken in a safe and controlled environment (Johnson, Richards and Griffiths, 2008). However, this is not what people have access to through the media displays of the results. With results portrayed as so promising, what prevents the rest of the population from starting to self-medicate to treatment their depression or perhaps to enhance their mood?

Psilocybin experience session. Image courtesy of Wikipedia
In the USA, psilocybin is classified as a Class I drug, along with MDMA and heroin, due to the potential for its abuse and the fact that it has no current acceptable medical use (Nutt, King and Nichols, 2013). The risks associated with the use of psilocybin are especially threatening for patients with depression who might have less predictable responses to psilocybin (Tyl et al. 2014). For a healthy individual, the worse that is likely to happen if they are found possessing psilocybin is imprisonment, but in the case of patients with depression who have an increased susceptibility for “bad trips,” the lack of control with which they could potentially ingest this drug could lead to worsening of their conditions and even self-inflicted harm (Amsterdam, Opperhuizen and Brink, 2011). The use of psilocybin and other hallucinogenic compounds might have a bright future as a treatment for depression, but the time period between the release of the preliminary results and the actual development of a viable treatment that is accompanied by suitable regulations will likely be long.

In the meantime, as psilocybin is promoted through the media as a therapeutic approach for depression, it may become more socially acceptable to use this drug, thus obscuring the reasons why it was made illicit to begin with. These reasons include, but are not limited to, the safety concerns around psilocybin’s use. Marijuana’s transition into becoming a legal drug started with its medical use and the stigma surrounding the drug decreased to the point where not only did people not see it as “bad”, but its use is becoming more and more legal for recreational purposes and its consumption is increasing (Cerdá et al. 2012). The question becomes: do we want psilocybin to follow in this path when we do not fully understand the long-term consequences the hallucinogen will have for both patients with depression and for healthy individuals?

As humans, we have a tendency of bending scientific results to align with our existing beliefs and biases. Carhart-Harris, the primary author of the Lancet study, told Time that the experience under the effects of psilocybin is a faster psychotherapeutic approach “that changes the way you feel and think so you feel differently about yourself” (Park, 2016). This is the perfect example of how, through media, the use of psilocybin seems like an experience that we should all have; we might not all suffer from depression, but we surely do have personal issues that might benefit from one or multiple of these “sessions”. The main problem with this study is not the research itself, but the fact that its overly positive portrayal might persuade people to use hallucinogens for its possible antidepressant effects regardless of whether one is diagnosed with clinical depression or warranting a prescription for antidepressant drugs.

Psilocybin may not be as harmful of a drug as others in the same controlled substance category, but this does not mean that there are no risks associated with its use. We must think carefully about how to discuss, research, and translate the use of psilocybin from the bench to the real world.

References

Amsterdam, J. V., Opperhuizen, A., & Brink, W. V. (2011). Harm potential of magic
mushroom use: A review. Regulatory Toxicology and Pharmacology, 59(3), 423
429. doi:10.1016/j.yrtph.2011.01.006

Ballenger, J. (2008). Safety, Tolerability, and Efficacy of psilocybin in 9 Patients With
Obsessive-Compulsive Disorder. Yearbook of Psychiatry and Applied Mental
Health, 2008, 242-243. doi:10.1016/s0084-3970(08)70820-x

Baumeister, D., Barnes, G., Giaroli, G., & Tracy, D. (2014). Classical hallucinogens as
antidepressants? A review of pharmacodynamics and putative clinical roles.
Therapeutic Advances in Psychopharmacology, 4(4), 156-169.
doi:10.1177/2045125314527985

Carhart-Harris, R. L., Erritzoe, D., Williams, T., Stone, J. M., Reed, L. J., Colasanti, A., .
. . Nutt, D. J. (2012). Neural correlates of the psychedelic state as determined by
fMRI studies with psilocybin. Proceedings of the National Academy of Sciences,
109(6), 2138-2143. doi:10.1073/pnas.1119598109

Cerdá, M., Wall, M., Keyes, K. M., Galea, S., & Hasin, D. (2012). Medical marijuana
laws in 50 states: Investigating the relationship between state legalization of
medical marijuana and marijuana use, abuse and dependence. Drug and Alcohol
Dependence, 120(1-3), 22-27. doi:10.1016/j.drugalcdep.2011.06.011

Cormier, Z. (2016, May 17). Magic-mushroom drug lifts depression in first human trial.
Nature News. Retrieved June 11, 2016, from http://www.nature.com/news/magic
mushroom-drug-lifts-depression-in-first-human-trial
1.19919?WT.mc_id=FBK_NA_1605_NEWSMAGICMUSHROOMDEPRESSION
PORTFOLIO

Gasser, P., Holstein, D., Michel, Y., Doblin, R., Yazar-Klosinski, B., Passie, T., &
Brenneisen, R. (2014). Safety and Efficacy of Lysergic Acid Diethylamide
Assisted Psychotherapy for Anxiety Associated With Life-threatening Diseases. The Journal of Nervous and Mental Disease, 202(7), 513-520. doi:10.1097/nmd.0000000000000113

Hendricks, P. S., Thorne, C. B., Clark, C. B., Coombs, D. W., & Johnson, M. W. (2015).
Classic psychedelic use is associated with reduced psychological distress and
suicidality in the United States adult population. Journal of Psychopharmacology,
29(3), 280-288. doi:10.1177/0269881114565653

Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot
study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction.
Journal of Psychopharmacology, 28(11), 983-992.
doi:10.1177/0269881114548296

Johnson, M., Richards, W., & Griffiths, R. (2008). Human hallucinogen research:
Guidelines for safety. Journal of Psychopharmacology, 22(6), 603-620.
doi:10.1177/0269881108093587

Nutt, D. J., King, L. A., & Nichols, D. E. (2013). Effects of Schedule I drug laws on
neuroscience research and treatment innovation. Nature Reviews Neuroscience
Nat Rev Neurosci, 14(8), 577-585. doi:10.1038/nrn3530

Park, A. (2016, May 17). How Magic Mushrooms Could Treat Depression. Time.
Retrieved June 11, 2016, from http://time.com/4338947/magic-mushrooms-for

Roubicek, J., & Drvota, S. (1960). Psilocybin, nové fantastikum.?eskoslovenská Psychiatrie, 56, 44-55.

Tyl, F., Páleníek, T., & Horáek, J. (2014). psilocybin – Summary of knowledge and
new perspectives. European Neuropsychopharmacology, 24(3), 342-356.
doi:10.1016/j.euroneuro.2013.12.006

Want to cite this post?
Martinez, Maria Paula. (2016). Should Getting High be a Possible Treatment for Depression? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/should-getting-high-be-possible.html

1 comment:

David said...

How would someone volunteer to be part of clinical trials for psilocybin?