Psychiatry & the psychedelic drugs. Past, present & future

Abstract

a b s t r a c tThe classical psychedelic drugs, including psilocybin, lysergic acid diethylamide and mescaline, were used extensively in psychiatry before they were placed in Schedule I of the UN Convention on Drugs in 1967. Experimentation and clinical trials undertaken prior to legal sanction suggest that they are not helpful for those with established psychotic disorders and should be avoided in those liable to develop them. However, those with so-called 'psychoneurotic' disorders sometimes benefited considerably from their tendency to 'loosen' otherwise fixed, maladaptive patterns of cognition and behaviour, particularly when given in a supportive, therapeutic setting. Pre-prohibition studies in this area were sub-optimal, although a recent systematic review in unipolar mood disorder and a meta-analysis in alcoholism have both suggested efficacy. The incidence of serious adverse events appears to be low. Since 2006, there have been several pilot trials and randomised controlled trials using psychedelics (mostly psilocybin) in various non-psychotic psychiatric disorders. These have provided encouraging results that provide initial evidence of safety and efficacy, however the regulatory and legal hurdles to licensing psychedelics as medicines are formidable. This paper summarises clinical trials using psychedelics pre and post prohibition, discusses the methodological challenges of performing good quality trials in this area and considers a strategic approach to the legal and regulatory barriers to licensing psychedelics as a treatment in mainstream psychiatry.

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

“…Especially in the latter patient group, this may shift the risk-benefit ratio against psychedelic interventions. In line with this, pre-prohibition clinical studies, which tested psychedelics for mental disorders across the board, found positive results mostly in (then so-called) "psychoneurotic" disorders (105).…”

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

“…For example, high doses of Selective Serotonin Reuptake Inhibitors (SSRIs), exposure, and response treatment are effective for people in the later stages of OCD [132], which has also been recently conceptualized within a staging framework [133]. In addition, there is interest in pharmacological approaches that are being used for treatment-resistant depression, such as ketamine and psilocybin [134]. Interestingly, ketamine showed some promise in a small series of studies in the 1990s [135].…”

Psilocybin occasioned mystical‐type experiences

“…In the long‐term, in order for psilocybin treatment to become established practice, rescheduling from Schedule I needs to be achieved and specific training for psychedelic therapy must be developed, standardised and licensed to maintain patient safety and efficacy of treatment (Carhart‐Harris et al, 2018b; Rucker, Iliff, & Nutt, 2018). Despite the growing awareness of their potential therapeutic capabilities many regulatory authorities continue to consider these compounds to be controversial (Nutt, 2014).…”