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Psychedelics Show Promise in the Treatment of PTSD
The Diagnostic Statistic Manual of Psychiatry (DSM) includes the following stressors as trauma that can lead to PTSD:
Exposure to actual or threatened death
Serious injury
Experiencing or witnessing sexual violence
Learning that the event happened to a close family member or friend
Repeated exposure to cruel details of traumatic events
To this list, we can add COVID-19. The pandemic was a large-scale traumatic stressor that severely impacted the mental health of the global population, with an escalation in conditions like depression, anxiety, and PTSD.
How Many People Have PTSD?
The prevalence of PTSD worldwide is about 3.9% of the general population. That is roughly 273 million people worldwide. About 6% of the US population will have PTSD at some point in theirlifetime. In any given year, about 5% of adults in the US have PTSD. In 2020, that meant about 13million Americans had PTSD.
Who Are Most at Risk?
Women, veterans, and first responders are most at risk. About 8 in every 100 women (8%) and 4 inevery 100 men (4%) will have PTSD at some point in their life. Sexual assault is the leading cause of PTSD, which may account for the higher prevalence among women.
Veterans are more likely to develop PTSD than the general population, especially those who hadcombat experience in a war zone.
Individuals such as paramedics, disaster responders, firefighters, and police officers face situations that put them at an elevated risk of experiencing mental health conditions, including PTSD.
The Human Toll of PTSD
PTSD has a significant impact on individuals and society. The condition is strongly associated with suicide, with veterans being 1.5 times more likely to die by suicide than civilians – around 17 veterans die in this manner every day.
People with PTSD often find life very challenging. They struggle with parenting, relationships, and careers. It is also common for those with PTSD to have other mental and physical health issues as well, including depression, anxiety disorders, and addiction. Alcohol and drug abuse is common.
Post-traumatic stress disorder is an oppressive condition that can have a distressing effect on the life of the individual and those around them. Reliable treatment that's effective in the long term is crucial.
Current treatments and their efficacy
The medical profession has traditionally used selective serotonin reuptake inhibitors (SSRIs)sertraline and paroxetine to treat PTSD. However, a large proportion of patients (about 40–60%) do not experience lasting relief from these medications
In addition, other accepted therapies like prolonged exposure therapy and cognitive behavioural therapy have limited success. Many people with PTSD don’t experience relief from these the rapies, so they abandon the treatment.
Due to the poor outcomes of these and other treatments, there is an urgent need to find new compounds and different treatment approaches for PTSD.
The potential of psychedelic-assisted psychotherapy to treat PTSD
A growing body of research evidence is indicating that psychedelic-assisted psychotherapies could be effective for the treatment of PTSD and other mental health conditions, such as treatment-resistant depression, addiction, end-of-life anxiety, and eating disorders.
In line with these developments, the US Food and Drug Administration (FDA) has now granted break through therapy classification for psilocybin for treatment-resistant depression and 3,4-methylenedioxymethamphetamine (MDMA) for PTSD, which means research on these substances will be fast-tracked.
New Therapeutic Approach
Psychedelic-assisted psychotherapies are seen as a radical innovation and paradigm shift in the treatment of mental disorders. The new approach enlists psychedelics like ketamine, MDMA, psilocybin, or LSD taken under supervision as part of a psychotherapy treatment program.
Psychedelic-assisted therapy typically involves three stages. The first step is usually a consultation with the therapist to discuss the patient's condition and goals for the treatment. The consultation serves to prepare the patient for the psychedelic therapy sessions to follow.
The next step is the first psychedelic session when the patient takes the psychedelic substance under professional guidance. Because of the potency and unpredictability of psychedelic substances, the therapist accompanies and guides the patient throughout the experience.
The setting for the sessions is relaxed and aesthetically pleasing, with music the patient chose playing in the background if desired. The patient sits or lies down comfortably in the presence of the therapist. Depending on the psychedelic chosen for the treatment and the treatment plan, there will be at least two sessions or up to twelve sessions.
The therapist provides reassurance throughout the session while the substance is active.Psychedelics are unpredictable. What happens on a trip (the psychedelic-induced experience) varies from person to person and is dependent on the dosage and the emotional state of the patient. This last factor and the environment where the session takes place play a big part in the nature of the experience, whether it will be pleasant or present terrifying hallucinations. That is why care is taken to prepare a soothing and reassuring environment for the sessions, and to have the therapist present throughout.
The final phase is the integration process when the therapist helps the patient to integrate the irpsychedelic experiences in order to recontextualise their traumatic experience.
Psychedelics under Investigation
MDMA-assisted psychotherapy for PTSD
Scientists have studied MDMA for decades. It is the key ingredient in the illicit drug Ecstasy, also known as Molly. The researchers found that the compound, in tandem with psychotherapy, is safe and effective for the treatment of PTSD.
A randomized, double-blind, placebo-controlled trial published in Nature Medicine found that 67% of the participants in the trial could no longer be diagnosed with PTSD two months after they underwent MDMA-assisted psychotherapy.
In addition to this study published on May 10, 2021, six previous studies also produced promising results for MDMA-assisted therapy for PTSD. What’s very encouraging is indications that the therapeutic benefits are long-lasting. There are currently several ongoing studies involving psychedelics in different locations around the world
Ketamine
Ketamine is an intensively studied psychedelic drug. In the past two decades, research on ketamine as a potential treatment for different mental health conditions has increased, particularly around its ability to rapidly relieve depression. Researchers are also looking into its ability to impact emotional memories, with a focus on its potential use in treating PTSD.
A scientific review on the efficacy of psychedelic-assisted therapy notes a study where a single IV infusion of ketamine reduced the severity of PTSD symptoms quickly and significantly, with the effects lasting for seven days afterwards.
Another study combined the use of ketamine with mindfulness-based cognitive therapy. Ketamine combined with mindfulness practice resulted in a state in which patients calmly accepted the unpleasant memories as they arose rather than reacting fearfully to them.
Psilocybin
Psilocybin is a mind-altering compound contained in psychedelic mushrooms. The substance has been studied for the treatment of depression, and anxiety that is common in terminal cancer patients.
So far, there has not been a study on psilocybin-assisted psychotherapy as a treatment for PTSD.However, scientists are optimistic about the possibilities, as psilocybin has shown it can reduce anxiety and demoralization. Several studies have found that psilocybin can help patients confront traumatic memories and develop self-compassion and forgiveness, all of which would benefit patients with PTSD.
Psilocybin intake can cause life-altering mystical experiences. When this happens, it can affect a person profoundly, leading them to completely reassess their perspective on their experiences and life in general.
LSD
LSD is the most potent psychedelic and the one with the longest and most well-known history. And interestingly, LSD was the first substance to be used in psychedelic-assisted therapy way back in 1970.
The large-scale recreational use of LSD in the 1960s led to the drug being declared a Schedule 1substance, which also effectively put a halt to scientific research on LSD. However, before these developments, more than 1,000 studies involving 40,000 patients showed positive indications for the use of LSD in psychiatry.
Currently, research on the therapeutic use of LSD for PTSD is ongoing, with researchers looking into the potential benefits and risks.
Cannabis
Cannabis contains more than 100 different cannabinoids of which CBD and THC are the most studied. Cannabis and synthetic cannabinoids are mainly of interest for the temporary relief of PTSD symptoms, but they may also prove to be useful in a therapy setting. (Krediet et al., 2020)
Both THC and CBD seem to be able to help patients deal with fear and traumatic memories. Since getting rid of fear is a critical aim of PTSD treatment, these substances may boost the effectiveness of exposure therapies.
Cannabis for the treatment of PTSD symptoms is currently under intense study, with mostly positive outcomes. One study found that people with PTSD who use cannabis for their symptoms are 2.57 times more likely to recover from this condition compared to those who did not use cannabis.
Final thoughts
PTSD takes a heavy toll on society. It is a debilitating disorder that can create unbearable stress in the life of the victim as well as family and friends. It is estimated that millions of people world wide are affected by the condition.
PTSD has traditionally been treated with cognitive behavioural therapy, talk therapy, and medications. Given that about 40% of patients don't respond to SSRIs, there is renewed interest amongst scientists to investigate and develop alternative therapies, including therapies that involve taking psychedelics.
Research into the potential of psychedelics for the treatment of PTSD is surging worldwide. The psychedelics under investigation include MDMA, ketamine, psilocybin, cannabis, and LSD.
A new treatment modality has been developed – psychedelic-assisted psychotherapy combines the use of a psychedelic with psychotherapy. Clinical results so far have been very promising, and the findings indicate that this new treatment can be more effective and faster than current treatments, bringing new hope to patients.