The surprising new treatment for mental illness

In April 1943, Swiss chemist Albert
Hofmann accidentally exposed himself to a drug he derived from ergot fungus and recorded its unexpected,
mind-altering effects. The drug, lysergic acid diethylamide—
or LSD— was soon heralded
for its psychiatric potential. But how do LSD and other
psychedelic drugs affect the body? And can they actually be medicinal? Psychedelics are a class of drugs that
alter mood, cognition, and perception, often triggering unusual states
of consciousness like hallucinations. They all interact with the body's
serotonin neurotransmitter system, which regulates many processes,
including mood, sleep-wake cycles, appetite, and memory. Lower rates of serotonin signaling are associated with impaired
sleep and attention and diminished responses
to positive information. Meanwhile, higher rates tend to track
with more positive moods and greater emotional stability. All psychedelic drugs increase the amount
of serotonin signaling. However, they interact with the serotonin
system in different ways and affect other neurotransmitter systems, all of which determines their unique
effects and medical potential. Hofmann’s discovery inspired a wave
of psychedelic research that largely stalled in the 1970s, due to concerns over breaches
in research ethics, as well as conservative drug policies. However, it's picked back up
in recent decades, and some psychedelics show promise in addressing even
treatment-resistant conditions. Take LSD and the mushroom-derived
compound psilocybin: when they cross the blood-brain barrier,
receptors recognize them as serotonin. Interestingly, they tend to suppress
the areas that make up the brain’s
“default mode network” and initiate more connections
with other brain regions. The default mode network is important
in self-referential thinking and mind wandering. It’s thought that,
by suppressing its activity, LSD and psilocybin may generate
the distinctive psychedelic experience of ego dissolution, characterized by a radical shift
in self-perception. The default mode network is also
associated with mental health disorders. By disrupting its activity, psilocybin
and LSD might help normalize it. This may be why they can reduce the
symptoms of conditions like depression— potentially doing so faster
than traditional treatments. Trials that pair LSD or psilocybin
with talk therapy also show promise in treating disordered
tobacco and alcohol use, perhaps by similarly altering
people’s self-perception. And they seem to activate receptors
that facilitate social behavior, empathy, and gratitude, leading people to feel greater harmony
with a larger community. It's thought that this is why
they can help alleviate the distress people living with advanced
cancer diagnoses experience, as preliminary trials suggest. Overall, LSD and psilocybin seem
to function similarly, but LSD is more potent and associated with longer-lasting
psychedelic experiences. MDMA, meanwhile, triggers the release
of neurotransmitters, including dopamine, norepinephrine,
and serotonin, and elevates levels
of the hormone oxytocin. These changes generate effects like
heightened heart rate and sensory perception, as well as feelings of euphoria,
bonding, empathy, and safety. Because of this, researchers
have begun investigating MDMA as a possible therapy for
post-traumatic stress disorder. MDMA releases oxytocin, sometimes
referred to as the bonding hormone, which may help reinforce an environment
of safety, trust, and connectedness. MDMA is also thought to modulate
activity in the amygdala, which plays a central role
in processing fear. PTSD can be difficult to treat because of how painful it is to revisit
traumatic experiences. However, it’s thought that MDMA
could help patients discuss trauma without debilitatingly negative emotions, and potentially aid in uncoupling
traumatic memories from the threatening
feelings they usually surface— a process known as fear extinction. More studies are needed to test
this theory and determine MDMA’s safety
and effectiveness. Psychedelics also show some promise in helping address chronic pain
and cluster headaches. And unlike pain-relieving opioids,
they aren’t considered addictive. However, they're not without risks. Some research suggests psychedelics
can be stressful on the heart. And their extensive psychological effects make it hard to predict
individual responses. Psychedelics can “unmask” pre-existing
psychiatric disorders, like schizophrenia, which is why clinical trials usually
have thorough screening processes. And paranoia, psychosis,
and hallucinations— which can persist even
after the drug has been metabolized— are potential side effects. Therapy sessions that employ
psychedelics usually require preparation— like mindfulness and breathing techniques— and should take place in safe,
supportive environments with emergency protocols in place. We’ve learned a lot about psychedelics
since Hofmann’s fateful experiment. But there’s much more to uncover—
and not without challenges. Psychoactive substances like psychedelics
pose issues for blind clinical trials, since their effects can be pretty
obvious to participants who shouldn’t know they’re
receiving treatment. To fully understand
their therapeutic potential, we need many more scientifically,
ethically rigorous trials that weed out bias, prioritize participant
welfare, and grapple with complex results. Who knows? The results could be mind bending.