Canadian Nurse

https://www.infirmiere-canadienne.com/blogs/ic-contenu/2020/07/10/les-champignons-magiques-et-lavenir-des-soins-de-s

Jul 10, 2020, By: Kristof Lenart

At first, it may be difficult to imagine illicit psychedelic drugs such as “magic mushrooms” being used in clinical settings. But following recent research, this may well be where the future of psychiatry and psychotherapy lies.

Spanning the last two decades, this new wave of research is paving the way for the integration of psychedelic-assisted psychotherapy into the Canadian health-care system. This would involve psychedelic-assisted therapy as a treatment for mental illnesses such as post-traumatic stress disorder (PTSD), anxiety, depression and addiction.

Developments in this research offer new ways of understanding and treating otherwise intractable psychiatric conditions and carry with them important implications for nurses in the clinical setting. Currently, a number of prominent academic research institutions around the world are investigating the therapeutic potential of these medicines. They have made remarkable progress and mark the dawning of what is likely to become a new and powerful adjunct to traditional therapy.

What are psychedelics?

So what are psychedelics, and how might they revolutionize psychiatry?

Psychedelic, a term coined by Canadian psychiatrist Humphry Osmond in the mid-1950s, means “mind-manifesting” and refers to a type of psychotropic drug in a class entirely of its own. Examples of psychedelic compounds are mescaline, psilocybin, lysergic acid diethylamide (LSD), ibogaine and ayahuasca.

Historically, many psychedelics have been used by Indigenous cultures across the globe as part of sacred healing rituals. Each compound contains unique properties, but all share the pharmacological effect of profoundly altering consciousness. It is this central feature that may be a major component in its remarkable ability to treat an ever-growing set of psychiatric conditions.

Decades of research

World-class institutions such as Imperial College London, Johns Hopkins University School of Medicine, and New York University are among the many involved in psychedelic research. Researchers have been focusing on the therapeutic applications of psychedelics for intractable psychiatric conditions such as treatment-resistant depression (TRD) and post-traumatic stress disorder (PTSD). The outcomes of phase I and phase II clinical trials, though preliminary, have thus far been promising, especially at a time when there has been little advancement in therapies and drugs for treating mental disorders in over 30 years (Carhart-Harris et al., 2016).

Psychedelics exert their effect by inducing powerfully altered psychological states of varying duration (minutes to hours), where perception and awareness are transformed and a “reset” of the mind takes place.

The revival of research into these once-taboo drugs began nearly two decades ago, after a long prohibition was enacted in the United States in response to the hippie-counterculture of the 1960s. This revival builds on an already large body of research from the 1950s and 1960s. Today’s researchers are reopening the gateway for therapeutic indications of these drugs and bringing hope to Canadians suffering from debilitating mental health disorders.

A remission of depression

The research on psilocybin has been drawing attention around the world. Disbelief is common when learning that a one-time dose of psilocybin — the active component of “magic mushrooms” — can produce a sustained remission of depression that lasts from months to years (Agin-Liebes et al., 2020). Though many of the results are still preliminary and some of the studies involve small sample sizes, the studies consistently demonstrate the remarkable potential of psilocybin-assisted psychotherapy.

The research has garnered favourable attention from the U.S. Food and Drug Administration (FDA), which has given the go-ahead for much larger-scale studies on how psilocybin could be used to treat TRD and major depressive disorder.

The power of psilocybin lies in its ability to transform the mind and produce a psychologically transformative state where the sense of self is altered and barriers to exploring past traumas are temporarily lifted. The drug affects the serotonergic system, and functional MRI scans show it significantly increases neuronal crosstalk between regions of the brain that don’t normally communicate (Carhart-Harris et al., 2017).

Psilocybin-assisted psychotherapy

As public awareness grows, nurses may soon receive questions about psychedelic therapies and medicine.

Administered in a comfortable setting with two trained therapists, the sessions involve the patient lying on a couch with eye shades on and music playing. This setting facilitates the emotional breakthrough and experience that often leads to mood improvement, antidepressant effects, and stress relief — with clinically significant improvements lasting more than six months.

Emotions of love and joy, a feeling of oneness, and a sense of transcending time and space are but a few of the effects commonly elicited during the six to eight-hour sessions.

This research builds on the more established body of later-stage research surrounding psilocybin as a treatment for anxiety and depression in patients with end-of-life and life-threatening diseases (Griffiths et al., 2016). For example, in a recent randomized double-blind study, 92% of the cancer patients who received the high-dose psilocybin showed a clinically significant (greater than 50%) decrease in depression scores after the first session. These effects showed a sustained symptom remission rate of 65% at the six-month follow-up assessment.

Dr. Robin Carhart-Harris, head of the Centre for Psychedelic Research at Imperial College London, said that the drug plays an important role in affecting brain circuits associated with depression. With 11.3% of Canadians meeting the criteria for depression at least once in their lives (Government of Canada, 2016), and over one-fifth of cases being treatment-resistant, there exists a great unmet need (Rizvi et al., 2014).

Safety and risks

Though the research is both exciting and promising, researchers have approached psychedelics with a great deal of care and a strong emphasis on safety. Strict exclusion criteria filter out patients with any personal or family history of bipolar, schizophrenia, and psychotic disorder as there is speculation that psychedelics may accelerate early-onset or acute episodes. The safety risk is low — psychedelics show no addictive properties, and there is no known lethal dose (Solon, 2017).

Perhaps the greatest risk for patients may be the intense nature of the experience. Much of this risk, however, can be managed through the presence of two trained therapists providing comfort and support throughout the entire session. This support — along with pre-session relationship-building and a strong emphasis on “letting the experience take them where it will” — has been effective at minimizing negative experiences (Carhart-Harris et al., 2018).

The FDA has recently granted psilocybin with “breakthrough” status and Health Canada has approved research trials, but high safety standards are in place and patient well-being is of the utmost importance.

Implications for nursing practice

With the prospect of psychedelic legalization for clinical application, along with growing public awareness of the clinical potential of these compounds, health-care providers should pay attention to emerging research.

Interest in psychedelic medicine is growing; for example, Maclean’s has predicted that psychedelics will be the next big thing (Mann, 2018), and several successful decriminalization initiatives have transpired in the U.S. in the past year. As both the media and the public warm up to the clinical potential of psychedelic-assisted therapies, health-care workers may soon find these developments hold new implications for them.

As public awareness grows, nurses may soon receive questions about psychedelic therapies and medicine. This may bear similarities to the period leading up to the decriminalization of medical assistance in dying (MAID) by the Canadian government. As the prospect of psychedelic medicine becomes a legal option for eligible patients, nurses may be on the front lines of patient engagement with the topic.

Additionally, new guidelines outlining the appropriate response to questions about the topic may be produced, much as they were for MAID.

Finally, it may also lead to new job streams and specialized training opportunities for nurses directly involved in care.

Understanding and awareness

Natalie Gukasyan, a psychiatrist and research fellow at Johns Hopkins University, predicts that if research continues in its current direction, psilocybin could soon be rescheduled and approved for clinical use with the integration of specialized services into the health-care system (Haridy, 2019). Such integration could mean nurses play a role as one of the two facilitators of care during psychedelic therapy sessions.

Psychedelic medications serve as a beacon of hope to suffering Canadians and patients across the globe.

Having primary clinical knowledge and a fundamental understanding of the topic could be the most important aspect that concerns health-care providers. Awareness of emerging changes in therapeutic options available to patients may help nurses deliver better care and education to patients as well as fulfil standards of continually acquiring knowledge and skills.

A cultural shift

The acceptance of previously illegal drugs for medical purposes has helped pave the way for the embrace of psychedelics for therapeutic purposes. This cultural shift is highlighted by recent events such as marijuana legalization and the FDA’s recent rescheduling of esketamine¹ (the first legal psychedelic) for the treatment of TRD (Krupitsky & Grinenko, 1997).

With an accelerating pace of research and a rapidly growing body of knowledge, these mind-altering substances may soon change the way we offer care and approach mental illnesses. The renewed interest in psychedelics is opening the doors to research on a plethora of disorders. Studies are planned or underway for the application of psychedelics in the treatment of Alzheimer’s disease, anorexia nervosa, obsessive-compulsive disorder (OCD), and addictions (alcohol, tobacco, crack cocaine and heroin).

Mark Haden, the executive director of Multidisciplinary Association for Psychedelic Studies (MAPS) Canada, predicts the legalization of psychedelics for some clinical applications in Canada by 2022 (M. Haden, personal communication, February 28, 2020). These drugs may radically transform psychiatry and become a powerful tool in treating mental health problems.

A beacon of hope

Psychedelic medications, when judiciously used in well-regulated settings, serve as a beacon of hope to suffering Canadians and patients across the globe. Given these far-reaching implications, health-care professionals should stay informed of the rapidly advancing research and clinical developments. Understanding these advances will help nurses to adapt and inform their patients accordingly.

During a time when there has been little improvement in the effectiveness of medication targeting anxiety and depression — despite the billions invested in research — psychedelics could be the answer psychiatry has been looking for.

¹Though ketamine is not explicitly a “classical psychedelic”, its psychedelic effects are most strongly observed in what is called the “emergent syndrome,” which occurs as the anesthesia wears off. For more information on this, please see MAPS Bulletin Winter 2016: Vol. 26 No. 3 Annual Report.

References

Agin-Liebes, G. I., Malone, T., Yalch, M. M., Mennenga, S. E., Ponté, K. L., Guss, J., … Ross, S. (2020). Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer. Journal of Psychopharmacology, 34(2), 155-166. https://doi.org/10.1177/0269881119897615

Carhart-Harris, R. L., Bolstridge, M., Rucker, J., Day, C. M. J., Erritzoe, D., Kaelen, M., … Nutt, D J. (2016). Psilocybin with psychological support for treatment-resistant depression: An open-label feasibility study. The Lancet Psychiatry, 3(7), 619–627. doi:10.1016/s2215-0366(16)30065-7

Carhart-Harris, R. L., Roseman, L., Haijen, E., Erritzoe, D., Watts, R., Branchi, I., & Kaelen, M. (2018). Psychedelics and the essential importance of context. Journal of Psychopharmacology, 32(7), 725–731. doi:10.1177/0269881118754710

Carhart-Harris, R. L., Roseman, L., Bolstridge, M., et al. (2017). Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Science Reports, 7, 13187. doi.org/10.1038/s41598-017-13282-7

Government of Canada. (2016.) Public Health Agency of Canada. What is depression?

Griffiths, R. R., Johnson, M. W., & Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30(12), 1181–1197.

Haridy, R. (2019). The future of psychedelic science: What the next decade holds.

Krupitsky, E. M., & Grinenko, A. Y. (1997). Ketamine psychedelic therapy (KPT): A review of the results of ten years of research. Journal of Psychoactive Drugs, 29(2), 165–183. doi:10.1080/02791072.1997.10400185

Mann, A. (2018, October 25). How science is bringing psychedelic mushrooms out of the shadows. Maclean’s.

Rizvi, S. J., Grima, E., Tan, M., Rotzinger, S., Lin, P., McIntyre, R. S., & Kennedy, S. H. (2014). Treatment-resistant depression in primary care across Canada. Canadian Journal of Psychiatry, 59(7), 349–357. https://doi.org/10.1177/070674371405900702

Solon, O. (2017, May 24). Study finds mushrooms are the safest recreational drug. The Guardian.

Kristof Lenart is an RN working in the ER at St. Paul’s Hospital in Vancouver. Kristof is inspired by the promising therapeutic implications that psychedelics may offer those suffering from mental health conditions and problematic substance use, including many of the patients he works with. He is also the founder of the Vancouver Psychedelics Meetup, a monthly gathering that features guest speakers and discussions on topics related to psychedelics.