Researchers are becoming more convinced of the value of psychedelics in treating depression and addiction. Dr Mike Scully, Chair of the Faculty of Addictions Psychiatry at the College of Psychiatrists of Ireland weighs in on the addiction in psychedelics.

By Alex Meehan

Published in the Sunday Business Post on 15/01/2017

It’s late at night deep in a jungle in Peru, and a group of people are getting ready to drink a tea that will bring on powerful hallucinations. Known as ayahuasca, the brew contains the psychedelic active ingredient DMT, or dimethyltryptamine.

But these people aren’t here to get high – for them, that’s just a side effect. They are here because drinking ayahuasca has gained a reputation for being able to ‘cure’ conditions like anxiety, depression, alcoholism and drug dependency, and for forcing people to confront their own weaknesses and issues.

Ayahuasca has been used as part of shamanic healing rituals in the Amazon region for thousands of years, and a growing number of American and European tourists are being drawn to it. It may represent a less than orthodox approach to tackling health and wellbeing issues, but its increasing popularity reflects a wider renewed interest in the potential therapeutic value of psychedelics.

Scientific research is now under way into the use of substances such as LSD, MDMA, psilocybin and the compounds found in ayahuasca for the first time since the 1960s, when hallucinogenic drugs were banned in the wake of abuse scandals and society’s general mistrust of the altered states of consciousness they produced.

Late last year, the results of a study into the therapeutic use of psilocybin — the powerful, naturally-occurring psychedelic compound found in magic mushrooms — was published in the Journal of Psychopharmacology.

The study showed that a single dose of psilocybin can significantly improve the well-being and positivity of terminally ill cancer patients. Of the approximately 80 participants who were given the drug in a controlled environment, many reported immediate and marked reductions in their levels of anxiety and depression.

Perhaps most interestingly, these results persisted for six months for 80 per cent of the patients who took part in the study. This compares highly favourably to existing end-of-life measures offered to this cohort of patients, which mostly consist of counselling and drugs such as anti-depressants. A particular problem with these measures is that they typically take some time to start working and may not work for all patients.

A separate study by the Beckley/Imperial Research Programme in Britain into psilocybin for treatment-resistant depression also revealed remarkable results. In that study, patients received two separate doses of psilocybin seven days apart, together with psychological support.

The findings, which were published in The Lancet Psychiatry, revealed that 67 per cent of patients were depression-free one week after treatment, with 42 per cent still in remission three months later. These patients had suffered an average of over 18 years of depression and had found no respite in any other treatment.

“What the study shows is that this drug is potentially extremely important,” says Amanda Feilding, founder of the Beckley Foundation and a long-term advocate of research into altered states of consciousness.

“We administered two doses of psilocybin to 12 people, but the first dose was very low and was basically just to check for adverse reactions. The second dose was only moderate to low in size, but seems to have had a profound effect.”

Feilding is planning to continue the research with a much larger, double blind experiment with the goal of checking and reproducing the results of the original study. However, the results produced so far seem to imply that even one dose of psilocybin can have a significant effect on people with severe depression.

The standard treatment for depression and anxiety disorders is the twin approach of psychotherapy and the use of anti-depressants, in particular a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs. These drugs are enormously widely prescribed – it’s estimated that as many as one in ten Irish people are on anti-depressants at any given time – but the exact mechanism by which they work is not known.

They are believed to block the re-absorption of a neurotransmitter called serotonin which is naturally produced in the brain, thus promoting feelings of well-being and happiness. SSRIs have been shown to be effective for major depressive disorder but are not known for being particularly effective for lesser types of depression.

“Instead of taking a daily SSRI pill, which in 20 per cent of people has no effect at all, taking psilocybin could be something you do three or four times a year that could give you a much longer lasting remission, and would cost a lot less,” says Feilding. “I can envisage a situation where we might see booster doses administered every three months or so as a new treatment for depression.”

Feilding has been advocating for research into psychedelic substances for therapeutic purposes for almost 50 years. She set up the Beckley Foundation in 1998 and this most recent study got the go ahead in 2014, but it took the organisers two years to get access to the psilocybin necessary to carry out the trial.

“It’s essential that research is made easier and for that to happen, countries such as Britain and Ireland need to remove psychedelics from the schedule one list of prohibited substances, reclassifying them to schedule two. Then, with less wasted expense, we could carry out this valuable research,” she says.

“If effective treatments result from this, the potential savings are enormous; the first and most important would be in human suffering, but there would also in an immense saving in the cost to national health services of the treatments being used at the moment. An enormous amount of money is being spent on antidepressants, and yet we know that their level of effectiveness is far from ideal.”

According to Feilding, depression is not the only condition that could be helped by further research in this area — so too could addiction. A recent study by the Johns Hopkins School of Medicine and New York University into the use of psilocybin to treat nicotine addiction showed an 80 per cent success rate.

While all the research being carried out into the use of psychedelic drugs seems to be showing significant results, the question remains – why? Just what is happening in the brains of the people taking part in these studies?

“One of the things we know about conditions like depression, addiction, post-traumatic stress disorder and OCD is that they are grounded in excessive rumination, fixed patterns of thought and behaviour that you can see as hyper-active circuitry in the brain’s default mode network,” says Feilding.

“These ideas can become fixed so deeply that psychotherapy doesn’t really budge them. But what we’ve found with our research into LSD and psilocybin brain imaging is that with psychedelics, the blood supply to this default mode network is diminished. The controlling effect on perception and behaviour is relaxed, and other networks in the brain are able to communicate with each other more.”

The result is something similar to hitting a reset button on a computer. Interestingly, the higher the test subject gets, the more profound the experience tends to be and the more long lasting the results.

“We’ve noticed that the people who experience the most ego dissolution, which can be expressed as having a mystical experience, are very often the people who have the best results in treating their condition,” Feilding says.

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Phil Campbell, a 33-year-old Irish musician and producer, has suffered from depression and anxiety since he was 15. Diagnosed at 18, he was been prescribed a variety of anti-depressants and benzodiazepines over the years but found them relatively ineffective in controlling the symptoms of his illness, and also had issues with side effects interfering with his daily life.

He came off medication and attempted to control his symptoms with meditation, diet and fitness but in 2014, he decided to travel to Iquitos in Peru to try a series of ayahuasca tea ceremonies.

Made by brewing up an Amazonian vine called banisteriopsis caapi together with the leaves of the psychotria viridis plant, ayahuasca tea is notoriously unpleasant to drink, and the experience frequently includes a period of purging that can include vomiting and diarrhoea, as well as intense auditory and visual hallucinations and psychological introspection that can lead to elation, fear or illumination.

It’s becoming common for ayahuasca tourists to pay large sums of money – several thousand dollars is not unheard of – to take part in week long ayahuasca retreats, ranging in sophistication from simple jungle camps to comfortable five star resorts.

“I had never taken psychedelic drugs recreationally, but I did a lot of research into ayahuasca online, watched a lot of testimonials on YouTube and decided that it was worth a shot. When I’m interested in something I become quite obsessive so I read everything I could by the likes of Graham Hancock and Terrence McKenna, who have written a lot on psychedelics,” says Campbell.

“When you’re in a dark place it’s very tempting to look for a miracle cure, and the reactions seemed to be very positive from people who have done it. At the point when I went to Peru I really didn’t care if something bad happened or I had a bad reaction and died – I was desperate and willing to roll the dice. The depression I was suffering at the time meant I was willing to take any risk to escape how I was feeling.”

Campbell decided on the Kapitari retreat camp, located a 45-minute boat ride down the Amazon from Iquitos and a 40 minute hike through the jungle. Owned by local indigenous Peruvians, Kapitari invests any profit it makes back into conserving the region.

“Ayahuasca tourism is a big thing in this area, but lots of the camps are expensive and run by Americans facilitating Silicon Valley IT workers with their spiritual quests. They have comfortable accommodation, wifi and the like – I was looking for something more authentic,” Campbell says.

Kapitari only gets electricity for two hours a day and offers few material comforts. Accommodation is in wooden huts with hammocks, and the food on offer is very basic. Campbell paid $600 for seven days food and board, including four night-time ayahuasca ceremonies.

“The brew itself tastes vile, indescribably bad. For a year and half afterwards, every time I thought of it I could still taste it. You’re given a bucket and most people start to vomit fairly quickly, but I got on okay with it at first,” Campbell says.

“After about 40 minutes, you start to gradually feel odd. After an hour or so, you’re hallucinating, seeing colours, hearing things and feeling really strange. Getting sick and purging are a big part of the experience. You’re meant to follow a strict diet for a few weeks before this; one person in our group didn’t take that seriously, and had a pretty bad time the first night as a result.

“You sit in silence while a shaman sings and shakes a leaf rattle while progressing around the circle. After about two and half hours, he got as far as me and I got seriously sick. Everything came up and it was pretty painful. I really thought my heart was going to explode. – it was very intense. At the same time, I was extremely high.”

While the trip didn’t lead to a cure, Campbell believes it did benefit him.

“The experience sounds crazy — and it was– but it taught me some important lessons about myself. It taught me that I was much stronger than I thought I was, and that I had it within me to overcome anything. It’s very hard to articulate. I felt total self-acceptance, love and pure calm. It was a taste of what life would be like if I was to accept myself and be free of depression and anxiety,” he says.

“The day after each ceremony I felt really comfortable in myself. I felt no depression or panic, anxiety or shame, or any of the lows that follow using recreational drugs like MDMA. It felt like there was no depletion of serotonin. I’m a big believer in getting out of your comfort zone, so I’d encourage people who are interested and who understand the risks to do it. It will open your eyes. But the effect didn’t last for me.

“It lasted around a month but the resolve I learned in Peru didn’t survive in the face of my normal life and routines when I got home. One week of doing this isn’t enough time to do the work that will allow you to get to the root of your problems and resolve them. It was a very interesting window into how things can be, and I would do it again, but for longer. I don’t believe ayahuasca is a cure – I believe it’s a teacher that shows you what work you have to do, but it won’t do the work for you.”

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The use of serious drugs such as ayahuasca, LSD and psilocybin can be extremely dangerous, and nobody involved in the research currently ongoing into their therapeutic use advocates a DIY approach.

However, it seems to be the case that prevailing ideas about the danger of such drugs aren’t always accurate. According to Dr Mike Scully, Chair of the Faculty of Addictions Psychiatry at the College of Psychiatrists of Ireland, addiction to psychedelic drugs is extremely uncommon.

“When I was training as a junior doctor, hallucinogenic drugs had a really negative reputation. They were considered habit and dependence-forming substances and were said to be very damaging. But when you actually look at the modern literature on psycho-pharmacology, that impression does not appear to be evidence-based,” he says.

“For example, I looked at a paper from 2015 published in the Journal of Psychopharmacology, from a large population study of 130,000 adults in the United States, including 19,000 psychedelic users. It failed to find evidence for a link between psychedelic use [of LSD, psilocybin or mescaline], and mental health problems.

“It’s a study, so it’s not necessarily 100 per cent accurate for everyone. It’s not saying that these drugs can’t cause problems, but it’s obvious that they’re not causing vast problems. To my mind, that clears the way to make this a respectable area of study.” .

Scully is particularly interested in the potential for new treatments to be developed that will help alleviate the suffering of Irish patients.

“There’s a developing evidence base that these drugs can be helpful in mood disorders, particularly treatment-resistant mood disorders and anxiety disorders, as well as alcohol-abuse disorders. However, attempting to be rational in public around drug use and mental health isn’t very popular,” he says.

This was something Britain’s former chief government drugs advisor David Nutt learned when he lost his position in 2010 after publishing a paper that ranked the comparative harm done by various drugs next to their legal classifications.

“The classifications and harms didn’t match, most notably when it came to alcohol and tobacco, which are the most harmful substances in widespread use,” Scully says.

“The kind of science now being done makes it easier to say this, because as neuro-imaging technology has improved we can show in concrete terms the effects these drugs have. Alcohol is the most problematic drug that people come into contact with but it’s also the least resourced within the public health system. The message that sends is that the harms that alcohol creates when it’s used problematically don’t matter enough for us as a society to change how it’s regulated.”

Scully advocates a more compassionate approach to the treatment of drug-related addiction issues in Ireland.

“The US Surgeon General published a report last month that made some conclusions that I agree with. It said that we should look at drugs and addiction issues from a healthcare perspective, and that treatment and assistance should be in a healthcare setting rather than in a criminal justice setting,” he said.

“But most government money in Ireland for drug and alcohol issues go into enforcement not treatment. There’s consistent evidence that you get very poor return on investment for that money, and there’s reasonably good evidence that money spent on treatment helps people. But that treatment approach is still a minority one at the level of public policy.”

“To a certain cohort of society, even mentioning putting money into treatment rather than law enforcement will be met with howls of outrage,” he said.