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LSD, MDMA… how psychedelic drugs can treat psychiatric disorders

Daniele Zullino
Head of Addictology in the Department of Mental Health and Psychiatry at Geneva University Hospitals
Key takeaways
  • For a number of years, medical and scientific circles have been interested in the use of psychedelic substances to treat certain mental disorders.
  • LSD and psilocybin are used to treat patients suffering from depression and/or anxiety disorders, with or without addiction problems.
  • During their psychedelic journey, patients generally experience traumatic memories being brought back, but in a new context.
  • The effects can be dramatic, with symptoms sometimes resolving after just one or two sessions.
  • The psychiatric world had not seen such innovations since the advent of antidepressants in the 1960s.

Will LSD, psilo­cy­bin – the main psy­choac­tive sub­stance found in hal­lu­cino­genic mush­rooms – or MDMA soon become treat­ments for depres­sion, addic­tion, or obses­sive-com­pul­sive dis­or­der? Psy­che­delics are a fam­i­ly of sub­stances that induce a state of altered con­scious­ness and per­cep­tion. These psy­choac­tive sub­stances act on the recep­tors for sero­tonin, nick­named the “hap­py hor­mone”. Long demonised as dan­ger­ous, these drugs were the sub­ject of much research in the late 1940s. But their asso­ci­a­tion with the protest move­ments of the 1960s and 1970s led gov­ern­ments to ban them.

For sev­er­al years now, sci­en­tif­ic research has been tak­ing a clos­er look at the effects of LSD and psilo­cy­bin on men­tal ill­ness and addic­tion, and as a sup­port for patients at the end of their lives. Research and stud­ies are mul­ti­ply­ing. Psy­chi­a­trists have analysed 25 stud­ies on the effec­tive­ness of LSD and psilo­cy­bin in psy­chi­a­try, anx­i­ety-depres­sive symp­toms, addic­tive dis­or­ders, and obses­sive-com­pul­sive dis­or­der (OCD). Their con­clu­sion is clear: “Psy­che­delics are promis­ing ther­a­pies with rapid and long-last­ing effi­ca­cy, and their use appears to be gen­er­al­ly well-tol­er­at­ed”. Switzer­land, where LSD was syn­the­sised in the 1930s, is a pio­neer in this approach. For the past three years, Pro­fes­sor Daniele Zulli­no has been con­duct­ing psy­che­del­ic ther­a­py (LSD and psilo­cy­bin) for patients suf­fer­ing from anx­i­ety, addic­tion and/or depres­sion, at the Gene­va Uni­ver­si­ty Hospitals.

What is the connection between the Swiss scientific community and treatments using hallucinogenic substances?

Over the last twen­ty years or so, we have wit­nessed a “psy­che­del­ic renais­sance” in Switzer­land. Research had nev­er actu­al­ly stopped, despite the pro­hi­bi­tion intro­duced by Pres­i­dent Nixon in 1971. There have always been exper­i­ments with dif­fer­ent sub­stances, notably in Zurich and Basel. And it was in the ear­ly 2000s that two psy­chi­a­trists, Peter Gasser and Peter Oehen, were giv­en autho­ri­sa­tion to use them as treat­ments, par­tic­u­lar­ly for peo­ple at the end of their lives. Then, in 2014, the Fed­er­al Office of Pub­lic Health (FOPH) decid­ed to autho­rise excep­tion­al treat­ments for doc­tors who request­ed them. Research is there­fore quite well devel­oped, with around thir­ty doc­tors involved in recent years.

Which patients do you treat in this psychedelic-assisted psychotherapy?

We treat Swiss patients who have been suf­fer­ing from depres­sion or anx­i­ety dis­or­ders for years or even decades, using a range of ther­a­peu­tic effects, both phar­ma­co­log­i­cal and psy­chother­a­peu­tic. These patients must already be under the care of ther­a­pists but are expe­ri­enc­ing prob­lems with their usu­al treat­ment: this ther­a­py should be a last resort, nev­er the first line of defence. More than half also come with an addic­tion prob­lem. So, these are patients for whom we hope that a moment of digres­sive think­ing, with new asso­ci­a­tions and the devel­op­ment of cer­tain cog­ni­tive schemas, can kick-start the psy­chother­a­peu­tic process. As such, it’s not phar­ma­cother­a­py in the tra­di­tion­al sense of the term, but rather a treat­ment out­side the research pro­to­col: this is com­pas­sion­ate use.

How does the treatment work?

Before the first ses­sion of LSD or psilo­cy­bin admin­is­tra­tion, we car­ry out sev­er­al assess­ment inter­views, enabling us to do a full psy­chi­atric inves­ti­ga­tion and review the patien­t’s his­to­ry. Prepara­to­ry ses­sions are then held to explain every­thing to the patient, show them around the premis­es and intro­duce them to the staff. We also assess the patien­t’s moti­va­tions, treat­ment objec­tives and expect­ed effects. On the day of treat­ment, patients arrive at 8.30 a.m. and under­go psy­cho­me­t­ric tests and a check of their vital signs. Thir­ty min­utes after tak­ing the sub­stance, they go to bed in a room with a mask over their eyes and music in their ears. The psy­che­del­ic jour­ney then begins, last­ing around eight hours for psilo­cy­bin and twelve hours for LSD. The choice between the two sub­stances is large­ly left to the patient, depend­ing on the dura­tion of the effect and the price (CHF 130 for a stan­dard dose of 10 micro­grammes of LSD and CHF 440 for 25 mg of psilo­cy­bin). The effects are similar.

It’s a real inno­va­tion in psy­chi­a­try, the likes of which has not been seen since the dis­cov­ery of antidepressants.

The next day, the patient returns for what is known as the inte­gra­tion ses­sion, where every­thing that has hap­pened is reviewed. The patient writes down every­thing he or she has expe­ri­enced as accu­rate­ly as pos­si­ble. We dis­cuss how these expe­ri­ences can be inte­grat­ed into dai­ly life and the psy­chother­a­peu­tic approach. The inter­view is record­ed, so that the patient can lis­ten to it again alone and with his ther­a­pist. Four weeks lat­er, an ampli­fi­ca­tion inter­view takes place to take stock again and decide on a poten­tial new ses­sion. The treat­ment is admin­is­tered in one to three ses­sions – although some patients respond very well after just one or two ses­sions. How­ev­er, each ses­sion should ide­al­ly be spaced two to three months apart.

Why treat these patients with LSD and psilocybin? What is the history of these substances? 

We have sci­en­tif­ic data to sup­port our approach for resis­tant depres­sion, for anx­i­ety dis­or­ders linked to severe ill­ness­es, for the treat­ment of alco­hol and tobac­co addic­tion, and for OCD. What’s more, there have nev­er been any severe side-effects with LSD or psilo­cy­bin. And LSD and psilo­cy­bin are not addic­tive: this was made-up by Richard Nixon’s admin­is­tra­tion in the 1970s. In order for these sub­stances to be placed on the list of nar­cotics, they had to be addic­tive and of no ther­a­peu­tic val­ue. At the time, it was a polit­i­cal deci­sion to com­bat protest groups linked to the Viet­nam War and the civ­il rights move­ment led by African-Amer­i­cans. Oth­er­wise, oth­er sub­stances are of inter­est, such as DMT, the active sub­stance in ayahuas­ca, but we don’t cur­rent­ly have autho­ri­sa­tion to use them.

What do patients generally experience during these sessions?

One of the most com­mon expe­ri­ences that patients have is the appear­ance of cer­tain impor­tant mem­o­ries that have been expe­ri­enced in a trau­mat­ic way, but which are then put back into a new con­text, lead­ing to learn­ing sig­nals. Then, to treat OCD, pho­bias or claus­tro­pho­bia, we also use expo­sure: the patient is tak­en into a lift, and the pan­ic reac­tion does not occur because the atten­tion is focused on some­thing else. This sit­u­a­tion, which has been seen as high­ly anx­i­ety-pro­vok­ing for years, is expe­ri­enced in a com­plete­ly dif­fer­ent way, and a ben­e­fi­cial process begins.

The expe­ri­ences with the most spec­tac­u­lar effects are the “chal­leng­ing expe­ri­ences”, i.e. dif­fi­cult expe­ri­ences, mem­o­ries or emo­tions that resur­face in a par­tic­u­lar­ly painful way, with a cer­tain anx­i­ety about fac­ing them. These patients describe enor­mous changes in the days that follow.

What effects have you observed in your patients?

We haven’t analysed all the data yet, but the impact is very pos­i­tive. After two ses­sions, half the patients are in remis­sion from their dis­or­ders, whether addic­tion or depres­sion. Some peo­ple with decades of treat­ment stop tak­ing anti­de­pres­sants, patients suf­fer­ing from OCD see their symp­toms dis­ap­pear direct­ly after one ses­sion, oth­ers treat­ed for depres­sion come back a month lat­er and have com­plete­ly stopped drink­ing and smok­ing with­out hav­ing made the deci­sion to do so. Of course, in some cas­es, not much changes. But we are some­times sur­prised by the dra­mat­ic effect, and that’s very encouraging.

Where do you think we are in terms of the use of psychedelics to treat mental health problems?

Research is devel­op­ing: the UK is quite active, stud­ies are being car­ried out in Ger­many and pre-clin­i­cal research is tak­ing place in France, par­tic­u­lar­ly in Amiens. There’s real enthu­si­asm. At con­fer­ences, psy­che­del­ic top­ics are being dis­cussed in front of packed audi­ences. This is some­thing new, because these are what we call dis­rup­tive treat­ments – they’re not con­tin­u­ous – some­thing we haven’t had until now. This is a real inno­va­tion in psy­chi­a­try, the likes of which has not been seen since the ear­ly 1960s with the dis­cov­ery of anti­de­pres­sants. Every­one is expect­ing a major revolution.

How do you see the future of this type of therapy?

We’re like­ly to see an accel­er­a­tion in the devel­op­ment of these treat­ments, with the first psilo­cy­bin approvals in the Unit­ed States expect­ed in one or two years’ time. There’s huge inter­est from start-ups: it’s going to have a snow­ball effect. In ten years’ time, it will be a well-estab­lished treat­ment, which will cer­tain­ly not make depres­sion or addic­tion dis­ap­pear, but which will take up a cer­tain place in the ther­a­peu­tic arse­nal. The big chal­lenge is to inte­grate it into cur­rent psy­chother­a­peu­tic mod­els. But we’re at the very begin­ning of the process, because we can’t start again from what was achieved in the 1960s: the sci­en­tif­ic method­ol­o­gy was­n’t the same. So, we need to see how we can com­bine psy­chother­a­peu­tic tech­niques with the effect of these sub­stances to derive max­i­mum benefit.

Interview by Sirine Azouaoui

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