Psychedelic Assisted Therapy

[Kizzie]

Note:

This thread is not meant to encourage any member or reader to try these substances illegally. It is strictly informational and meant to provide hope about the future of treatment for Complex PTSD/Relational Trauma.

The use of psychedelics such as MDMA and psilocybin is still illegal in most countries, but due to their promise in helping treat mental health issues in conjunction with therapy, there is a lot of research being conducted worldwide. Here are some recent articles I found in PubMed.   

Research Articles

Banks, M. I., Zahid, Z., Jones, N. T., Sultan, Z. W., & Wenthur, C. J. (2021). Catalysts for change: the cellular neurobiology of psychedelics. Molecular biology of the cell, 32(12), 1135–1144. https://doi.org/10.1091/mbc.E20-05-0340

Abstract - The resurgence of interest in the therapeutic potential of psychedelics for treating psychiatric disorders has rekindled efforts to elucidate their mechanism of action. In this Perspective, we focus on the ability of psychedelics to promote neural plasticity, postulated to be central to their therapeutic activity. We begin with a brief overview of the history and behavioral effects of the classical psychedelics. We then summarize our current understanding of the cellular and subcellular mechanisms underlying these drugs' behavioral effects, their effects on neural plasticity, and the roles of stress and inflammation in the acute and long-term effects of psychedelics.

Berkovitch, L., Roméo, B., Karila, L., Gaillard, R., & Benyamina, A. (2021). Efficacité des psychédéliques en psychiatrie, une revue systématique [Efficacy of psychedelics in psychiatry, a systematic review of the literature]. L'Encephale, 47(4), 376–387. https://doi.org/10.1016/j.encep.2020.12.002

Conclusions: Psychedelics are promising treatments for anxiety, depression and addiction, their efficacy is quick and sustainable, and they are well tolerated. These effects need to be confirmed in larger studies and compared to standard care.

Bird, C., Modlin, N. L., & Rucker, J. (2021). Psilocybin and MDMA for the Treatment of Trauma-related Psychopathology. International review of psychiatry (Abingdon, England), 33(3), 229–249. https://doi.org/10.1080/09540261.2021.1919062

Conclusion: The combination of psychotherapy and pharmacology as is presented in drug-assisted psychotherapy models seems to be a valuable approach in treating both depression and PTSD, especially in those who have not responded to available treatments.

Feduccia, A. A., Jerome, L., Yazar-Klosinski, B., Emerson, A., Mithoefer, M. C., & Doblin, R. (2019). Breakthrough for Trauma Treatment: Safety and Efficacy of MDMA-Assisted Psychotherapy Compared to Paroxetine and Sertraline. Frontiers in psychiatry, 10, 650. https://doi.org/10.3389/fpsyt.2019.00650

Conclusion: Findings from both nonclinical and clinical studies support a novel mechanism by which MDMA amplifies the therapeutic effects of psychotherapy by a dynamic interaction of brain regions, and affiliated neurochemicals therein, known to be involved in fear extinction learning, memory reconsolidation, emotional processing, and cognition. With many apparent advantages over existing medications, including efficacy, tolerability, and duration of therapeutic effects, MDMA-assisted psychotherapy has the potential to favorably impact the lives of thousands who suffer from PTSD world-wide.

Healy, C. J., Lee, K. A., & D'Andrea, W. (2021). Using Psychedelics With Therapeutic Intent Is Associated With Lower Shame and Complex Trauma Symptoms in Adults With Histories of Child Maltreatment. Chronic stress (Thousand Oaks, Calif.), 5, 24705470211029881. https://doi.org/10.1177/24705470211029881

Conclusion: These findings demonstrate that using psychedelic drugs with therapeutic intent is associated with lower levels of complex trauma symptoms and internalized shame in individuals with histories of child maltreatment. Psychedelic use may have therapeutic benefit in treating the posttraumatic sequelae of child maltreatment.

Henner, R. L., Keshavan, M. S., & Hill, K. P. (2022). Review of potential psychedelic treatments for PTSD. Journal of the neurological sciences, 439, 120302. Advance online publication. https://doi.org/10.1016/j.jns.2022.120302

Abstract: In recent human-subject studies MDMA-assisted therapy resulted in significant improvement in PTSD symptoms with a good safety and side effect profile. There is not yet direct clinical evidence for classical psychedelics in treating PTSD, but the evidence supports such a trial. The studies to date have been relatively small, and participants are well screened for potential co-morbidities which could increase the risks of psychedelic treatment. Nonetheless, the data is promising for psychedelic-assisted treatment to become a much-needed treatment option for PTSD.

Kelmendi, B., Kaye, A. P., Pittenger, C., & Kwan, A. C. (2022). Psychedelics. Current biology : CB, 32(2), R63–R67. https://doi.org/10.1016/j.cub.2021.12.009

Abstract: Recent data on the effectiveness of psychedelics for treating mental illnesses has led to a resurgence of interest in their neurobiological effects. The purpose of this Primer is to provide those interested in the field of psychedelics with a concise and accessible overview of the scientific data.

Krediet, E., Bostoen, T., Breeksema, J., van Schagen, A., Passie, T., & Vermetten, E. (2020). Reviewing the Potential of Psychedelics for the Treatment of PTSD. The international journal of neuropsychopharmacology, 23(6), 385–400. https://doi.org/10.1093/ijnp/pyaa018

Conclusion: When properly applied, according to published treatment manuals, new models of substance-assisted psychotherapy may offer a valuable contribution to the spectrum of existing pharmacological and psychotherapeutic treatments for PTSD.

Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., Ot'alora G, M., Garas, ... Doblin, R. (2021). MDMA-assisted Therapy for Severe PTSD: a Randomized, Double-blind, Placebo-controlled Phase 3 Study. Nature medicine, 27(6), 1025–1033. https://doi.org/10.1038/s41591-021-01336-3

Conclusion:  These data indicate that, compared with manualized therapy with inactive placebo, MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities. We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation.

Olson D. E. (2022). Biochemical Mechanisms Underlying Psychedelic-Induced Neuroplasticity. Biochemistry, 61(3), 127–136. https://doi.org/10.1021/acs.biochem.1c00812

Abstract -  A hallmark of many stress-related neuropsychiatric diseases, including depression, post-traumatic stress disorder (PTSD), and addiction, is the atrophy of neurons in the PFC. Psychedelics appear to be particularly effective catalysts for the growth of these key neurons, ultimately leading to restoration of synaptic connectivity in this critical brain region.

Reiff, C. M., Richman, E. E., Nemeroff, C. B., Carpenter, L. L., Widge, A. S., Rodriguez, C. I., Kalin, N. H., McDonald, W. M., & the Work Group on Biomarkers and Novel Treatments, a Division of the American Psychiatric Association Council of Research (2020). Psychedelics and psychedelic-assisted psychotherapy. The American journal of psychiatry, 177(5), 391–410. https://doi.org/10.1176/appi.ajp.2019.19010035

Conclusion: Randomized clinical trials support the efficacy of MDMA in the treatment of PTSD and psilocybin in the treatment of depression and cancer-related anxiety. The research to support the use of LSD and ayahuasca in the treatment of psychiatric disorders is preliminary, although promising. Overall, the database is insufficient for FDA approval of any psychedelic compound for routine clinical use in psychiatric disorders at this time, but continued research on the efficacy of psychedelics for the treatment of psychiatric disorders is warranted.

Sotille, R., Singh, H., Weisman, A., & Vida, T. (2022). Unraveling the Mysteries of Mental Illness With Psilocybin. Cureus, 14(5), e25414. https://doi.org/10.7759/cureus.25414

Abstract: New psychotherapeutics are required that specifically target the underlying cellular pathologies leading to neuronal atrophy. This neuronal atrophy model is supplanting the long-held neurotransmitter deficit hypothesis to explain mental illness. Interest in psychedelics as therapeutic molecules to treat mental illness is experiencing a 21st-century reawakening that is on the cusp of a transformation.... We have focused this review to include studies in the last two years that suggest psilocybin promotes neuronal plasticity, which may lead to changes in brain network connectivity.

Smith, K. W., Sicignano, D. J., Hernandez, A. V., & White, C. M. (2022). MDMA-Assisted Psychotherapy for Treatment of Posttraumatic Stress Disorder: A Systematic Review With Meta-Analysis. Journal of clinical pharmacology, 62(4), 463–471. https://doi.org/10.1002/jcph.1995

Conclusion: MDMA-assisted psychotherapy enhanced the achievement of clinically significant reductions in CAPS scores (relative risk, 3.65; 95%CI, 2.39-5.57) and CAPS score reductions sufficient to no longer meet the definition of PTSD (relative risk, 2.10; 95%CI, 1.37-3.21) with no detected statistical heterogeneity. While therapy was generally safe and well tolerated, bruxism, anxiety, jitteriness, headache, and nausea are commonly reported.

Vermetten, E., Krediet, E., Bostoen, T., Breeksema, J. J., Schoevers, R. A., & van den Brink, W. (2020). Psychedelica bij de behandeling van PTSS [Psychedelics in the treatment of PTSD]. Tijdschrift voor psychiatrie, 62(, 640–649.

Conclusion: Psychedelics may have potential to serve as a catalyst for the psychotherapeutic treatment of PTSD. Most evidence exists for MDMA-supported psychotherapy; relatively little research is available on ketamine and classical psychedelics. Future research needs to show whether the use of psychedelics can be integrated into available treatment options for PTSD.

[dollyvee]

A bit of an overview in how to use IFS with psychedelic therapy:
https://www.youtube.com/watch?v=qBikJMvkIT4

[dollyvee]

I had a discussion about microdose dosage with an acquaintance the other night and found that he feels "high" when taking 100mg of Golden Teachers. I can take around 250mg and feel a slight affect (what is described as flow state I think) which we both thought was interesting.

I had a look and apparently genetic make up determines your reaction to psychedelics in part.

Research reveals role of genetic variants on psychedelics' therapeutic effects
https://www.sciencedaily.com/releases/2022/07/220727153626.htm

5 genes that may affect your reaction to psychedelic drugs like 'magic' mushrooms and LSD
https://www.insider.com/psychedelic-drugs-genes-that-may-affect-your-reaction-2021-11

"About 20% of people have a variant of the HTR2A serotonin gene that gives them extra receptors. More receptors for serotonin means they may be extra sensitive to it and more susceptible to the hallucinogenic effects of psychedelic drugs."

"The CYP2B6 gene affects how you metabolize ketamine via the liver. Between 10 and 20% of people have a variant that causes them to clear the drug from their system half as fast as others.

These "slow metabolizers" should be extra cautious about taking ketamine, since they're more likely to have a long or intense trip, according to HaluGen. They also have a higher risk for adverse reactions to the drug — such as drowsiness, unpleasant hallucinations, and confusion — especially if they inject it rather than taking it orally or nasally."

[Papa Coco]

Good information Dolly, thanks.

Any time I've ever gone online to buy mushrooms I've been hit with the decision of what kind to even order. Golden Teachers comes up as one of the available strains, but having no knowledge of mushrooms, the names of the possible purchases available were written in another language I don't speak. Since I'm already feeling like a criminal just looking at the catalogue, that is enough confusion to make me turn off the web and just keep wishing I could buy something to micro-dose with. as a trauma survivor, living in the feeling of lack and wishing for a miracle is just another day-in-the-life for me, so getting past it is tough to do. I can handle wishing for a miracle. My whole life has been spent wishing for things I believe I can't have.

I really want to get over my fear of purchasing some psylocibin in any form. Talk about letting my irrational fears control me! Even though mushrooms have been decriminalized in Washington State, I still have this fantasy vision that I'll order my first psylocibin and the FBI or CIA or Fish and Wildlife, or the cops will show up at my door with handcuffs. My well-practiced ability to expect the worst is not letting me get past it long enough to place an order. I know drugs like this are way safer than many FDA approved medications (Like opiots) but I grew up in a time when it was considered dangerous and "sinful" and so I struggle with all that stigma.

My body responds very quickly to stimulation. I get seriously loopy on Nitrous when I'm at the dentist. When I was an alcoholic, I drank only three Vodka martinis a day, but for me that was enough to put me into blackout drunk every single night. Ketamine is working fabulously for me. Any medication I've ever been given has worked fast, (not always for the better). So my assumption is that I have a liver that will allow me to gain great benefit from micro dosing....if I'll just allow myself to try it!

Meanwhile, I really, really appreciate all the resources you keep sharing, and your comments. You are helping me feel like micro-dosing isn't as far out of reach as I keep allowing my trauma to tell me it is.

Trauma. The gift that keeps on giving. I'm even afraid of the cure!

[dollyvee]

Hi PC,

That's an interesting part that won't let you buy them and I do believe that the previous generations grew up heavily influenced by the stigma around drugs, and what would become of you if you took them. I think I have a bit of it, but was also a teenager in the 90s and 00s when that was being challenged and the initial push to legalize was going on.

I guess I have a what's the worst that could happen approach. Although, I'm also sure I have a tendency to risky behaviour at times too. Being a recovering alcoholic, I could see why you might hesitate as well. I see the catalogue as an opportunity to maybe try different things and see what the different strains do. There are some trip reports, but I think a lot it is anecdotal. Certain strains are more potent, but maybe that can be a good thing. I saw what I think was my "Jungian shadow" when I tried some APE (even at a reduced dosage than normal). I think I had a better ability to focus with a different strain but that could have also been the added B3.

As I mentioned to Kizzie, I understand that psychedelics work on the centres in our brain which form the ego - how we think we are and how the world "is" (as a reflection of us etc) - and when we take them it works to dissolve the ego. So, our CPTSD self, and all it's need for control and to see the world in a certain way (ie safe) is affected, which can be good or bad ie maybe we need to integrate the things we see in a way that makes sense to us when we come out of that state.

I liked drinking as well but have basically stopped this past year and a half as I started detoxing. I always thought I had an issue with my liver because of a few "incidents" in the past, but the doctors never found anything. After I learned about mycotoxins (and SIBO to an extent), it made sense why my liver was so overtaxed and I could have a glass and half of wine and be blackout drunk. One of these "incidents" happened at a work drinks and I was told later by a medic who saw it, that my body gets toxic very fast. If I constantly had mycotoxins circulating through my bile and liver, I understand why my liver can't handle the extra load of alcohol on top. Genetic make up is also a factor, and it could be in my case, but I know that my reaction to alcohol got worse over time I think.

[Geneva]

this is such a promising and exciting area for recovery with a few cautions. Research is ongoing about who benefits and I'm wondering if anyone knows more about risks with triggering psychosis.

Further down the line, if not sooner more will be known about  risks with more vulnerable groups but my initial excitement last week (just recently fully realised the significance of this type of therapy for us) has been tempered by me having had a parent who experienced a psychotic episode in their 80's which resolved within 18 months. I'm now 60 and haven't had psychotic experiences but reckon the close relative experience is a contraindication. This isn't to say there wouldn't be benefits but probably any prescriber and therapist worth their salt would be cautious.



 

[Armee]

There's a week long psychadelics assisted therapy conference online this coming week that was free to register. https://www.psychedelicassistedtherapysummit.com/
I half intend on attending which means I probably won't. But maybe.

I've had the same worries as you with a bipolar mom which is contraindicated at least in the research circles. Having a first psychotic episode at 80 sounds unusual without a medical explanation. Wonder what happened...

Here are a couple thoughts that pop into my mind...

I haven't tried them yet. I'm pretty scared to. My therapist is definitely worth his salt but also not the most cautious or by the book therapist out there, which is partially why he has been such a great therapist for me at least.

He is gently suggesting I strongly consider them. This is because I have worked so hard and still have ptsd after 5 years of really hard work. I don't shirk things, I try the difficult things, we've done pretty much all the things and ptsd is still here though improving. He does know I have a family history of bipolar.

He is not a medical doctor though so I dont trust his opinion on this. If I decided I wanted to try we would get a consultation from someone qualified. Like you then last thing I want is to make things worse.

Are you able to get more information on what might have triggered your mom's very late in life psychosis? (ie did it preceed dementia or a uti? Was it psychosis or hallucinations etc because hallucinations can be somewhat common in elder populations in a way that isn't psychosis.)

I guess if I were you and really wanted to explore it I'd probably try to get to the bottom of what happened with my mom and then seek a consultation with an expert in the field based on whatever medical information you have available.

If I listen in to the summit and hear something interesting that addresses this I'll write it down here.

[Kizzie]

Geneva, Papa Coco has had success with Ketamine so you might PM him or search his posts.  I know it's only one person but at least it's some hands-on experience and it has worked well for him I think.

I will say I tried it and it did not go well for me but I am known to have reactions to drugs/medications so am probably not the best person for this particular type of therapy. 

[Geneva]

Armee, it was my dad who was highly narcissistic and when he got a terminal cancer diagnosis in his early 80's, it rocked his core. A man whose identity was caught up with physical fitness and health, finally saw his demise which he had no control over- he was aiming to be 100. He was pretty emotionally fragile anyway as most narcissists are and allowed himself to crumble / fragment after this news. Declining some treatments and opting for lithium, he eventually got up and running again without meds and died of cancer not long after.

Actually I don't have a lot of detail about his experience other than the diagnosis of 'psychotic depression' but remember he said he was responsible for burning down the hospital he was staying in at the time but thought it may have just been a dream (the hospital didn't burn). I'm able to access his medical records if needed in future.

It does feel a risky business, I've never even smoked a cigarette but the evidence is pretty compelling, albeit not for everyone.

Thanks for the conference link - have subscribed so will post here if I manage to tune into any of the sessions. Good timing, as I'm keen to learn more. 

Having only tuned in to psychedelic's potential this past week, my therapist is also encouraging but I'd forgotten to raise the family psychotic episode. I'm hoping there's a way through this, although I'm also cautious and fearful.

many of us have histories of close family also being affected by trauma and/or possibly a genetic predisposition to certain reactions, will root around a bit more. Glad your therapist is supportive. I think most therapists will have knowledge of other therapists working in this way, or knowledge of people benefitting from this treatment even if they're not carrying it out themselves.

[Geneva]

thanks Kizzie, it's not going to be in everyone's toolbox. I'll look up Papa Coco's posts.

[Armee]

I think it's pretty common for older adults to have episodes of psychosis in a hospital setting...weird medication reactions, infections, unfamiliarity... I personally wouldn't be very concerned about that as a contraindication for psychadelic therapy.

For what it's worth the one my therapist seems to think has the most promise for me is MDMA, not psilocybin. I won't touch ketamine but that's because of avoidance related to my specific trauma.

[Geneva]

yeah, this was a pretty full blown psychosis starting prior to psychiatric hospital admission.

MDMA looks promising, a different experience but the sense of fearlessness, connectivity and empathy inducing qualities during the experience will bring up a lot of material for integration.

[Geneva]

Been listening to a few recordings from the online psychedelic assisted therapy conference. Looks like these are taster sessions before the run up to the main summit in October 2024. Last year's full summit recordings are also available.

Not sure contraindications were fully explained, other than acknowledging that's an issue for the service provider and may well vary. There were healers working from their indigenous traditions who were more of the view that they can intuit who will benefit or not and don't rely on classifications or categories from DSM/ICD11 etc

Some also talking about altered states not needing to be reached via plants and chemicals, but other means like meditation. There was a session on holotropic breathing, a method developed when psychedelics were banned but where participants advised not to do if they already experience panic attacks. So, horses for courses.

Interesting stuff. 

[dollyvee]

Hi Geneva,

I've been using psilocybin in small microdoses over the past year and feel it's been very helpful in migitigating some cptsd symptoms, and allowing me to break into some (dissociated) parts that are in "control," or driving the bus. I've also been clearing some mycotoxins during this time and feel it's also been helpful with inflammation, neuroinflammation, and anxiety. There is a history bipolar in my family tho that is through a half-uncle and could very well be from the grandfather's side.

I use it intentionally, setting a phrase or intention and trying to journal (work out) what is going on using dreams, experiences, emotional reactions etc. My t is also aware that I am doing this. I have tried a "macro" dose (around 600mg) last year, but found it made me sleepy. I came across an article about psychedelics, dissociation and sleepiness, which I think I posted somewhere on here. Psilocybin also affects seerotonin levels in the brain and can be related to sleepiness, but I believe this is something different. There's a clinic that recommends working with MDMA first as means to lessen dissociation and work with some of the issues causing that first. I'm interested to know more, but haven't been able to find anything on it really.

Just my two cents, but I think there's probably a lot of cultural ideas around taking "drugs" after decades of "the war on drugs" ideas etc which are now being overturned really with laws relaxing. Holotropic breathing was developed by Stanislav Grof who administered LSD for psychological purposes during the 50s and 60s. I find his work very interesting and well worth a read. I liked The Cosmic Game: Explorations on the Frontiers of Human Consciousness.

All the best with your search,
dolly

[Geneva]

that's interesting dolly, sounds like you're taking the medicine on your own rather than it being delivered in a therapeutic session. Maybe that's the benefit of smaller doses, being able to integrate experiences during later therapy sessions. Have only  been reading about retreats and research trials so far. Hope it continues to bring good things.