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Do psychedelics really work to treat depression and PTSD? Here’s what the evidence says

<a href="https://theconversation.com/profiles/sam-moreton-194043">Sam Moreton</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> As of July 1, authorised psychiatrists have been allowed to prescribe MDMA (the chemical found in “ecstasy”) to treat post-traumatic stress disorder (PTSD), and psilocybin (found in “magic mushrooms”) to treat depression that hasn’t responded to other treatment. Psychedelic therapies have researchers excited because evidence suggests they might have lasting beneficial effects on factors that cause psychological distress beyond the treatment period. These include <a href="https://link.springer.com/article/10.1007/s00213-017-4701-y">feeling disconnected from other people</a>, <a href="https://link.springer.com/article/10.1007/s00213-019-05391-0">fear of death</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S2212144719301140?casa_token=OP6tKGxjPHAAAAAA:NTQ4khgsOY5wmsQ5HzCMcZ4eZ43wQV-sdhUbf5LXFiIeKWNwdonhfCxo77k7QbNk4G69EfX-">rigid ways of thinking</a>. This stands in contrast to most medications for psychological issues, which only directly help while people keep taking them regularly. But how strong is the evidence for psychedelic therapy? <h2>Early promise</h2> Early results from studies around the world have found psychedelic therapy <a href="https://www.ranzcp.org/getmedia/0cf57ea2-0bd7-4883-9155-d2ba1958df86/cm-therapeutic-use-of-mdma-for-ptsd-and-psilocybin-for-treatment-resistant-depression.pdf">might be effective</a> for treating a range of psychological issues. For instance, most studies (<a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032994">but not all</a>) have found patients tend to report <a href="https://pubmed.ncbi.nlm.nih.gov/37357767/">fewer depression symptoms</a> for periods ranging from several weeks to several months after psilocybin therapy. Similarly, studies have found <a href="https://journals.sagepub.com/doi/10.1177/0269881120965915">reductions in PTSD symptoms</a> three weeks after MDMA therapy. <h2>Not so fast</h2> However, as psychedelic research has grown, <a href="https://pubmed.ncbi.nlm.nih.gov/35243919/">limitations</a> of the research have been identified by researchers both <a href="https://psyarxiv.com/ak6gx/">within</a> and <a href="https://www.sciencefictions.org/p/psychedelics">outside</a> the psychedelic field. One issue is that we aren’t sure whether findings might be due to a <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/placebo-effect">placebo effect</a>, which occurs when a treatment works because people expect it to work. In clinical trials, participants are often given either a medication or a placebo (inactive) drug – and it’s important they don’t know which they have been given. However, due to the strong effects, it is difficult to prevent participants from knowing whether they have been given a psychedelic drug. Researchers have tried to use a range of different drugs (such as Ritalin) as a placebo in order to “trick” those participants not given a psychedelic into thinking they have received one. But this can be difficult to achieve. In 2021, researchers <a href="https://www.tandfonline.com/doi/full/10.1080/17512433.2021.1933434?casa_token=Dovn7x_rkdUAAAAA%3AsPzBTYNTPnNwqj9NvwN0m9ptrP4x4-c83gp3tGcshs30dWHNnmB_Vx-X5H5Y3pZJdG02IWW6X2E">reviewed</a> clinical trials involving psychedelics such as LSD, psilocybin, and dimethyltryptamine (found in animals and plants) for mood and anxiety disorders. They found trials either had not assessed whether participants guessed correctly which drug they had been given, or that this had been tested and participants tended to guess correctly. More recent trials <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032994">either don’t measure this</a> or find participants have a <a href="https://journals.sagepub.com/doi/full/10.1177/02698811231154852?casa_token=VsPt344fVGwAAAAA%3AA-i1VPBE1EWyFITWNncZEt876lWMiC7rtTOLJBQnb2pHI2775imUJhrzeSZW6r9doaBeDaj61D0">pretty good idea</a> of whether they’ve had a placebo or a psychedelic drug. Given the publicity and excitement around psychedelic research in recent years, it is likely most participants have <a href="https://culanth.org/fieldsights/the-pollan-effect-psychedelic-research-between-world-and-word">strong beliefs</a> such therapies work. This could lead to a significant placebo effect for participants given a psychedelic dose. Additionally, participants who realise they have received a placebo could experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10184717/">disappointment and frustration</a>, resulting in worse symptoms. The benefits of a psychedelic may seem even greater when they are compared to the experiences of disappointed participants. <h2>Translating trials to practice</h2> Anecdotally, patients might be motivated to report they have gotten better, even when they haven’t. On a 2021 podcast, one clinical trial participant <a href="https://www.psymposia.com/powertrip/">described</a> how, in hindsight, the information they provided to the trial did not accurately capture the worsening of their symptoms. Trial participants are likely aware their results might affect whether treatments are legalised. They may not want to “ruin” the research by admitting the treatment didn’t work for them. There is also uncertainty about whether the findings from clinical trials mean treatments will work in private practice. There may be a lack of clarity around <a href="https://psyarxiv.com/ak6gx/">how trial participants</a> are recruited and selected. Therefore participants may not represent the typical person with PTSD or treatment-resistant depression. And while <a href="https://journals.sagepub.com/doi/full/10.1177/02698811211069100">the safety of psychedelics</a> within controlled contexts is often emphasised by advocates, less is known about safety of psychedelic therapy <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2021.737738/full">outside</a> clinical trials. <h2>Resolving issues</h2> These issues do not mean the promising psychedelic research conducted over the past several decades is worthless. Nevertheless, a <a href="https://pubmed.ncbi.nlm.nih.gov/35285280/#full-view-affiliation-1">recent review</a> of the effects of MDMA and psilocybin on mental, behavioural or developmental disorders by Australian researchers concluded the “overall certainty of evidence was low or very low”. Dutch researchers recently drafted a <a href="https://psyarxiv.com/ak6gx/">roadmap for psychedelic science</a> with a checklist for future research to help avoid these pitfalls. When more research is done, it might turn out psychedelic treatments help patients and don’t come with unacceptable harms – we simply don’t know that yet.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208857/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sam-moreton-194043">Sam Moreton</a>, Associate Lecturer, School of Psychology, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-psychedelics-really-work-to-treat-depression-and-ptsd-heres-what-the-evidence-says-208857">original article</a>.

Mind

‘Psychological debriefing’ right after an accident or trauma can do more harm than good – here’s why

<a href="https://theconversation.com/profiles/richard-bryant-161">Richard Bryant</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> The recent <a href="https://www.abc.net.au/news/2023-06-18/hunter-valley-wedding-bus-crash-survivors-remain-in-hospital/102487630">tragic bus accident</a> in the New South Wales Hunter Valley has again raised the issue of how we address the potential psychological effects of traumatic events. It is interesting we revisit the same debate after each disaster, and few lessons have apparently been learned after decades of research. After the Hunter Valley accident, immediate psychological counselling was <a href="https://www.theguardian.com/australia-news/2023/jun/15/hunter-valley-bus-crash-company-issued-with-defect-notices-after-police-raid">offered to those affected</a>. While we can’t say what form of counselling was offered, the traditional approach is known as “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118833/">psychological debriefing</a>”. This typically involves counsellors providing trauma survivors with a single counselling intervention within days of the event. Although the content of the intervention can vary, it usually involves education about stress reactions, encouragement to disclose their memories of the experience, some basic stress-coping strategies and possibly referral information. But the evidence shows this approach, however well-meaning, may not help – or worse, do harm. <h2>The belief that feelings must be shared</h2> The encouragement of people to discuss their emotional reactions to a trauma is the result of a long-held notion in psychology (dating back to the classic writings of Sigmund Freud) that disclosure of one’s emotions is invariably beneficial for one’s mental health. Emanating from this perspective, the impetus for psychological debriefing has traditionally been rooted in the notion trauma survivors are vulnerable to psychological disorders, such as post-traumatic stress disorder (PTSD), if they do not “talk through their trauma” by receiving this very <a href="https://journals.sagepub.com/doi/full/10.1177/1529100610387086">early intervention</a>. The scenario of trauma counsellors appearing in the acute aftermath of traumatic events has been commonplace for decades in Australia and elsewhere. Following the 9/11 terrorist attacks in New York City in 2001, up to 9,000 counsellors were mobilised and more than <a href="https://www.nytimes.com/2002/07/22/nyregion/finding-cure-for-hearts-broken-sept-11-is-as-difficult-as-explaining-the-cost.html">US$200 million</a> was projected to meet a surge in mental health needs. But fewer people than expected sought help under this program and $90 million remained <a href="https://theconversation.com/9-11-anniversary-a-watershed-for-psychological-response-to-disasters-2975">unspent</a>. <h2>What do we know about psychological reactions to disasters?</h2> The overwhelming evidence indicates the majority of people will <a href="http://www.psychologicalscience.org/publications/journals/pspi/weighing-the-costs-of-disaster.html">adapt</a> to traumatic events without any psychological intervention. Long-term studies indicate approximately 75% of trauma survivors will not experience any long-term distress. Others will experience short-term distress and subsequently adapt. A minority (usually about 10%) will <a href="https://journals.sagepub.com/doi/10.1177/1529100610387086">experience chronic psychological problems</a>. This last group are the ones who require care and attention to reduce their mental health problems. Experts now agree other trauma survivors can rely on their own <a href="https://www.rcpsych.ac.uk/mental-health/problems-disorders/coping-after-a-traumatic-event">coping resources and social networks</a> to adapt to their traumatic experience. The finding across many studies that most people adapt to traumatic experiences <a href="https://journals.sagepub.com/doi/10.1177/1529100610387086">without formal mental health interventions</a> has been a major impetus for questioning the value of psychological debriefing in the immediate aftermath of disasters. In short, the evidence tells us universal interventions – such as psychological debriefing for everyone involved in a disaster – that attempt to prevent PTSD and other psychological disorders in trauma survivors are not indicated. These attempts <a href="https://journals.sagepub.com/doi/10.1177/1529100610387086#bibr448-1529100610387086">do not prevent</a> the disorder they are targeting. <h2>Not a new conclusion</h2> In the aftermath of the 2004 Indian Ocean earthquake and tsunami, the World Health Organization listed a warning (which <a href="https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/other-significant-emotional-and-medical-unexplained-somatic-complaints/psychological-debriefing-in-people-exposed-to-a-recent-traumatic-event">still stands</a>) that people should not be given single-session psychological debriefing because it is <a href="https://journals.sagepub.com/doi/10.1177/1529100610387086#bibr448-1529100610387086">not supported</a> by evidence. Worse than merely being ineffective, debriefing can be <a href="https://www.jenonline.org/article/S0099-1767(19)30453-2/fulltext#:%7E:text=It%20is%20for%20these%20reasons,%2C%20anxiety%20or%20depressive%20symptoms.%E2%80%9D">harmful for some people</a> and may increase the risk of PTSD. The group of trauma survivors that are most vulnerable to the toxic effects of debriefing are those who are more distressed in the acute phase right after the trauma. This group of people have worse mental health outcomes if they are provided with early debriefing. This may be because their trauma memories are over-consolidated as a result of the emotional disclosure so shortly after the event, when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/#:%7E:text=Brain%20areas%20implicated%20in%20the,norepinephrine%20responses%20to%20subsequent%20stressors.">stress hormones</a> are still highly active. In normal clinical practice a person would be assessed in terms of their suitability for any psychological intervention. But in the case of universal psychological debriefing there is no prior assessment. Therefore, there’s no assessment of the risks the intervention may pose for the person. <h2>Replacing debriefing</h2> Most international bodies have shifted away from psychological debriefing. Early intervention might now be offered as “<a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/psychological-first-aid">psychological first aid</a>”. This newer approach is meant to provide <a href="https://www.who.int/publications/i/item/9789241548205">fundamental support and coping strategies</a> to help the person manage the immediate aftermath of adversity. One of the most important differences between psychological first aid and psychological debriefing is that it does not encourage people to disclose their emotional responses to the trauma. But despite the increasing popularity of psychological first aid, it is difficult to assess its effectiveness as it does not explicitly aim to prevent a disorder, such as PTSD. <h2>Wanting to help</h2> So if there is so much evidence, why do we keep having this debate about the optimal way to assist psychological adaptation after disasters? Perhaps it’s because it’s human nature to want to help. The evidence suggests we should monitor the most vulnerable people and target resources towards them when they need it – usually some weeks or months later when the dust of the trauma has settled. Counsellors might want to promote their activities in the acute phase after disasters, but it may not be in the best interest of the trauma survivors. In short, we need to develop better strategies to ensure we are meeting the needs of the survivors, rather than the counsellors. <hr /> If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208139/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/richard-bryant-161">Richard Bryant</a>, Professor & Director of Traumatic Stress Clinic, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/psychological-debriefing-right-after-an-accident-or-trauma-can-do-more-harm-than-good-heres-why-208139">original article</a>.

Caring

"Get my voice back": Kathy Griffin's intense pre-op drama

Kathy Griffin has shared footage of her pre-operation appointment before she undergoes vocal cord surgery in an effort to save her voice. The American comedian took to TikTok to show fans the process of her surgeon sticking a camera scope up her nose and through to her vocal cord to get a clearer view of the damage. "First step is the numbing spray. Then the scope goes up the nose, down into the vocal cords!" she explained with captions. "As you can see, the left chord is paralyzed.” After she was instructed to make noises to test the cords, Griffin is seen following the doctor’s orders and watching her vocal cord movement on the screen. Griffin reflected post-operation in the same clip, with the 62-year-old lying in a recovery bed following the surgery. <div><iframe title="tiktok embed" src="https://cdn.embedly.com/widgets/media.html?src=https%3A%2F%2Fwww.tiktok.com%2Fembed%2Fv2%2F7242029180651687214&display_name=tiktok&url=https%3A%2F%2Fwww.tiktok.com%2F%40kathygriffin%2Fvideo%2F7242029180651687214&image=https%3A%2F%2Fp19-sign.tiktokcdn-us.com%2Fobj%2Ftos-useast5-p-0068-tx%2F202ea4a9813e435c92a1c6996f018c11_1686166329%3Fx-expires%3D1686236400%26x-signature%3D%252Bk5fTTtG0O6jMWR7Pnky9ekvIlw%253D&key=5b465a7e134d4f09b4e6901220de11f0&type=text%2Fhtml&schema=tiktok" width="340" height="700" frameborder="0" scrolling="no" allowfullscreen="allowfullscreen"></iframe></div> "I just had my latest surgery on my left vocal cord, because I want to be in good shape for my big Vegas show," she said. "This is just part of my recovery post-lung cancer surgery," she added. "I'm cancer-free, so anyway a little scratchy today, but I'll be in good shape.” "I so appreciate you guys following along on my journey to get my voice back after lung cancer,” Griffin captioned the video, also sharing it to her Instagram. Griffin had part of her lung removed in 2021 after being diagnosed with lung cancer and was in remission four months later. Her latest hospital visit comes after she revealed her diagnosis of “complex PTSD” in early 2023. Griffin shared her diagnosis in a TikTok in April, asking her followers for recommendations on how to cope with anxiety and depression. "Let's talk about PTSD. Never talked about it publicly," she said. "You can laugh or whatever, but I've been diagnosed with complex PTSD, and it's called an extreme case." Image credit: TikTok

Caring

New psychedelic treatment for PTSD discovered

A new study has found that the key ingredient in the illicit drug known as Ecstasy or Molly could ease the symptoms of post-traumatic stress disorder. When combined with intense talk therapy, the study reports that MDMA significantly eased symptoms in those struggling with severe PTSD. “This is a big deal,” Steven Gold, a clinical psychologist in Fort Lauderdale and professor emeritus at Nova Southeastern University in Florida told <a href="https://www.sciencenews.org/article/mdma-ecstasy-ptsd-symptoms-psychedelic-psychology?utm_source=email&utm_medium=email&utm_campaign=latest-newsletter-v2&utm_source=Latest_Headlines&utm_medium=email&utm_campaign=Latest_Headlines">ScienceNews</a>. “All other things being equal, the use of psychedelic medication can significantly improve the outcome.” Though <a href="https://www.nature.com/articles/s41591-021-01336-3#citeas">the findings</a>, published in Nature Medicine, are preliminary, they offer hope to the millions of people with PTSD who are in desperate need of new treatments. Antidepressants such as Zoloft and Paxil are often prescribed to these patients, but don’t work for an estimated 40 to 60 percent of people with PTSD. How did they test it? The study involved 90 people across 15 sites in the United States, Canada, and Israel. All participants received 15 therapy sessions with therapists who were trained to guide people experiencing the drug. Of the 90 participants, half received MDMA in three eight-hour therapy sessions while the other half received placebos. MDMA, true to its nickname Ecstasy, evokes feelings of bliss and social connectedness. Those who took either the drug or the placebo wore eye covers, listened to music, and occasionally talked to their therapist about their experience during the sessions. By the end of the 18-week trial, most participants showed fewer PTSD symptoms such as unwanted, intrusive memories. But, those who took MDMA experienced the best benefits. By the trial’s end, 67 percent of the participants taking MDMA had improved so much they no longer qualified for a PTSD diagnosis. In comparison, 32 percent of those taking the placebo no longer met the criteria for a PTSD diagnosis by the end of the study. Many participants had been living with severe PTSD for years. “Typically, we see PTSD as a disorder for life. Now, we may begin to let that go,” said Eric Vermetten, a psychiatrist at the Leiden University Medical Centre in the Netherlands who works with veterans and military members with PTSD and was not involved in the study. Though it isn’t exactly clear how the drug changes the brain, some imaging studies suggest MDMA dampens activity in the amygdala, a structure in the brain involved in fear. Other results from studies in mice suggest the drug may heighten social learning, which may strengthen the relationship between a patient and their therapist. The study did require a significant amount of emotional work before, during and after the MDMA sessions too. “[MDMA] is not a magic pill,” co-author Amy Emerson said. Since more than 75 percent of the cohort were white, Gold said it is unclear whether the effects would be similar with a more diverse group of people. Nor is it clear how long the effects might last. Another clinical trial is in the works, but restrictions on MDMA in the United States have complicated future research. “There are a lot of barriers to break down related to this treatment,” Emerson said. “And there is a lot of hope.”

Mind

Queen Elizabeth and her corgis help PTSD sufferer

A war surgeon has shared an incredibly touching story of how the Queen and her corgis came to his rescue when he had a sudden episode of PTSD. During a visit to Buckingham Palace in 2014, Dr David Nott, a top vascular surgeon, was speaking to the Queen about his achievements when he was suddenly overcome by an episode of PTSD. Dr Nott has volunteered at Doctors Without Borders and the British Red Cross for over 20 years, in crisis areas such as Sarajevo and Afghanistan. He had just returned from Syria 10 days earlier, where he had operated on gravely injured children. <img src="https://pbs.twimg.com/media/CkRKi0eUgAAy9x6.jpg" style="width: 399px; top: 0px; display: block; margin-left: auto; margin-right: auto;"/> “She must have detected something significant,” Dr Nott told BBC Radio Four’s Desert Island Discs on Sunday. “I didn’t know what to say to her. It wasn’t that I didn’t want to speak to her – I just couldn’t. She picked all this up and said, ‘Well, shall I help you?’ I thought, ‘How on earth can the Queen help me?’” Dr Nott went on the share how the Queen instantly knew what to do, saying, “All of a sudden the courtiers brought the corgis, and the corgis went underneath the table. And she went to one of the courtiers and said, ‘Can we open up that, please?’ So she opened up this lid and there was a load of biscuits. So she got one of the biscuits and broke it in two and said, ‘Okay, why don’t we feed the dogs?’” “And so for 20 minutes during this lunch, the Queen and I fed the dogs. She did it because she knew that I was so seriously traumatised. You know, the humanity of what she was doing was unbelievable.” The compassion shown by the Queen helped Dr Nott through his episode and he was able to regain his strength. “Stroking animals, touching them and feeding them – we just talked about the dogs and how many she had. She was just so warm and so wonderful. I will never forget it.” Related links: <a href="/entertainment/art/2016/06/buckingham-palace-recreated-in-jelly-form/">Pimm’s creates jelly Buckingham Palace for Queen’s birthday</a> <a href="/news/news/2016/06/queens-10-favourite-songs-right-now/">The Queen’s 10 favourite songs right now</a> <a href="/news/news/2016/06/rare-photos-63rd-anniversary-queen-coronation/">Rare photos of Queen’s coronation released on 63rd anniversary</a>

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