Psychedelics against mental disorders? New research advances

Psychedelics against mental disorders? New research advances
Psychedelics against mental disorders? New research advances

They will not be a miracle cure, but psychedelic or related substances have regained the favor of psychiatric researchers. Some trials are being carried out in France, within a strictly supervised framework. Explanations with psychiatrist and researcher Lucie Berkovitch.

Psychedelic substances (LSD, mescaline, psilocybin, etc.) are classified as narcotics and produce hallucinations. Since when have they been given medical use?

There were numerous studies on these substances in the psychiatric field, before the prohibition of the 1970s, with fairly disparate results. It has once again become a very active field of research over the past ten years, particularly in the United States, Great Britain and Switzerland, with an increasing number of scientific publications.

In what indications
are these substances tested worldwide?

The indications tested so far are resistant depression, anxiety linked to the end of life, tobacco and alcohol addictions. We have some more recent data on what we call generalized anxiety disorder. There are also some rather promising results in obsessive-compulsive disorder. Beyond psychedelics in the strict sense, ketamine has been marketed for several years to treat resistant depression, and MDMA (ecstasy) is on track to obtain authorization by the United States Medicines Agency for the treatment post-traumatic stress.

How do psychedelics
do they work?

They bind to serotonin receptors, called 5TH2A. They somehow pretend to be serotonin (a neurotransmitter which plays a role in regulating mood, among other things). This mechanism is different from that of antidepressants, which prevent the breakdown of serotonin naturally produced by the brain. This is why antidepressants take several weeks to become effective. With psychedelics, this direct action on the receptors can give immediate effects!

Lucie Berkovitch, psychiatrist at Sainte-Anne hospital in Paris, and researcher at CHU Paris psychiatry and neurosciences. | DR
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Lucie Berkovitch, psychiatrist at Sainte-Anne hospital in Paris, and researcher at CHU Paris psychiatry and neurosciences. | DR

How can this improve
the results of psychotherapy?

The dominant hypothesis is that this activation of receptors will increase brain plasticity, the ability of neurons to create more connections between them. And thus facilitate the integration of new information. It is assumed that psychotherapy will thus have more impact, because the person will be able to more easily change their thought patterns.

Is this detected
in neuroimaging?

There is greater activity in sensory regions, associated with an amplification of perception. We also observe a decrease in activity in regions that are dedicated to reasoning or interpreting our senses. And then modifications in the structures that are involved in the perception of self and emotions, with a lesser reaction to negative emotions, and a lesser tendency to focus on oneself. Some of these regions play a role in anxious ruminations (editor’s note, having negative thoughts that go around in a loop) which are often suspended during the psychedelic experience.

Is the psychedelic effect
necessary to obtain a therapeutic effect?

The onset and intensity of the psychedelic effect depend on the dose received. In studies, patients are given hallucinogenic doses and often feel that the improvement is closely linked to the experience they had. Are hallucinations necessary? We don’t know yet. My bet is that there is effectiveness independently of the psychedelic experience, but that the latter reinforces the placebo effect and amplifies
the clinical response. Among manufacturers, some are working to synthesize similar products, which would activate serotonin receptors without inducing a psychedelic effect.

“Clinical trials on resistant depression by the end of the year”

What is authorized or tested in France?

Ketamine, which works a little differently from psychedelics (it does not produce hallucinations but a sensation of dissociation from the body) is used in several hospitals to treat resistant depression or suicidal crisis. A clinical study on psilocybin against alcohol use disorders began a few months ago in France (including the European Psi-Alc study). Other clinical trials for resistant depression are expected to begin by the end of the year.

Using narcotics against
addiction, isn’t that paradoxical?

Addiction is getting stuck in repeated, uncontrollable behaviors that lead to negative consequences. There is no strong addictive potential of psychedelics in themselves; they are generally consumed occasionally and do not lead to a “come down” or signs of withdrawal that prompt them to take more again.

And how to limit the risk of bad trip during clinical trials?

It’s true that the main risk is that the experience goes badly and promotes the appearance of psychiatric symptoms. This risk depends a lot on how the psychedelics are taken and the individual’s risk of developing a disorder like schizophrenia or bipolar disorder. Today, in clinical studies, particular care is taken in the selection of people who receive these treatments. And the shots are done in a secure environment, with specialized support. So there were no cases of psychiatric decompensation in these studies. But we must remain attentive to these risks.



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