Psychedelics and Mental Health

A discussion of emerging trends in psychedelic use, the potential clinical advances, and the importance of following the data.

Transcript

Marissa: So welcome back everybody! We are covering an important topic today that you might be seeing trending in the news: psychedelics and mental health. So, we brought in a special guest, Jen Talarico, who is a senior counselor here at SUNY Cortland, to talk about this and navigate through everything with us. So welcome, Jen!

Jen: Thank you for having me 

Marissa: As a little disclaimer before we hop into everything: Listen to this episode in its entirety, not necessarily the parts you want to hear. There might be some promising findings with this, but let's not get ahead of the data. This is in a controlled setting with professionals, and we'll cover a lot more of this throughout the episode, but take this whole episode as a whole.

So, before we start talking about some of this data, let's talk a little bit about what psychedelic are. Sarah, could you walk us through that a little bit? 

Sarah: Absolutely. So there are some different types of psychedelics, but basically psychedelics are a class of psychoactive substances that produce changes in your perception mood and your brain processes.

So, these can also be referred to a hallucinogens. So it's important to note that the vast majority are schedule 1, drugs and unfortunately, this greatly limits the ability to do research on these types of drugs. They're deemed by the DEA to have no accepted medical use, and a high potential for abuse. 

So, according to the 2020 national survey on drug use and health, 7.3% of adults age, 18 to 25 have used hallucinogens in the last year. 

This list is not extensive, but because of time restrictions, we're just going to kind of cover a few of the most popular ones and kind of the ones we're going to do a deeper dive into today. So in terms of classic hallucinogens, that I think most people kind of know about is LSD. So this is also known as acid. This is made from lysergic acid, which is a fungus that grows on rye and other grains.

Psilocybin, aka Shrooms, comes from mushrooms, found in tropical places in the US, Mexico and South America. 

Then we have MDMA, Molly, or ecstasy - so it's really interesting because this has both stimulant and hallucinogenic qualities. So this is another fun fact, whereas we're talking about fun facts. So, Molly actually got its name, because it's supposed to be the molecular form of MDMA when, in reality now, it's actually mostly other drugs. So, synthetic drugs, caffeine sometimes fentanyl whatever people can kind of, get their hands on the easiest. 

Ketamine is the surgery drug for animals in humans. A lot of the illicit ketamine comes from vets offices. So this can come into powder form, liquid pill form.

So just for this episode, we'll be talking about the use of ketamine, psilocybin/mushrooms and MDMA/ecstasy in controlled settings. So I just wanted to kind of add before we get into what the data says.

It's really interesting too, because there are a lot of synthetic drugs that can exhibit hallucinogenic qualities, but they fall into the category of synthetic. I don't know, Jen, if you, you have any ideas about synthetics…

Jen: Okay so I think the scary thing when it comes to synthetic hallucinogens, is that we don't necessarily know what is in them or where they're coming from when it comes to bath salts or, you know, other substances.

We don't know, you know, is this bleach, battery acid? Things that could be toxic to our body that we really don't know what we're putting into our body. And actually, you know, for some of the substances we already talked about as far as hallucinogens, we're going to go more into today.

We think they're natural, maybe where they're coming from, but we don't know that. For sure either. Those could also be synthetic and we're not really sure what has gone into the process of making. 

Sarah: Yeah, absolutely. That makes complete sense. Mariss, do you want to tell us a little bit about what the data say on, you know hallucinogens?

Marissa: Yeah! So when we started this episode, we talked about listening to everything as a whole. But there are some promising findings, but we always have to remember not getting ahead of the data. There is a huge difference between therapeutic uses in a clinical setting, verse recreational use - for fun with your friends. You can't just like pop a Molly and say that you've cured your depression. It doesn't work that way.

So some of the interesting findings, but under controlled settings: so there's the current evidenced-based research for the 3 best studied psychedelic medicines like Sarah said before - ketamine, psilocybin, and MDMA 

Those substances are using a gold standard way to investigate a treatment worthiness of FDA approval. So there are interesting findings, but in order for something to be considered the gold standard in an investigation, they need to use direct, randomized, double blind comparisons, using a multi centered approach.

So this is science talks for saying, a bunch of researchers at a bunch of different institutions in places, ran a study and they didn't know who got a psychedelic and who didn't. So, Jen, are there potential problems with this?

Jen: Yeah. So the complicated piece with this is where the studies are all different, right? Like a lot of the places that maybe are taking into account, not wanting to cause further trauma, you know? It's hard to sign up for a study if you've never done psychedelics before. Right? 

So the problem with doing the placebo is well, they're going to have a reaction or they're not going to have a reaction.

Marissa: You’re either on shrooms or you’re not.

Jen: Yeah so that is the hard thing with having a placebo on this is that a lot of the studies are actually showing that people are just signing up with the expectation that they're probably going to be getting this.

Marissa: Taking all of that into consideration when something is in that gold standard, psilocybin has been found to have a positive impact on people with major depressive disorder.

MDMA is showing some promising results in the treatment of post-traumatic stress and substance and alcohol use disorders. This doesn't mean that you can swap your White Claws for a Molly this is in a controlled setting. 

Ketamine has also shown potential in the treatment of bipolar disorder and depression when options of traditional medication had been exhausted.

So, that's what we need to keep in mind that some of these studies are also in the early stages they're going through clinical trials. There might be some compelling findings, but there's a lot more research to be done.

Sarah: Keep in mind that these are people who've been diagnosed by professionals with these disorders, not just people who have self-diagnosed themselves. A lot of people's self-diagnose, especially with web M. D these days, everyone can be like a keyboard doctor typing in their symptoms and figuring out what's wrong with them. But these are people who have actually been diagnosed with these conditions.

Therefore, you know, these medications have been found to be helpful under specific circumstances with specific conditions.

Marissa: So aside from psychedelic, being from that regulated source - not from your buddy growing shrooms in their backyard…What could this look like in practice? Psychedelic therapy is more like elevated talk therapy experience that requires special care and supervision.

Like Sarah just mentioned, it's done in a setting with a trained professional and all parties are aware that this is happening. So, you can't just, like, drop acid and go to your therapist and then leave them in the lurch that you're on a psychedelic and they're here talking to you and they have no idea. So, Jen, tell me a little bit about who and what qualifies for this sort of treatment?

Jen: Again just really reiterate what you just said, Marissa about how this treatment is with a trained professional. They've been carefully trained, they’ve been supervised, and it’s in a controlled setting with regulations with safety protocols that are in place.

So, with that in mind, you know, I think of the analogies of seeking professional treatment - so if you or a loved one were diagnosed with diabetes, you wouldn't just start giving yourself insulin or giving your family member insulin, right? You would want to speak to a professional - someone who's very specialized. They know exactly what medications, what treatment care plan… because it isn't just about the psychedelic use, this is about a treatment plan that goes with that. 

What comes along with this treatment is, you know, an intensive history study. They're going to look at your history: what's worked what hasn't worked? They're going to want to look at brain chemistry. What level of dosage should they be giving you? What specific treatment? What chemicals right? Which substance should they be giving you? And then they want to monitor it with MRIs. They want to have baseline for brain activity to see in between each treatment. What's working? What's not working? Let's go back to the drawing board. Let's change the dosages around.

Studies have shown that a provider that understands the biological and psychological experiences at the same time is what works the best. 

So, again, you know, when you're doing this for fun, as discussed earlier, is a much different experience in treating it from a mental health perspective, right? You might be with your friend who might have an idea biologically what's going on, but psychologically they're not going to know how to treat. This is going to be a trained professional that knows this.

Also in the setting, you're going to have professionals who know what to do if something goes wrong. They're going to have drugs and whatever safety equipment/ medications they need to neutralize it, if something does need to happen for safety reasons.

Sarah: Can I ask a question too quickly? Sorry I don't want to interrupt but like, what if someone has been using psychedelics for a long time, but they're using a certain quality of psychedelics, and then all of a sudden they're using the medical grade quality, and its two completely separate drugs? 

Jen: Yes, that's a wonderful question. And not to sound funny, but really who knows? Right? I mean, that's the scary thing. Could it be a much stronger combination what they've been using also, these medically trained professionals, have it down to the exact amount of what they're giving you, they know exactly what's in it every single time. What individuals are getting… where do they buy it from? Who is making it? How are they making it? No one really knows.

Sarah: what are the drawbacks so what are, what are some of the negative things that can can come from this type of treatment?

Jen: So, I think when it comes to the drawbacks, a lot of the times when we're using on our own, like, if someone is using recreationally. I think thinking about what kind of an   you're in, and what kind of environment you're in.

You know, if someone isn't aware of their own mental health, or even, you know, what day they've had - what's going on in the world around them? This could really result in a negative experience. Right? Like a bad trip… and a bad trip can last for a really long time.

If someone has issues in their life with loss of control, taking a 12 hour trip might not be in their best interest. This could be a really traumatic experience in itself. 

I hear a lot that individuals are wanting a spiritual experience, or they're wanting to be connected with others, and I always think about: Is there another way to do this? Are we putting the effort in time into finding a space where we can just put our phones down, and we can communicate with each other, sit around a room and talk about mind expansion topics, right? 

Do we need that substance? And if we need that substance to connect with friends or connect with ourselves, this is a sign of a whole other issue right? 

You know, when we're looking at treating this from a mental health perspective, in a controlled setting, we're looking at synapses, firing and neuroplasticity and looking at healing trauma.

It's not about how do we connect with others or connect with ourselves? So, I think for us really knowing what you're looking for. Because, if not, that could cause a lot of drawbacks in a lot of different ways.

Also risk of dependence. So, even though physical dependence might not be as much of an issue with these substances, psychological dependence is. Again, if you're needing this to connect or feel a certain way to function… and that can also result in some of those come down experiences.

Some of these substances can hit you with high intensity and when you come off of them, it could be a fast come down or it could be slow and gradual. It can lead to a sense of dullness or disappointment. You just had a substance in your system that elevated a lot of your experiences.

It can lead to depression and anxiety. It can make it hard to process or function normally for a while. That come down, especially that slow process, you might be thinking you're feeling sober, but you're really not. Your cognitive processing is not where it needs to be. You're hopping in a car and you're going into class. You're really not functioning, and for safety reasons and for just taking in your environment, it's not happening as it should.

And then also, I'm thinking the drawback: are people prepared for what came with their experience? You know, sometimes a lot of emotions come up. A lot of trauma can come up. In a controlled setting, wonderful. That's what they're looking for. They know how to deal with it.

In a non-controlled, setting - how risky? Does your friend or do you know how to handle when that happens? Also, I think it's really important to…I've heard a lot of experience lately with micro dosing.

Even if you're not taking a large amount - and again, are we measuring? Do you even know what we're taking, how much we're taking? But thinking about even if you're not having a full blown tripping experience, what is the impact on your body in that moment?

Coming to counseling, for example, to a counselor that does not know you’re micro dosing or using these substances can be dangerous too. I'm not trained a lot of counselors are not trained in psychedelic administration. We're not prepared to know how to navigate, nor would we want to. It could cause more trauma and more harm.

Another drawback with recreational psychedelic use versus the clinical setting is it's still considered am illegal scheduled 1 drug. So, definitely something for individuals to think about is if you get caught on the substance, with the substance… What does that look like for you? What ramifications could be put in place either from a campus perspective, from a county, legal, government perspective? A lot to keep in mind.

I do want to say again with, with all of this being said, as Marissa mentioned earlier, there are some studies that are showing positive results. So I know I talked a lot about possible consequences and negative things that can occur, but I think we are all looking forward to more research coming out. And if there are good studies, and they're showing positive things... Again, being able as a counselor, and other counselors in the field, to be able to refer individuals that have been treatment resistant to have this option... If this is something the clinical setting that could do them justice, if this could help get them to the places that they need to be.

Sarah: Can I ask a quick question too? So, like, people's brains are all different. So, even if there are promising research studies shown, it would vary greatly, depending on the person and the condition. Right?

Jen: Absolutely. I think that this is why we're all eager as well to see what these studies have to say for different diagnoses, different individuals, different age groups, and different cultural backgrounds. There's so many different factors that can go in place for this. So it will be really interesting to see what the studies show, and who might benefit from this, and who may not benefit from this. 

Marissa: Right? And that's a really good point you bring up because all medications have side effects. Like, even the ones that do really good things for people. So, what are the side effects of psychedelics and, do you respond well to this? 

Not everybody does, just how not everybody responds well to certain blood pressure medications, not everyone responds well to cannabis when they use it - and the same for psychedelics.

And the research is new, this isn't longitudinal data of people who have been taking ecstasy, you know, at a small dose every day for 6 years. It's not really used as a supplement right now.

Sarah: Yeah, no, you're right. The goal is to get them off of that for good not to, like, show you how you can use it for the rest of your life. So that's also really interesting to think about, like, you're not going into these clinical trials to be taught like “Hey, this is how, you know, you use better. It's like, no, we're trying to get you off of it. That's the ultimate goal. Yeah.

Jen: And whatever's going on, that’s we want to treat, let's treat that. 

Sarah: So, we just wanted to think Jen, so much for coming in today's episode. We really appreciated, you know, having you here with us today.

Jen: Thank you for having me I think this is such an important topic, especially with our current trends and what we're hoping to see in the future. So thank you again for having me!

Sarah: And we will talk to you on next week's episode. Thanks so much. Bye.

Marissa: bye!