Opinion – Psychedelic Turn: US review highlights urgency of psychedelics in mental health

In the first five months of 2021, about 42 million antidepressant pills were sold in Brazil, 13% more than in the same period in 2020. Consumption would be even greater if these drugs worked for at least a third of people who suffer with treatment-resistant depression.

For these helpless millions, the great hope is psychedelics, as a new publication on the renaissance of these mind-altering drugs reiterates. Released by US NGO Brainfutures, the report “Psychedelic Medicine – A Review of Clinical Research with a Class of Rapidly Emerging Behavioral Health Interventions” can be downloaded here.

Three dozen experts signed the study, including Tom Insel, who once directed the US National Institute of Mental Health. Also featured as authors Rick Doblin, Bill Linton and Tom Eckert, who have already been interviewed in this blog.

The review points to more than 36,000 scientific papers since 1950 on LSD, psilocybin from “magic” mushrooms, DMT from ayahuasca and mescaline from peyote cactus — the so-called “classic” psychedelics, which act primarily on the brain’s pathways of the neurotransmitter serotonin. But ketamine and ibogaine also play a role, which also act in other ways.

A sample of nearly two hundred rigorous studies from the last 25 years was selected from there: 46 randomized controlled trials, 47 studies in which researchers and participants knew which drug was being tested, 84 systematic reviews and 8 meta-analyses. In total, 4,650 volunteer participants.

The panorama of benefits for disorders such as depression, post-traumatic stress disorder, anxiety and substance abuse is unequivocal. “These positive results, compared with the lack of consistent efficacy of many psychotropic drugs and psychological treatments, are, in part, the biggest driver of accelerating research and investment in the field,” the report says.

Psychedelic-assisted psychotherapies (PAT) have the potential to save US employers $270 billion annually in costs created by absenteeism and healthcare costs, the report notes. Two-thirds of US and European publics support legalizing the medical use of psychedelics.

Companies have already invested US$ 2 billion in recent research and development of these new old drugs (whose study was interrupted in 1970 by legal prohibition), 85% of that in the USA. There are 46 psychedelic companies trading on exchanges, with a combined market value of US$6 billion.

The compilation by Brainfutures, an NGO championing advances in mental health science, regulation and public policy, highlights several studies with results favorable to psychedelics, including:

· The world’s first phase 3 study for post-traumatic stress disorder after three sessions of MDMA, in which 67% of participants no longer met diagnostic criteria (Mitchell et al., 2021);

· Phase 2 clinical trial with psilocybin effective in the treatment of depression with significant clinical response of 71% of volunteers and remission of 54% of them four weeks after treatment (Davis et al., 2021);

· Efficacy of ketamine against treatment-resistant depression, with positive responses above 60% already within the first 24 hours, maintained by several patients four weeks after dosing (Wan et al., 2015).

Considering the evidence obtained so far and the lack of alternatives in the face of the epidemiological worsening of mental health disorders, the group of experts presents three recommendations:

· Regulatory authorities should quickly approve substances for which there is strong evidence of safety and efficacy, such as psilocybin and MDMA;

· Ensure equitable access and reimbursement by health insurance for mental health use of ketamine, which is already legalized, followed by psilocybin and MDMA;

· Allocate public research funds to further scientific studies with DMT, ibogaine, LSD and mescaline, drugs that are currently under-researched.

Brazil has a long tradition of studies with DMT, because of ayahuasca, but it is still experiencing a phase of heroic resistance from researchers at universities such as USP, UFRN, UFRJ and Unicamp. Throw away the first bottle of antidepressants whoever thinks it is likely that Brazilian authorities will strictly follow Brainfutures’ recommendations.

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To learn more about the history and new developments of science in this area, including in Brazil, look for my book “Psiconautas – Travels with Brazilian Psychedelic Science”