A scientist explains why there is a strong medical argument for more clinical research on psychedelics

There is a strong medical argument for further research into the use of psychedelics drugs to treat mood disorders like depression, according to a review article published in the Journal of Psychopharmacology.

The researchers examined 21 studies published between 1949 and 1973, before psychedelics like LSD were outlawed. They found that 335 of 423 patients who received psychedelic therapy showed improvement.

PsyPost interviewed the review’s corresponding author, James J.H. Rucker of King’s College London. Read his responses below:

Why were you interested in this topic?

Rucker: My clinical interest is in treatment-resistant problems with mood, particularly clinical depression and the anxiety that usually accompanies it. More traditional antidepressant medications are criticised (justifiably) for not really getting to the root of the problem. On the other hand, psychotherapy is often criticised for being lengthy, expensive, not easily available and ineffective for some people.

I found my attention being turned to history, where we find psychedelics being used as catalysts in psychotherapy in the 1950s and 1960s. This stopped after they were made Schedule 1 compounds around 1970. This suggests, on the surface, that the psychedelics are harmful, but as I investigated the topic further it seemed to me that there was very little evidence that they were, in fact, harmful when used with consent, proper preparation and in the context of a supportive, medical setting. So, I think they are worth looking at again because there have been no new developments in the treatment of depression since the introduction of the serotonergic antidepressants in the late 80s, and there is nothing much of note in the drug development pipeline. Indeed, many pharmaceutical companies have packed up their development operations in psychiatry now.

What should the average person take away from your review?

That we need to reconsider the use of these compounds in medical settings, and consider whether they might be useful for some people with refractory clinical depression and anxiety that has not responded to more conventional forms of therapy.

Are there any major caveats? What questions still need to be addressed?

The major caveat is that we are talking about the medical use of psychedelics, not the recreational use of psychedelics. I am not condoning recreational use nor do I encourage it. I do voluntary work at music festivals and have seen plenty of cases where use of psychedelics in psychologically destabilising environments, often with other drugs being used in tandem, has proven dangerous because people quickly become disorientated and frightened and they cannot easily get access to timely medical support. In hospitals and other clinical research settings this is not a problem.

The second caveat is that I am not suggesting that psychedelics should form part of the first, second, or even the third line of treatment. They should be reserved for when other treatments have failed, and then only with the informed consent and proper preparation of the patient by someone who is experienced in their use. This brings up interesting questions in itself, because it has been argued that the only way to gain experience in ‘what’ psychedelics actually do is to take them yourself. Indeed, this is what used to happen in the 50s and 60s when the drugs were not criminalised — psychiatrists in training were encouraged to take LSD to gain an insight into the altered states of consciousness that their patients might experience.

There are so many questions to address, that it is hard to rank them! I want to know whether psychedelics could be used to help some of the patients I see with entrenched depression and anxiety who aren’t getting better with other treatments. But I also want to know whether it is safe to use psychedelics in those circumstances, and whether there are some people who we should avoid their use with.

Is there anything else you would like to add?

The legal status of psychedelics at the moment does a great job of preventing us from answering the research questions I posed above (or, at least, makes answering those questions much more expensive than it would be otherwise, which is basically the same thing). But at the same time it doesn’t stop people using them recreationally. It’s the worst of both worlds.

The political stance towards drugs would be wiser if it sought to regulate use rather than criminalise it. Like many facets of human behaviour that have endured through the millennia, drug use is something to be understood and integrated into our conception of our humanity, not something to be rejected and used as a basis to punish people. When it comes to psychedelics, it seems pretty clear that the reason they were criminalised was not to protect the public from themselves, but to control an aspect of culture that the political establishment of the time did not like, and that was probably 1960s countercultural opposition in the USA to the Vietnam war.

In addition to Rucker, the review article “Psychedelics in the treatment of unipolar mood disorders” was co-authored by Luke A. Jelen, Sarah Flynn, Kyle D. Frowde, and Allan H. Young