Pacific Psych Centers offers individualized treatment to every one of our patients. We take into account your medical history, past and current medications, and the mental health issues in play, as well as lifestyle, family situation, and professional obligations.
So we offer the widest possible array of options available today, from traditional psychoactive medication and counseling, to nasal esketamine, intravenous ketamine, transcranial magnetic stimulation and integrative nutrition. Still, we know there are patients who could benefit from other options as well. One of the most significant opportunities that we see to further help patients is psychedelic-assisted therapy, specifically, using MDMA and psilocybin.
The options below aren’t legally available to us yet, but we expect that over the next few years, they will be, and we will be recommending them for appropriate patients. So here’s a preview of what to expect out of psychedelic-assisted therapy.
MDMA for Post Traumatic Stress Disorder (PTSD)
First studied in the 1950’s, research on the safety and efficacy of MDMA in post-traumatic stress disorder has been slower than it should have been, due to politics. However, it is now in the final stage (Phase 3) of testing that is anticipated to lead to FDA approval by next year (2021).
MDMA is also known as Ecstasy, X, and Molly, but chemically, it is 3,4-methylenedioxymethamphetamine. Besides efficacy in PTSD, the agent has also shown promise in anxiety in those on the spectrum, and anxiety related to the end of life.
Its mechanisms of action include serotonin release, oxytocin release, and other neurotransmitter activity that helps the brain support positive empathy, trust in others, reasoning and social interaction. In other words, MDMA allows the person to express more of what they were before the stress occurred. At the same time, these mechanisms reduce the “fight or flight” response to memories that makes it more difficult for patients to deal with daily life.
People who experience PTSD often report an inability to acknowledge and deal with their feelings following traumatic events, such as accidents, or periods of their lives, such as military service. What MDMA appears to provide is an ability to reconnect with the past with less pain, and from there, with psychotherapy, to gradually recapture the person that enjoyed life before the stress occurred.
Psilocybin for Treatment-Resistant Depression (TRD)
Treatment-resistant depression (TRD) is fairly common, often requiring frequent treatment adjustments, such as different drugs or dosages, to keep sadness and other symptoms at bay.
For example, one large study found 57% of patients prescribed an SSRI initially for depression either were intolerant to it or it no longer worked for them within a year. Even for patients who were in their fourth or fifth treatment of the year, most did not receive long-term relief.
Psilocybin, the active ingredient in certain mushrooms, is related chemically to melatonin, often used for jet lag and insomnia. It is also related to serotonin, the substance that SSRIs such as Prozac and Zoloft are designed to enhance. Unlike agents that require daily dosing, however, psilocybin’s beneficial effects have been documented to manifest as long as decades later, with side effects after dosing, such as headache, generally much more limited than those of SSRIs and other antidepressants.
The effects that patients in trials have reported include a heightened sense of meaning, joy and beauty; an increased appreciation of life and nature, and a greater feeling of compassion. Imaging of the brain show that psilocybin may cause changes in the parts of the brain most responsible for “excessive rumination,” repetitive thinking. From an emotional standpoint, it seems to take people “outside themselves” where they can see the “forest” of possibilities again, instead of only trees.
Scientists have compared the effects of taking psilocybin as a “snow globe,” in which the mind is shaken up but re-settles into a calmer, more positive state. Though the exact mechanisms for this improvement are still being studied, as with many medications that we use, the success that researchers have seen seems likely to result, ultimately, in FDA approval as an antidepressant medication in conjunction with psychotherapy.
Though we can’t prescribe either of these treatments yet, we can certainly discuss what they entail, so feel free to ask any questions that you have.