Miscellaneous
They’re portrayed as a mechanism to achieve self-knowledge in the Amazon Prime show, Nine Perfect Strangers. They were the subject of promising clinical trials in the New England Journal of Medicine and Nature Medicine. They fascinate Joe Rogan and Tim Ferriss, and their promise was even the subject of a book by Michael Pollan (How to Change Your Mind). So is the buzz about psychedelics justified? What’s the deal with microdosing? And exactly which mental illnesses might benefit from psychedelic therapies? Psychopharmacologist Dr. Roger McIntyre of the University Health Network and Dr. Ishrat Husain, a psychiatrist at the Centre for Addiction and Mental Health, discuss the latest scientific developments for psilocybin, MDMA, ketamine and more. Episode 84 webpage. LINKS Learn more about Dr. Roger McIntyre’s company, Braxia Scientific, his Canadian Rapid Treatment Center of Excellence and the rest of his publications here. Here’s Dr. McIntyre’s webpage at U of T. Check out Mindset Pharma Inc, where Dr. Ishrat Husain is scientific advisor. See Dr. Husain’s scientific publications here. Here’s Dr. Husain’s webpage at CAMH. The New England Journal of Medicine study on psilocybin. The Nature Medicine study on MDMA and PTSD. Read up on these psychedelics and wellness trials happening now: Psilocybin clinical trial for treatment-resistant depression Braxia Ketamine clinical trial to treat bipolar depression - Braxia Psilocybin-based compound clinical trial for MSP-1014 to treat mood disorders - Mindset MDMA clinical trial to treat PTSD (phase 3) - Numinus Learn about earlier psychedelics studies at the trailblazing John Hopkins Centre for Psychedelic & Consciousness Research, where research on psilocybin began more than 20 years ago. Read some books that spurred today’s hype around psychedelics: How to Change Your Mind by Michael Pollan A Really Good Day by Ayelet Waldman INSIGHTS We use the term “psychedelics” a lot in this episode. But what does that word mean, and which drugs fall into that category? Dr. Husain explains that the term is Greek in origin and means “mind manifesting.” He calls them “very potent substances” that can “cause very profound hallucinatory experiences, which can be very powerful, but at the same time, for some people, can be quite distressing.” Dr. Roger McIntyre considers in the psychedelic category such drugs as lysergic acid diethylamide (LSD) and psilocybin (the active ingredient in so-called “magic mushrooms”), as well as dimethyltryptamine, ayahuasca, mescaline, MDMA (known as “ecstasy” or “molly”), and ketamine. [07:20] Canada legalized marijuana for both recreational and medical use in October 2018, and now anyone of legal age can access many different types of marijuana, as long as it’s less than or equal to 30 grams of dried cannabis. Dr. Ishrat Husain says, “With cannabis, a lot of the research wasn't completed before it was extended to medicinal use. And I hope the same thing doesn't happen with psychedelics, I think that it would be really important for us to do the robust research before it's translated into medicinal use.” The powerful nature of these drugs means that their administration needs to come with medical supervision from experts trained in psychedelic treatments. [08:21] Both Dr. Husain and Dr. McIntyre discourage recreational use of psychedelics. They also discourage microdosing of LSD and other psychedelics for self-administered therapeutic purposes. “I do cringe… when I hear about people taking micro- and macrodosing for whatever medical problem,” says Dr. McIntyre, “We just don't have the evidence that that works and it’s safe.” Similarly, Dr. Husain says, “we don't know what the risks are… I mean, these aren't risk free drugs...they do come with adverse effects that can cause, for instance, anxiety, it can cause dissociation, which means sort of like a break from reality, as well.” Specifically about microdosing, Dr. Husain says, “there is no study that confirms the mental health benefits of microdosing psychedelics at this point. In fact, studies that have looked at recreational users have shown that microdosing psychedelics are no better than taking a placebo.” [10:21] To minimize the risk that psychedelics are legalized before the medical and scientific implications are known, as well as minimize the risk of a backlash similar to what psychedelics experienced in the ‘70s, Dr. McIntyre believes it’ll be necessary for experts from many different fields to work together. “If you engage the medical establishment, you engage the political establishment, the legal establishment, the regulatory environment, and have all players at the table saying, can we find a line of sight here? How can we do this safely and appropriately? We've got to do this with [a] multilateral partnership.” [12:43] The interest that society and the media have taken in psychedelics recently is exciting for those studying them, says Dr. Roger McIntyre. “We don't get enough hype in psychiatry,” he says. “So I welcome the hype, I welcome the hope. We need hope for people who are affected by PTSD and depression and so on…” The attention, Dr. McIntyre says, has also helped attract funding for research studies. Still, Dr. Husain warns that we shouldn’t let the hype lead the way. “There's so much that we don't know yet,” Dr. Husain says. “We need to do the work before we can say that they're even useful as a treatment option,” he says. [13:35] Scientists are still learning what, exactly, psychedelics do to our brains. According to Dr. Husain, we know that psilocybin, the active compound in magic mushrooms, does at least two different things. It stimulates the receptors that create serotonin, a brain chemical responsible for improved mood, Dr. Husain explains. “Another thing that it's shown to do is, reset the brain. There's a network in the brain called the default mode network, and when we're in our own internal world, thinking about things or wondering how other people view us, that network in the brain is very, very active. And it's thought that psilocybin comes in and disrupts that network, so that we start fresh.” [16:40] Where is the future of psychedelics going? Both our experts think there’s much more study, and many more therapeutic uses, ahead. “We are entering the first inning of a baseball game,” says Dr. Roger McIntyre. “my dream in the ninth inning of this baseball game, is that we have a cure for these horrible illnesses and we can reduce suicide… we can get people better, get people better fast, and not just sweep symptoms under the rug, but can actually cure the illness.” Dr. Ishrat Husain is also hopeful that the research will clarify exactly how psychedelics work, so that we can use them as efficiently and safely as possible. “It would be fantastic if we're able to show that, yes, these medications are effective, and we understand why they're effective.” [18:39]