A promising new approach to treating post-traumatic stress disorder, PTSD, is to use psychedelic medicines in conjunction with professional psychotherapy. This approach is so promising that the FDA (US Food and Drug Administration) which is in charge of approving drugs for legal use has placed two psychedelic drugs, MDMA and psilocybin in a special category for testing and approval. Unlike standard antidepressants which have a similar use, psychedelics do not require months or years of use and improvement of PTSD has been shown to last for as long as 6 years! But how safe is psychedelic therapy for PTSD? After all we are talking about drugs that can cause hallucinations and years ago were assigned to the highest level of risk by the same FDA that is now fast-tracking their development.
Street Psychedelics and Their Side Effects
There are two issues to consider with the therapeutic use of psychedelics for therapy. One is the purity of the drug and the other is the list of side effects of the drug. When a user of street psychedelics goes to a rock concert and uses a drug like psilocybin the batch that they got may be very strong or very weak because there is no quality control. Then the drug may have other ingredients like cocaine or heroin to name just a couple. Those who receive a psychedelic like psilocybin for PTSD treatment receive the pure medicine at a dosage tailored to produce beneficial effects and not cause undue side effects.
Side Effects of Pharmaceutical Grade Psilocybin
Psilocybin occurs in nature where it is found in as many as 200 kinds of mushrooms. Psilocybin itself does not cause any effects in the body but its breakdown product, psilocin does. This drug was used long before recorded history for its “spiritual” effects. It can cause mental and visual hallucinations, changes in perception of reality, happiness bordering on euphoria, and distortion of a person’s sense of time. Because psilocybin is intended to help treat PTSD and not provide a “trip”, dosages are set to maximize benefits while limiting risks.
The main argument against using psilocybin or other psychedelics in therapy is the risk of a “bad trip.” By using pharmaceutical grade drugs the risk impurities causing trouble is eliminated. By adjusting dose for patient weight and physiology risks are reduced. Nevertheless anxiety and hallucinations are always possible. The fact is that these side effects are more common in uncontrolled situations like loud rock concerts than in a quiet and controlled therapeutic setting. When a person feels uncomfortable or unsafe is commonly when “bad trips” occur.
Other side effects of psilocybin include elevation of body temperature and blood pressure, nausea, vomiting, and loss of appetite. All of these effects are dose related and much less likely to happen in a controlled setting. Flashbacks are a concern as visual flashbacks could impair one’s ability to drive safely or handle dangerous machinery. While flashbacks have been reported to occur in as few as 5% to as high as 50% of all users of hallucinogens, they tend to occur within a week of drug use. The point of testing supervised by the FDA is to ensure that not only do drugs like psilocybin help with PTSD but that they do not cause undue harm when used in the right amounts and frequency.
Will Psychedelics Be OK’d for PTSD Therapy?
The FDA called psilocybin a breakthrough therapy and approved it for testing. It went into stage two clinical trials in the summer of 2022. The FDA trials work is that first of all the drug is used on animals to demonstrate that it does not cause harm in the intended dosages. Then it goes to human testing with the same goal to demonstrate that it is not harmful. Only after it has passed this level of testing is the drug used in a clinical setting to see if safe doses of the drug are effective in treating the target conditions which in the case of psilocybin include both depression and PTSD. Right now psilocybin is in stage II testing to show that it is an effective treatment. Then it goes to stage three where safety and effectiveness are compared to other drugs for treating the same conditions. In this case the other drugs are antidepressants. There is already preliminary evidence that the psychedelics MDMA and psilocybin work better than antidepressants at lower dosages and that the effects last for years. The bottom line seems to be that psychedelic therapy is safe and effective for PTSD treatment and we only need to await the formal results of clinical trials.