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The really good news is the psychedelic medicines like MDMA and psilocybin have the potential to change the face of psychiatry. They offer more effective ways to treat depression, PTSD, substance abuse disorders and other mental health conditions that have previously been available. By reducing these risk factors, they reduce the risk of suicide. The worrisome news is that psychedelics may increase the risk of heart disease! This has to do with psychedelic microdosing. Is psychedelic microdosing bad for the heart? If that is so, what does that mean for soon-to-be-standard psychedelic therapies?

Valvular Heart Disease and Microdosing

Microdosing of psychedelics like psilocybin means taking minimal amounts repeatedly over time. This is as opposed to taking enough to bring about a psychedelic experience. People who do this believe that it helps relieve anxiety and makes them more creative. Controlled studies indicate that a lot of this may be power of suggestion, a placebo effect. The concern that has popped up does not have to do with if or how microdosing works to help people. It has to do with reports of microdosing and valvular heart disease.

What Is Valvular Heart Disease?

The heart is a big muscle that thymically contracts from when we are born until we die. Blood passes through the heart. This happens because four heart valves open to let blood advance and snap shot to prevent it from going the other way. Common valvular heart disease has do with damaged valves that let blood flow backwards as well as forward. When the backward part gets to be excessive, the heart has to work too hard, the heart goes into failure, lungs fill up with fluid. What do psychedelics have to do with any of this?

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Psychedelic Activation of Receptor 5-HT2B

A big part of how psychedelics help with treatment of mental health conditions is that they affect receptors in the brain. One of these is the 5-HT2B receptor. However, the concern raised by those who have studied this is that the receptor does not just work in the brain. It also is involved in regulating other physiological processes in the body, including in the heart! Studies of the functioning of the heart have shown that when the 5-HT2B receptor is repeatedly activated it can lead to the development of valvular heart disease. That being the case, researchers looked at whether or not microdosing, which repeatedly stimulates the 5-HT2B receptor increases the risk of valvular heart disease. The psychedelics they studied in this regard wee MDMA, LSD, mescaline, and psilocybin.  All of these pose a risk with repeated use with MDMA posing the greatest risk.

Chronic Versus Targeted Use of Psychedelic Medicines

The issue of psychedelics potentially causing valvular heart disease has to do with chronic use. There are case reports of long term users of MDMA getting valvular heart disease. In this regard the good news is that for therapeutic purposes one only needs a dose or two of psychedelics like MDMA or psilocybin to work as adjunctive therapy along with focused psychotherapy for conditions like depression and PTSD. To the extent that microdosing might be found to be a viable way to treat mental health conditions and especially those that increase the risk of suicide, the issue of any of these causing an increase in valvular heart disease needs to be addressed.

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How Do You Know If You Have Valvular Heart Disease?

Fortunately, if you are worried that you have a problem with your heart valves, the necessary test is non-invasive. It is an echo cardiogram. This test shows if the heart valves are working properly or not. To the extent that microdosing may become a viable therapy, getting one of these tests along the way will be non-painful and not dangerous. To the extent that microdosing turns out only to have a placebo effect, then the issue will only be germane for recreational users. 

Because mild heart valve problems exist in normal people with good heart function, a person who is going to try microdosing may want to consider having a baseline echocardiogram before starting their experiment with this approach. They would then want to consider repeating the test periodically to see if problems are developing with their heart valves.

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