A 2021 study in JAMA Psychiatry concluded that "This randomized clinical trial found that psilocybin-assisted therapy was efficacious in producing large, rapid, and sustained antidepressant effects in patients with major depressive disorder." Another 2021 study in the New England Journal of Medicine showed that patients with moderate to severe major depressive disorder who received two doses of psilocybin did just as well — if not better — at six weeks than patients who received daily dosages of escitalopram (an antidepressant medication). A 2021 study from Nature, which was a randomized, double-blind, placebo-controlled study (the gold standard for research), showed that "MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated."

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There have been many studies of ketamine as a treatment for depression that does not respond to other treatments. And it has been approved as an option for selected patients with treatment-resistant depression.

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There is also great interest in the use of psychedelic medicines in hospice/end of life care. These medications can help people overcome their fear of death, and can help make the process of dying a more meaningful and spiritual experience.

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What are the pros and the cons?

Some of these drugs, such as MDMA, are considered to be potential drugs of misuse, given the euphoria they can cause. Possible adverse effects of some psychedelics could include dizziness, drowsiness, extreme dissociation from reality, panic attacks, and nausea. Their illegality makes them more dangerous, and people using street drugs can suffer medical complications from taking contaminated drugs.

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Despite their burgeoning promise in the field of psychiatry, psychedelic drugs are not yet considered to be mainstream medicine, and their use is still largely condoned only in experimental or monitored settings. These substances can cause severe impairment and should not be used without a guide who is not under the influence, who can provide calming support and/or call for help if someone is having a bad trip or an adverse reaction.

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On the plus side, for the conditions described above, they present a novel and incredibly promising treatment avenue for some of the most difficult-to-treat psychiatric conditions, such as PTSD or treatment-resistant depression. With proper supervision, they are relatively safe. Some patients say the experience of psychedelics can truly be life-altering. This is thought to be in part because the use of psychedelics frequently helps people to experience what is best described as mystical experiences, and that these experiences have been associated with improved outcomes.

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Future exploration of psychedelic drugs

In a 1986 paper, referring to psychedelic drugs, "The problem is not so much how to get these drugs off the streets, but how to get them back in the laboratories, hospitals, and other supervised settings." Just because a drug can be enjoyed or misused, or has been associated with a counterculture or a particular set of political values, that shouldn’t mean that it ought to be locked away forever — especially when there is promising evidence of potential benefit for some of the cruelest conditions that affect humanity.

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It is incredibly exciting to see what the future of psychedelic therapy holds.

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Harvard Health Publishing Contribution By Peter Grinspoon, MD