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December 2, 2020

Psychedelics in Psychiatry—Keeping the Renaissance From Going Off the Rails

Author Affiliations
  • 1Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Psychiatry. 2021;78(5):469-470. doi:10.1001/jamapsychiatry.2020.3672

There is a resurgence, some say renaissance, of clinical research on psychedelic substances after decades of dormancy. Recent studies have produced findings suggesting psychedelics may demonstrate substantial efficacy for serious psychiatric conditions such as mood and substance use disorders. As a result, ongoing clinical trials with the psychedelic psilocybin have been given the Breakthrough Therapy designation by the US Food and Drug Administration that could result in medical approval for major depressive disorder and/or treatment-resistant depression.

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3 Comments for this article
The importance of being thrustworthy earnest.
Luc Roelens |
I wellcome wholeheartedly this viewpoint. Indeed let us stay on the road to scientific exploration of the potential benefits of psychedelics. I would like to comment on an unmentioned common factor of these substances: they share the potential of changing consciousness with many 'psychothechniques', such as many different forms of meditation, autogenic training, hypnosis and so on. The overlap in effect of mental techniques and psychedelics palso deserves scientific exploration. And clinicians have to counter the longing for seemingly fast effects of psychedelics and to convince help-seeking people of the advantages of slow personal training whenever indicated.
Psychedelics and Psychiatry
Steven King, M.D., M.S. |
I believe Dr. Griffiths is conflating two different episodes in the past.

I trained in psychiatry in the 1970s and several of my professors had been involved in the 1950s research on psychedelics as treatments for mental disorders. They said they ended them long before their use became a political issue in the 1960s because they found that they were not especially effective and whatever benefits that were attained were far outweighed by the risk of adverse events.

Perhaps Dr. Griffiths' research will show something new but there is no need to obscure the past.
Psychedelic treatment has moved on
Ryan Sparkes |
In response to Steven King:

From my reading, it seems that much of the early researchers into psychedelic treatments for mental ill-likely did not venture beyond the biomedical model of disease.

From what I understand, some early researchers would induce somebody to take LSD, leave them in a white walled clinical settings, alone for hours at a time, and provide little support/aftercare in the way of psychotherapy, before concluding that LSD was not efficacious as a treatment. From a biomedical model this makes sense, however, we now know the subjective experience and the importance of set/setting, including aftercare,
are the cornerstones of effective treatment. Furthermore, in the context I have just described, it is no surprise if adverse negative effects were widely reported.

While I do not know your professors, there were researches even in those early days that were stunted due to the socio-political issues of the time. It was during that time that context (set/setting) of the psychedelic experience as a moderator to treatment efficacy was being explored. The treatment offered today in research builds up a therapeutic relationship, creates a comforting environment during the 'trip session', uses music to guide inner exploration of emotion, and understands the importance of ongoing therapy after the trip experience is over.

As you alluded to, it is a very different mechanism of treatment now, compared to those early days of the 1950's.