Growing interest in psychedelic treatments for mental illness, but expert warns more robust research needed
Studies are small in scale, should be viewed with 'critical lens,' says clinician scientist
After decades of therapy for anxiety and suicidal thoughts, nurse Stephanie Hug says she found relief from a 12-week pilot treatment program that combines the psychedelic anesthetic ketamine with psychotherapy.
"I had tried different medications, I exercised, I did the positive self-talk, you know, I tried so many things," said Hug, an operating room nurse in Nanaimo, B.C.
As a child, Hug says she was groomed and sexually assaulted, long dealing with feelings of shame and high anxiety.
"I just felt like this is just going to be my life. I'm going to be anxious, sad, I'm going to have these [thoughts]."
Late last year, she took part in Roots to Thrive, a ketamine-assisted therapy program run through Vancouver Island University in Nanaimo, B.C. The program, which involved 16 people, is different from a clinical trial that can include thousands of participants.
Ketamine is an anesthetic that is controlled under the Controlled Drugs and Substances Act, and is illegal to use unless authorized for medical, scientific or industrial purposes. The drug is recreationally used by some illegally for its psychedelic properties, ability to separate mind from body, and alter sensory experiences with sight and sound.
Hug says the results she got in the ketamine-assisted therapy have been "amazing."
"My inner monologue is a lot kinder and not so rampant. It used to just be like uncontrolled chaos in there all the time with the underlying negativity."
Dr. Ishrat Husain, a clinician scientist and psychiatrist at the Centre for Addiction and Mental Health in Toronto, says he understands the hope around psychedelic-assisted therapy, but more robust research is needed.
"I encourage that research, but I think that we need the findings of that research — and the research needs to be well-designed and controlled — before we can recommend it for clinical practice."
In recent years, scientists have been looking at treating mental health with psychedelics, including ketamine, MDMA and psilocybin — the active ingredient in magic mushrooms — though approvals from Health Canada remain limited.
Globally there are 74 ongoing registered clinical trials using ketamine as a treatment for depression, according to ClinicalTrials.gov, a U.S. government database, nine of which are underway in Canada.
A recent systematic review of 28 studies, conducted by Quebec researchers, found that while ketamine appears "promising" for short-term treatment of treatment-resistant depression (TRD), "more clinical and experimental data is needed with regards to the efficacy, tolerance and security of long-term administration."
Channel 'inner therapist,' says facilitator
The Roots to Thrive program, run by Shannon Dames, a professor of nursing at Vancouver Island University, was devised to help front-line workers with TRD and PTSD. Ketamine was added to the existing program for its "mind-loosening" effect to "address barriers that are preventing people from living well," she said.
"We don't look at the ketamine as the medicine, we look at it as a facilitator."
Compared to much therapy, which involves talking out the trauma, Dames says the focus of her program is "really about going in."
"We really teach people kind of how to be their inner therapist."
Participants received medical and mental health screenings before the first program last year. They then received three doses of ketamine over 12 weeks, in the form of a lozenge or an intramuscular injection, and wore eye masks in each session to block out external stimuli.
In her first session, Hug said she saw herself as a toddler at her grandparents' house, playing with a bucket of water, and was struck by the unconditional love children receive.
"This knowledge came where I suddenly knew that me and this child have the same heart, we're the same person. And I am just as deserving of love now as I was then."
While Hug felt unwell after the second session — something she attributes to taking her mask off — her third session left her with a feeling that "no matter what happens, I love me, I trust me, I am safe inside of me."
"I just hope that this medicine will reach the people that are feeling hopeless."
Dames said 11 of the 16 participants, initially diagnosed with PTSD, screened negative after treatment. Meanwhile, 13 participants suffering from anxiety and depression showed "significant and clinically meaningful improvements."
"It was almost like it was like riding a magical bus for three months, just watching all of that happen."
Husain says that while some results from studies of psychedelic treatments are promising, they should be viewed with "a critical lens."
Many studies involve a small number of patients by clinical trial standards, he said, and often do not contain a placebo group, or comparisons with standard available treatments. Some studies are also so new that any potential long-term effects are unknown.
"I do think we need to be cautiously optimistic and take a critical look before we just bring them into clinical practice, because we don't want to bring the cart before the horse," he said.
"We need robust clinical trials. We need good governance of those studies. We need a critical appraisal of the evidence and they need to be regulated."
Dames received $50,000 in federal funding for the first program, and in January, received $450,000 over five years from the Michael Smith Foundation for Health Research, B.C.'s health research funding agency, and the Lotte & John Hecht Memorial Foundation, a charity that offers grants in education and medicine.
Psilocybin, MDMA being studied
Aside from ketamine-assisted therapy, Canadian researchers are looking at the use of other psychedelics in mental health work.
In August last year, Health Canada granted several exemptions to the Controlled Drugs and Substances Act to allow terminally ill patients to use psilocybin, the psychoactive ingredient in magic mushrooms, to manage end-of-life distress. More than three dozen additional exemptions were granted to patients and health-care providers in the months that followed.
Dr. Bruce Tobin worked on securing the first exemption, and says he has seen a tipping point in how these treatments have been perceived in recent years.
"Five years ago, I wasn't meeting very many doctors who knew much about it or were very supportive of it," said Tobin, founder of TheraPsil, a Victoria-based advocacy group for patients.
"I would say that things have changed dramatically at this point. We have many doctors who are very interested in learning more about this therapy."
Tobin described psilocybin's effect as "a loosening of emotional defences."
"Patients let out the fear, the anger, the anxiety, the grief, old resentments so many of us tend to hold."
The exemptions granted so far have focused on end-of-life distress, but as more research is conducted its use could expand to TRD, chronic anxiety, addictions and PTSD, Tobin said.
"I feel very confident that we're going to see the promise of psilocybin confirmed rather than discredited."
In a statement to The Current, Health Canada said it "thoroughly reviews all requests for exemption and makes decisions after taking into account the risks and benefits."
"We still have much to learn about the risks, which is why the sale and possession of psilocybin is still illegal," the statement continued.
"Until there is a sufficient evidence base, Health Canada will review each request for an exemption on a case-by-case basis."
Dr. Evan Wood, a professor of medicine at UBC in Vancouver, says there is "a real openness" to psychedelic-assisted therapies because existing treatments don't work for everyone.
"Our existing mental health treatments have major limitations. And anyone who works in mental health, you know, has good insight into that," said Wood, who last year became chief medical officer with Numinus, a company licensed by Health Canada to research psychedelic-assisted therapies.
Wood also believes there won't be "the same kind of political headwinds, for instance, that medical cannabis faced" — as long as the studies can robustly demonstrate safety and cost effectiveness.
He added that even if psychedelic-assisted treatments become more mainstream, they won't be a cure for everyone or all conditions, but could become another tool in the mental health-care system.
"[That] will provide a huge leg up for people that are looking to be able to make change, that otherwise existing treatments and therapies just simply aren't effective for."
Written by Padraig Moran. Produced by Jean Paetkau and Amanda Grant.
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