Case Study: Magic Mushrooms as Medicine? Mind-Body Connection Pt. 3

Can "tripping" cure depression? Can LSD reduce chronic anxiety? This article explores the use of psychedelics to treat mental illness. Read on to find links for more information, as well as how to enroll in FDA approved clinical trials.

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This article was reviewed and fact-checked by our Editorial Team.
Case Study: Magic Mushrooms as Medicine? Mind-Body Connection Pt. 3

This article is the last in a 3-part series on the connection between mind and body with childhood trauma

#1: Why Is This Patient Smelling Music?
#2: Does Childhood Abuse Prevent Weight Loss?

Magic Mushrooms

As a former oncology nurse, and a home health nurse, I have witnessed many times how people with a terminal diagnosis experience anxiety, anger and fear over death. Some folks cope fairly well, but I've seen people so crippled by a terminal diagnosis that they push friends and family away. Instead of a beautiful, light-filled, dignified death, they experience terror, darkness and pain. So, imagine my excitement when I heard about a research study in which psilocybin (the active ingredient in "magic mushrooms”) in conjunction with psychotherapy was used to treat anxiety and depression in patients with terminal cancer. The results were promising - many subjects felt uplifted, connected, unified, precious and even sacred. The results of the study showed decreased depression and anxiety in cancer patients for 8 months following a single dose of psilocybin, compared with a placebo.1

In Defense Of Psychedelics

One of my favorite authors, Michael Pollan, who wrote In Defense of Food (the one that told us to, "Eat food, not too much. Mostly plants.”) has written a book about the use of psychedelics like LSD, psilocybin, MDMA/Ecstacy, ayahuasca, and 5-MeO-DMT (From the venom of the Sonoran Desert toad) in medical research. Though his book, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression and Transcendence, was a bit dry, I found it interesting to read about the history of psychedelics in the U.S, and how their use was criminalized in the 1970s.2 The most interesting part of the book was about Pollan's guided "trips" with psychedelics. He wrote honestly and openly about his experimentation with psilocybin, toad venom and LSD. I admit that when I was younger, I tried LSD and psilocybin, and probably would have tried the toad venom if I could have gotten my hands on it, but I did it to "party.” Pollan's journey was one of self-exploration. He had recently lost his father, and he was looking for some resolution. For thousands of years, native peoples have traditionally used these drugs for these very same purposes. It wasn't until the 1960s in American that the use of psychedelic drugs began to be perceived as criminal activity; however, Pollan and others are quick to point out that no one in the medical community is suggesting that they are legalized. We are talking about approval for medical use.3

PTSD

Evidence is mounting that these drugs, when administered in controlled therapeutic settings, may be able to succeed where traditional medications have fallen short. The Multidisciplinary Association for Psychedelic Studies (MAPS) is currently engaged in FDA approved, phase 3 trials for the use of MDMA (known as 3,4-methylenedioxy-methamphetamine, and also as ecstasy)-assisted psychotherapy for PTSD. The goal of MAPS is to train at least 300 therapists in this modality before 2021 in anticipation of completion of the phase 3 trials.4

MDMA can increase feelings of trust and compassion (why it's popular on the party scene), making is an effective part of psychotherapy for patients with a PTSD diagnosis. Researchers have found that the drug, administered for two eight-hour psychotherapy sessions spaced about a month apart, can reduce symptoms for the majority of participants, and the effects may last up to six years. This is good news because PTSD is incredibly difficult to treat. Thirty to forty percent of people with PTSD get no relief from current therapies, including cognitive behavioral therapy, group therapy, and antidepressants. PTSD affects 8 percent of Americans; almost 25 million people, many of them veterans. In 2016, approximately 868,000 veterans received disability benefits for PTSD, at a cost of $17 billion to the Veterans Administration.1&4 However, MDMA isn't just for PTSD in veterans. In the references there's a link to a story about a woman who used MDMA-assisted therapy to recover from PTSD after being raped.5

Depression

Recent research has pointed to the effect of psilocybin (the active ingredient in magic mushrooms) on blood flow to the amygdala, an area of the brain associated with emotional regulation (I wrote about this in great detail in part 2). Folks with depression tend to have higher blood flow in the amygdala than those who do not have depression. After being given a dose of psilocybin, MRI scans of 19 patients with treatment-resistant depression showed reduced blood flow to the amygdala. This reduced flow correlated with a decrease in depressive symptoms in all 19 subjects one week after treatment, and in nearly half of participants five weeks later. Research is being planned for an experimental study of psilocybin as compared to existing standard-of-care antidepressant medications.1, 2&4

Alcoholism

LSD (I wrote about it in a previous article), also known as lysergic acid diethylamide, is a semisynthetic compound first developed in 1938 by Dr. Albert Hofmann at the Sandoz pharmaceutical company in Basel, Switzerland. In the 1940s LSD became recognized for possible therapeutic effects, and was even used by Bob Wilson, founder of alcoholics anonymous. It played a role in the discovery of the serotonin neurotransmitter system. From the 1950s through the early 1970s, LSD was used as a treatment for alcoholism as well as for anxiety, depression and for people with advanced stage cancer. Now, thanks to MAPS, there is increasing evidence for LSD as a treatment modality. A recent MAPS study found a reduction in anxiety following two LSD-assisted psychotherapy sessions for 12 patients.1&4

Mapping The Way

Go to the MAPS site to learn more about psychedelic research studies, including how to enroll in clinical trials.4

Current MAPS studies:

  1. Medical marijuana (the first clinical trial of marijuana for PTSD in veterans)
  2. LSD-assisted psychotherapy
  3. Ibogaine (naturally occurring chemical found in West African shrubs) for drug addiction
  4. Ayahuasca-assisted treatment for addiction and dependence (ayahuasca is derived from a South American vine, containing naturally occurring MAOIs – it is legal in the US for religious uses)

Money

As you might expect, research on psychedelics is funded mainly by academic institutions and nonprofits. Drug companies won't be making money off of these treatments since MDMA and psilocybin, the active ingredient in magic mushrooms, are off-patent substances that exist in the public domain. I'd like to encourage you to support organizations like MAPS with financial donations and to share their research with others who might be able to support funding.1

Advocating

I'm not advocating for legal, recreational drug use (though the legality of alcohol, one of the most toxic, addictive, lethal substances around does give me pause for concern...and where's the medical benefit of drinking? Don't get me started…). I am advocating that nurses share this information with patients. As the most trusted healthcare provider in the U.S. we have a duty to share these potentially life-altering, maybe even life-saving treatment modalities with those who are most vulnerable: veterans, sexual assault survivors, victims of childhood trauma, those with treatment-resistant depression, people addicted to drugs and/or alcohol and those with a terminal diagnosis.6

I'm hoping for a good discussion here. What are your thoughts, experiences and ideas surrounding the use of psychedelics to support the treatment of those with mental illness?

References

1. How a Psychedelic Drug Helps Cancer Patients Overcome Anxiety

2. Pollan, M. (2018). How to change your mind: What the new science of psychedelics teaches us about consciousness, dying, addiction, depression and transcendence. Penguin Press: New York, NY.

3. Will These Psychedelic Drugs Soon be Legal?

4. Multidisciplinary Association for Psychedelic Studies (MAPS):

5. My Story of MDMA-Assisted Psychotherapy after a Life Changing Rape

6. Journal of Palliative Medicine: taking psychedelics seriously

 

DISCLAIMER: These case studies are presented for learning purposes only and with full understanding that it is outside the scope of practice for a nurse to make a medical diagnosis. When participating, assume that a licensed healthcare provider is making the actual diagnosis, ordering all the tests and interpreting the results. You are looking at the case retrospectively to learn from the data presented – the idea is to increase your knowledge so you can sharpen your assessment and teaching skills.

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SafetyNurse1968

About SafetyNurse1968, BSN, MSN, PhD

Patient Safety Columnist / Educator

Dr. Kristi Miller, aka Safety Nurse is an Assistant Professor of nursing at USC-Upstate and a Certified Professional in Patient Safety. She is obsessed with patient safety. Please read her blog, Safety Rules! on allnurses.com.

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Specializes in SICU, trauma, neuro.

Little problem with advocating for hallucinogenics... they’re illegal. It’s not even in our scope of practice to recommend legal drugs... no way would I ever consider recommending illegal ones. 1) the BON doesn’t tend to like us breaking the law, and 2) as they are illegal we’re talking about pts buying them off the street. That is ALL kinds of irresponsible — do YOU trust drugs bought on the black market? Plus, as trials are underway and therefore incomplete, there really isn’t enough safety and efficacy data for me to be comfortable “sharing and advocating these modalities.”

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Specializes in Education, Informatics, Patient Safety.
1 hour ago, Here.I.Stand said:

Little problem with advocating for hallucinogenics... they’re illegal. It’s not even in our scope of practice to recommend legal drugs... no way would I ever consider recommending illegal ones. 1) the BON doesn’t tend to like us breaking the law, and 2) as they are illegal we’re talking about pts buying them off the street. That is ALL kinds of irresponsible — do YOU trust drugs bought on the black market? Plus, as trials are underway and therefore incomplete, there really isn’t enough safety and efficacy data for me to be comfortable “sharing and advocating these modalities.”

I do appreciate your comments though I wish you had read the article more carefully. I very clearly stated that I'm not advocating for the illegal use of drugs. I'm advocating to let our patients know that these trials exist and that these treatment options are becoming available. FDA approval means that a drug has been approved for legal use for the treatment for which the drug is intended.

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I suspect that guiding patients toward research on hallucinogens and currently-illegal psychotropic drugs may be both a little premature and possibly out of our scope, as Here.I.Stand mentioned. For one, most of the studies on these drugs have had relatively few participants and have not been repeated or verified. It is difficult to draw firm conclusions from them, given these limitations. Patients are seldom well-versed in interpreting medical research and studies, and those exceptions who are likely don't need the nudge to start looking. The difference between a nudge and an endorsement is pretty fuzzy.

However, I do think it behooves us as medical professionals to keep an open mind about potential therapies, and possibly even to advocate to governing bodies those therapies which show real promise of efficacy but are taboo for political reasons. And to that extent, I admit that some of the small-scale studies about using psilocybin's use for treating depression have been remarkable. Specifically, I thought the results of this study were very impressive:

https://journals.sagepub.com/doi/full/10.1177/0269881116675513

In 51 patients with life-threatening cancer diagnosis, one-time high-dose psilocybin was associated with depression and anxiety symptom remission of 71% and 63% respectively 6 months after administration, with no serious adverse effects.

On the one hand, one could certainly quibble with the study's results on the basis of possible self-selection bias among participants, small sample size, or the somewhat unorthodox control group. But on the other hand, if some new anti-depressant achieved similar results in a clinical trial, it would be generating a whole lot of buzz.

If nothing else, we should be clamoring for larger trials.

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Specializes in Education, Informatics, Patient Safety.
3 minutes ago, Cowboyardee said:

I suspect that guiding patients toward research on hallucinogens and currently-illegal psychotropic drugs may be both a little premature and possibly out of our scope, as Here.I.Stand mentioned. For one, most of the studies on these drugs have had relatively few participants and have not been repeated or verified. It is difficult to draw firm conclusions from them, given these limitations. Patients are seldom well-versed in interpreting medical research and studies, and those exceptions who are likely don't need the nudge to start looking. The difference between a nudge and an endorsement is pretty fuzzy.

However, I do think it behooves us as medical professionals to keep an open mind about potential therapies, and possibly even to advocate to governing bodies those therapies which show real promise of efficacy but are taboo for political reasons. And to that extent, I admit that some of the small-scale studies about using psilocybin's use for treating depression have been remarkable. Specifically, I thought the results of this study were very impressive:

https://journals.sagepub.com/doi/full/10.1177/0269881116675513

In 51 patients with life-threatening cancer diagnosis, one-time high-dose psilocybin was associated with depression and anxiety symptom remission of 71% and 63% respectively 6 months after administration, with no serious adverse effects.

On the one hand, one could certainly quibble with the study's results on the basis of possible self-selection bias among participants, small sample size, or the somewhat unorthodox control group. But on the other hand, if some new anti-depressant achieved similar results in a clinical trial, it would be generating a whole lot of buzz.

If nothing else, we should be clamoring for larger trials.

Well said. I'm an oncology nurse and I come from the perspective of sharing knowledge with patients about available clinical trials. I think you make a good point about the difference between advocating to the patient and simply passing along information -- though that is murky as well, since nurses are so trusted...when I have passed along info, I have always done it with the permission of the primary caregiver. perhaps I should have mentioned that.. I really appreciate your perspective of moderation and healthy skepticism. Advocating for larger clinical trials is definitely needed, but larger trials mean a need for more participants. When I wrote this article I was thinking of the folks with treatment resistant depression we have lost to suicide. I get pretty passionate about them and I can lose perspective. Thanks again for your comments.

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Specializes in Addictions, psych, corrections, transfers.

I'll say it since no one else did. Thank you for the information because you are just trying to educate, so I'm not sure what all the negativity is about. I've also had some interest in this field. I'm a mental health/addictions nurse and there is definitely some promising information coming from this alternative approach. Hopefully, we can get more research going and possibly give another avenue for wellness for a our clients.

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On 3/21/2019 at 1:11 PM, Here.I.Stand said:

Little problem with advocating for hallucinogenics... they’re illegal. It’s not even in our scope of practice to recommend legal drugs... no way would I ever consider recommending illegal ones. 1) the BON doesn’t tend to like us breaking the law, and 2) as they are illegal we’re talking about pts buying them off the street. That is ALL kinds of irresponsible — do YOU trust drugs bought on the black market? Plus, as trials are underway and therefore incomplete, there really isn’t enough safety and efficacy data for me to be comfortable “sharing and advocating these modalities.”

Not all hallucinogens are illegal in this country (and others). Do a little research on protected hallucinogenic use for religious ceremony.

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Specializes in Wound care; CMSRN.

Major work is being done with Ketamine and some analogues to treat depression, with good results. The biggest inhibition to that research has been interference from "law enforcement" agencies in the practice of medicine.
Protesting that research will put you on the side of our Calvinist theocratic approach to medicine and law.
Humans have been treating themselves with psychoactive drugs for millions of years because they (apparently) gained benefit or saw the need.
The "because it's illegal" approach to this argument is just a non starter. Not only does it not explain anything, it doesn't solve anything.
Research CAN solve things. Putting a whole class of substances on a "forbidden list" CI, and enforcing draconian penalties against their use, is just dark age ignorance.
That and the fact that the first thing the US government did when they noticed "acid" was try to weaponize it and when they found that problematic they made it illegal. Sheesh.

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Great article-I, too, am an Oncology RN. I've been interested in this topic for years, for patients, and for personal reasons. I've watched documentaries and read numerous articles on psilocybin. Although the research--trial size, etc has been limited, it is noteworthy the significant positive effects this drug in particular has on chronic refractory depression. Just because pharma can't benefit from it, there will be more of a challenge to get more studies funded. I hope to see this in my lifetime, as the current treatments are lacking. How many veterans do we lose every day to PTSD? If there's something, ANYTHING out there that could be promising, GET ON IT, US!

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Specializes in Education, Informatics, Patient Safety.
21 minutes ago, SamyRN said:

Great article-I, too, am an Oncology RN. I've been interested in this topic for years, for patients, and for personal reasons. I've watched documentaries and read numerous articles on psilocybin. Although the research--trial size, etc has been limited, it is noteworthy the significant positive effects this drug in particular has on chronic refractory depression. Just because pharma can't benefit from it, there will be more of a challenge to get more studies funded. I hope to see this in my lifetime, as the current treatments are lacking. How many veterans do we lose every day to PTSD? If there's something, ANYTHING out there that could be promising, GET ON IT, US!

I so appreciate your comments! You've definitely grasped what I'm trying to say. I'm so passionate about making patients aware of their options. I don't think many people with treatment resistant depression are aware of these studies - hopefully we can spread the word and save some lives.

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Specializes in Education, Informatics, Patient Safety.
On 3/24/2019 at 8:48 AM, Tomascz said:

Major work is being done with Ketamine and some analogues to treat depression, with good results. The biggest inhibition to that research has been interference from "law enforcement" agencies in the practice of medicine.
Protesting that research will put you on the side of our Calvinist theocratic approach to medicine and law.
Humans have been treating themselves with psychoactive drugs for millions of years because they (apparently) gained benefit or saw the need.
The "because it's illegal" approach to this argument is just a non starter. Not only does it not explain anything, it doesn't solve anything.
Research CAN solve things. Putting a whole class of substances on a "forbidden list" CI, and enforcing draconian penalties against their use, is just dark age ignorance.
That and the fact that the first thing the US government did when they noticed "acid" was try to weaponize it and when they found that problematic they made it illegal. Sheesh.

The studies on ketamine are truly exciting. I have a friend who is getting injections for chronic pain from Ehler's Danlos syndrome, and I know another person who is getting injections for depression with suicidal ideation. Thanks so much for bringing it up.

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Specializes in Education, Informatics, Patient Safety.
On 3/23/2019 at 11:28 PM, angeloublue22 said:

I'll say it since no one else did. Thank you for the information because you are just trying to educate, so I'm not sure what all the negativity is about. I've also had some interest in this field. I'm a mental health/addictions nurse and there is definitely some promising information coming from this alternative approach. Hopefully, we can get more research going and possibly give another avenue for wellness for a our clients.

Thank you for reading and for commenting. Mental health/addictions nurses really see it all. Thanks for what you do - you are a true hero!

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