Psychedelic drugs such as MDMA are showing promising results in treating a range of mental disorders. However, important questions remain about how, where and by whom such therapies can be delivered. (Image credit: D-Keine via Getty Images)
Psychedelics, including psilocybin, MDMA, and LSD, are being explored as psychiatric treatments. Clinical trials suggest that these drugs may help relieve mood disorders such as treatment-resistant depression and bipolar disorder; anxiety disorders including post-traumatic stress disorder (PTSD); eating disorders such as anorexia; and addictions including alcoholism.
These trials combine psychedelics with psychotherapy, suggesting that substances that induce altered states of consciousness may enhance the therapeutic effect. However, as experts note, the psychotherapy component is often not sufficiently detailed in most studies.
This is a significant problem—it influenced the Food and Drug Administration's decision to reject the use of MDMA to treat PTSD this summer.
These shortcomings must be addressed if psychedelic therapy is to gain the necessary approval. Otherwise, “it will be a serious loss for patients and a significant step backwards for scientific progress,” said Dr. Albino Oliveira-Maia, a psychiatrist, neurobiologist and director of the neuropsychiatry department at the Champalimaud Foundation in Lisbon.
Oliveira-Maia and his team analyzed 45 studies involving psychedelics — including work on psilocybin, MDMA, LSD, and ayahuasca — and found that many of them only scratched the surface of the psychotherapy provided with the drugs. Live Science spoke with Oliveira-Maia about why this is important, and what scientists need to do to integrate psychedelic therapy into clinical practice.
Nicoletta Lanes: What prompted you to conduct this review?
Dr. Albino Oliveira-Maia: One of the recurring themes in the literature on the therapeutic use of psychedelics is that they are used in conjunction with psychotherapeutic interventions. And there has been a lot of debate about how necessary this is — whether it is required for the intervention to work effectively and for its safety.
As you may know, the FDA decided not to approve the use of MDMA-assisted psychotherapy for PTSD this summer. That was one of the impetuses, though not the only one… [for us to conduct this review] to see how well this psychological component is described in the available literature.
NL: Where are the most significant gaps in reporting?
AO-M: The first thing that became very obvious was that the descriptions varied greatly across studies. And another aspect that quickly became clear was that the differences were so great that it was difficult to extract information systematically.
This [information] ranged from a simple description of the basic materials for psychological intervention to an adequate description of the training of specialists.
NL: Why is it important to detail the training of specialists?
AO-M: This has become a source of concern.
Given specific high-profile cases where individuals were, shall we say, not properly certified according to local standards, provided treatment and may have acted less ethically towards patients participating in the study.
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