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What psychedelics are being used in clinical trials?

Psychedelics are increasingly being studied in clinical trials for their potential therapeutic benefits. Here are some of the key psychedelics currently being investigated:

1. Psilocybin

  • Conditions: Treatment-resistant depression, major depressive disorder (MDD), end-of-life anxiety, obsessive-compulsive disorder (OCD), and substance use disorders (e.g., alcohol and tobacco addiction).
  • Notable Trials:
    • Johns Hopkins University and Imperial College London have conducted significant studies on psilocybin for depression and end-of-life anxiety.
    • COMPASS Pathways is conducting large-scale Phase 3 trials of psilocybin therapy for treatment-resistant depression.

2. MDMA (3,4-Methylenedioxymethamphetamine)

  • Conditions: Post-traumatic stress disorder (PTSD), social anxiety in autistic adults, and anxiety related to life-threatening illnesses.
  • Notable Trials:
    • The Multidisciplinary Association for Psychedelic Studies (MAPS) has completed Phase 3 trials for MDMA-assisted psychotherapy for PTSD, with promising results.
    • MDMA is expected to seek FDA approval for PTSD treatment by 2024.

3. LSD (Lysergic Acid Diethylamide)

  • Conditions: Anxiety, depression, cluster headaches, and end-of-life distress.
  • Notable Trials:
    • Studies at institutions like the University of Basel and MAPS are exploring LSD’s potential for anxiety and depression.
    • Research on microdosing LSD for cognitive enhancement and mood improvement is also ongoing.

4. Ayahuasca (DMT)

  • Conditions: Depression, PTSD, and substance use disorders.
  • Notable Trials:
    • Research in Brazil and Canada is investigating ayahuasca’s effects on treatment-resistant depression and addiction.
    • Studies focus on its unique combination of DMT and MAO inhibitors, which allow for oral bioavailability.

5. Ketamine (and Esketamine)

  • Conditions: Treatment-resistant depression, bipolar depression, and suicidal ideation.
  • Notable Trials:
    • While not a classic psychedelic, ketamine has rapid-acting antidepressant effects and is FDA-approved as a nasal spray (Spravato) for treatment-resistant depression.
    • Numerous trials are exploring its mechanisms and long-term efficacy.

6. Ibogaine

  • Conditions: Opioid addiction, PTSD, and depression.
  • Notable Trials:
    • Research in Mexico, New Zealand, and other countries is investigating ibogaine’s potential to interrupt addiction and reduce withdrawal symptoms.
    • Due to its cardiac risks, studies are cautious and often focus on safety protocols.

7. 5-MeO-DMT

  • Conditions: Depression, anxiety, and PTSD.
  • Notable Trials:
    • Studies are exploring the short-acting but intense effects of 5-MeO-DMT, often derived from the Sonoran Desert toad.
    • Beckley Psytech and other organizations are conducting clinical trials for its therapeutic potential.

8. Mescaline

  • Conditions: Depression, anxiety, and substance use disorders.
  • Notable Trials:
    • Research is less advanced compared to other psychedelics, but studies are exploring its potential, particularly in the context of traditional peyote use.

Key Organizations Conducting Clinical Trials

  • Multidisciplinary Association for Psychedelic Studies (MAPS): Leading research on MDMA and other psychedelics.
  • COMPASS Pathways: Focused on psilocybin therapy for depression.
  • Usona Institute: Conducting trials on psilocybin for major depressive disorder.
  • Beckley Psytech: Investigating 5-MeO-DMT and other psychedelics.
  • Imperial College London and Johns Hopkins University: Pioneering research on psilocybin and LSD.

Current Status and Future Directions

  • Many of these trials are in Phase 2 or Phase 3, with some (like MDMA for PTSD) nearing FDA approval.
  • Regulatory hurdles and stigma remain challenges, but the growing body of evidence supporting psychedelics’ therapeutic potential is driving increased interest and investment.

What are psychedelics & how do they work?

Psychedelics are a class of psychoactive substances that alter perception, mood, and cognitive processes. They are known for inducing profound changes in consciousness, often characterized by vivid visual and auditory hallucinations, altered sense of time, and deep introspective experiences. Common psychedelics include:

  1. LSD (Lysergic Acid Diethylamide): A synthetic compound derived from ergot fungus.
  2. Psilocybin: Found in certain species of mushrooms, often referred to as “magic mushrooms.”
  3. DMT (Dimethyltryptamine): A naturally occurring compound found in some plants and animals, and a key ingredient in the traditional Amazonian brew ayahuasca.
  4. Mescaline: Found in peyote and other cacti.
  5. MDMA (3,4-Methylenedioxymethamphetamine): Often associated with psychedelic effects, though technically an empathogen-entactogen.

How Psychedelics Work

Psychedelics primarily exert their effects by interacting with the brain’s serotonin system, particularly the 5-HT2A receptor. Here’s a breakdown of their mechanisms:

  1. Serotonin Receptor Activation: Psychedelics like LSD, psilocybin, and DMT primarily bind to serotonin 5-HT2A receptors in the brain. This activation leads to altered neuronal activity and communication.
  2. Default Mode Network (DMN) Disruption: The DMN is a network of brain regions associated with self-referential thoughts and the sense of ego or “self.” Psychedelics reduce the activity and connectivity within the DMN, leading to a dissolution of ego boundaries and a sense of interconnectedness.
  3. Increased Brain Connectivity: Psychedelics promote increased connectivity between different brain regions that don’t typically communicate with each other. This can lead to novel insights, creative thinking, and a sense of expanded consciousness.
  4. Neuroplasticity: Psychedelics have been shown to promote neuroplasticity, the brain’s ability to reorganize itself by forming new neural connections. This may underlie their potential therapeutic effects in treating mental health disorders.

Effects of Psychedelics

The effects of psychedelics can vary widely depending on the substance, dosage, set (mindset), and setting (environment). Common effects include:

  • Visual and Auditory Hallucinations: Enhanced or altered sensory experiences.
  • Altered Sense of Time: Time may seem to slow down or speed up.
  • Emotional Intensity: Heightened emotions, ranging from euphoria to anxiety.
  • Ego Dissolution: A sense of losing the self or merging with the universe.
  • Mystical Experiences: Profound spiritual or existential insights.

Therapeutic Potential

Recent research has revived interest in the therapeutic potential of psychedelics, particularly for conditions such as:

  • Depression: Psilocybin and LSD have shown promise in alleviating treatment-resistant depression.
  • PTSD: MDMA-assisted therapy is being explored for post-traumatic stress disorder.
  • Anxiety: Psychedelics have been used to reduce anxiety in patients with terminal illnesses.
  • Addiction: Psychedelics like psilocybin and ibogaine are being studied for their potential to treat substance abuse disorders.

Risks and Considerations

While psychedelics can offer profound experiences and therapeutic benefits, they also carry risks, particularly in uncontrolled settings:

  • Bad Trips: Intense anxiety, paranoia, or terrifying hallucinations.
  • Psychological Distress: Potential for exacerbating underlying mental health conditions.
  • Legal Status: Many psychedelics are classified as Schedule I substances, making them illegal in many countries.

Conclusion

Psychedelics are powerful tools for exploring the mind and have significant potential for therapeutic use. However, they require careful consideration, respect, and often professional guidance to ensure safe and beneficial experiences. Ongoing research continues to uncover their mechanisms and potential applications in mental health and beyond.

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