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In the Psychiatry and Mental Health session at HBI 2022 we heard Adrienne Rivlin (partner of strategic consultancy LEK) about how psychedelic therapy promises to radically transform the mental health sector. But to what extent is the sector (not to mention society) for the change of mindset that this will require?
There are currently dozens of ongoing clinical trials testing such a wide range of mental health conditions, such as depression, addiction, OCD, PTSD, and end-of-life existential anxiety. they can be treated with psychotropic drugs such as psilocybin (magic mushrooms). , MDMA (ecstasy) and ayahuasca.
Studies show very promising results that could open a new avenue of treatment. For example, a 2021 study at Imperial College comparing psilocybin with Escitalopram, a selective serotonin reuptake inhibitor (SSRI), for depression found that six weeks after treatment, 70% of the psilocybin group saw their symptoms decrease by 50% or more, while only 48% of the SSRI group did so. And, 58% of patients in the psilocybin group saw a sufficiently large decrease in their symptoms to be considered in remission six weeks after treatment, compared with 28% of patients in the SSRI group.
Results like these have encouraged investors: Hundreds of millions of dollars are already being poured into the nascent sector, both in Europe and North America. Currently, most of the money is spent on drug development, but some mental health providers are also beginning to invest in the support infrastructure that will be needed to treat patients with psychedelics, such as special psychedelic clinics and digital tools that are they can use to offer psychedelic treatment. accompanying therapy.
The treatment model is very different from current standard mental health treatments: instead of taking an antidepressant every day to relieve the worst symptoms of depression, patients do one or two intensive sessions of six to eight hours stumbling with a psychedelic like psilocybin, with the supervision of a therapist who helps them in the experience. Then, during the days, weeks, and months after the trip, the patient may receive follow-up therapy sessions, to help them make sense of the experience or “integrate” it.
And while Rivlin noted that there is some debate about this, it seems that the benefit of many experiences comes not so much from the drug itself, but from the drug-inducing experience, which can be transformative. Many of those involved in the trials view the experience as one of the most significant in their lives, and those who do are more likely to experience long-term mental health benefits.
This type of treatment therefore fits uncomfortably with how we are used to treating patients in modern medicine. Instead of working through physiological processes over which the patient has little control, the effectiveness of this type of treatment seems to depend largely on how the patient responds to it, psychologically.
This brings them closer to standard forms of psychotherapy (not with psychedelic help), as well as to spiritual, religious, and alternative forms of therapy such as meditation, yoga, hypnosis, and shamanic rituals, than pharmacological drugs. standard as antidepressants. But psychedelic therapy has the added problem of involving the use of vision-inducing drugs that, since they were banned in the 1960s, have been widely seen as dangerous and subversive.
Thus, even if governments are willing to allow these drugs to be authorized (Rivlin hopes this can happen in two or four years!), Psychiatrists and the wider community of professionals will also have to win. of mental health. And doctors and regulators set in a particular mindset can be difficult to change. But the positive results of scientific studies speak for themselves and should offset any stigma or bias they overcome. against the drugs themselves, but also against this radically different approach to treating patients.
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