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Psychedelic Therapy: It May Not Be for Everyone

Apr 9, 2024

Psychedelic Assisted Therapy (PAT) has been being used in the treatment of various mental
health conditions. Indeed, Psychedelic Assisted Therapy has shown promising results in treating
conditions such as anxiety, depression, Post Traumatic Stress Disorder (PTSD), Obsessive
Compulsive Disorder (OCD), and others.

The medications being researched and offered in PAT include ketamine, 3,4-
methylenedioxymethamphetamine (MDMA), psilocybin (found in certain species of
mushrooms), lysergic acid diethylamide (LSD), and cannabis. These substances, when used in
controlled therapeutic settings and in conjunction with psychotherapy, have demonstrated the
ability to facilitate profound psychological experiences and promote therapeutic breakthroughs.

Ketamine, for example, has gained attention for its rapid-acting antidepressant effects and has
been used in the treatment of depression and suicidal ideation. MDMA-assisted therapy has
shown promise in treating PTSD, with ongoing research exploring its potential benefits.
Psilocybin and LSD have also been studied for their therapeutic effects on conditions such as
depression, anxiety, and existential distress.

Cannabis, while not traditionally considered a classic psychedelic, is being explored for its
potential therapeutic applications, particularly in the treatment of conditions such as chronic
pain, PTSD, and certain psychiatric disorders.

Overall, the field of PAT continues to evolve rapidly, with ongoing research aimed at
understanding the mechanisms of action, optimizing treatment protocols, and expanding the
range of conditions that can be effectively treated using psychedelic substances. As research
progresses, it’s essential to ensure that PAT is conducted safely, ethically, and with careful
consideration of individual patient needs and safety.

However, it’s crucial to recognize that PAT may not be suitable for everyone. Just as with any
medical intervention, there are individuals whose unique physiology or mental health history
may pose risks when undergoing psychedelic therapy. These contraindications highlight the
importance of thorough screening and individualized treatment planning to ensure the safety and
efficacy of PAT for each patient. As the field continues to evolve and research progresses, it’s
essential to remain vigilant about identifying both the potential benefits and limitations of PAT.
Ongoing research efforts aim to expand our understanding of how psychedelics interact with
different brain chemistries and mental health conditions, ultimately paving the way for more
precise and personalized approaches. In this dynamic landscape, collaboration between
researchers, clinicians, and patients is crucial for advancing the field responsibly and ethically,
while also maximizing the therapeutic potential of PAT for those who stand to benefit from it.

Multidisciplinary Association for Psychedelic Studies (MAPS) conducts PAT with MDMA, or
ecstasy for Post Traumatic Stress Disorder. MDMA comes with its own unique set of
challenges, as it is close to a stimulant in chemical structure. The exclusion criteria for these
studies cover a range of psychiatric and medical conditions, including primary psychotic
disorders, bipolar I disorder, dissociative identity disorder, eating disorders with active purging,
major depressive disorder with psychotic features, personality disorders, current alcohol and
substance use disorders, pregnancy or lactation, and medical conditions that could be
exacerbated by sympathomimetic drugs like MDMA.

It’s worth noting that while cannabis may share some risks with PAT, the specifics of its
interactions and contraindications may vary. Nonetheless, it’s important for individuals
considering PAT to be aware of and discuss any relevant medical conditions, medications, or
substance use with their healthcare providers to ensure appropriate guidance and decision-

Bipolar Disorder/Psychosis
There is a need for a cautionary approach taken by therapists and healthcare professionals
regarding the use of psychedelics, particularly in individuals with bipolar disorder or a family
history of bipolar disorder. Bipolar disorder is characterized by episodes of mania or hypomania,
which can include symptoms such as elevated mood, increased energy, and impulsive behavior,
as well as episodes of depression. Psychedelic substances have the potential to induce intense
psychological experiences and alter perception, which may exacerbate manic or psychotic
symptoms in susceptible individuals. Given the risk of triggering episodes, therapists often
advise against the use of psychedelics in individuals with bipolar disorder or a predisposition to
bipolar disorder. Additionally, substance-induced bipolar disorder, which can occur as a result of
psychedelic use, further complicates the picture and underscores the importance of careful
screening and risk assessment before considering psychedelic therapy.

The medical community generally advises individuals with a past diagnosis of schizophrenia, as
well as those with a first-degree relative with schizophrenia, to avoid the use of psychedelics.
Schizophrenia is a mental disorder characterized by disturbances in thinking, perception,
emotions, and behavior. Individuals with schizophrenia may experience hallucinations,
delusions, disorganized thinking, and impaired social functioning. Psychedelic substances have
the potential to exacerbate psychotic symptoms and trigger acute episodes of psychosis in
susceptible individuals. There have been reports of individuals with schizophrenia experiencing
worsening symptoms, including paranoid delusions and psychotic episodes, after using
psychedelics. Instead, alternative treatment options that have been shown to be effective and safe
for individuals with schizophrenia are recommended. It’s important for individuals with schizophrenia, or those with a family history of schizophrenia, to discuss any potential use of
psychedelics or other treatments with their healthcare providers. Open communication and
informed decision-making are essential to ensure the best possible outcomes for individuals with
schizophrenia and other severe mental health disorders.

Mood Stabilizers/Drug Interactions
The potential for interactions between mood stabilizers, monoamine oxidase inhibitors (MAOIs),
and psychedelics, highlights the importance of considering these effects when using psychedelic
substances. These medications are known to affect neurotransmitter levels in the brain, and there
is evidence to suggest that they can diminish the effects of psychedelics. This blunting effect
may reduce the therapeutic benefits of psychedelics for individuals taking mood stabilizers.

MAOIs are another class of medications that can interact dangerously with psychedelics. MAOIs
inhibit the activity of monoamine oxidase enzymes, which can lead to increased levels of
neurotransmitters such as serotonin. When combined with psychedelics, which also affect
serotonin levels, this can result in a potentially life-threatening serotonin syndrome.

As for lithium, there is limited research suggesting that individuals taking lithium may be at an
increased risk of seizures when using certain psychedelics. However, more studies are needed to
better understand the potential risks and interactions between lithium and psychedelics.

Overall, individuals who are considering using psychedelics, particularly those who are already
taking mood stabilizers, MAOIs, or lithium, should consult with their healthcare provider to
discuss potential risks and determine the safest course of action. Open communication with
healthcare professionals is essential to ensure the safe and effective use of psychedelics in
conjunction with other medications.

As research in this field continues to evolve, ongoing efforts to refine screening criteria, address
safety concerns, and expand access to psychedelic-assisted therapies will be crucial for
maximizing their therapeutic potential while minimizing risks for vulnerable populations. While
PAT holds promise as a therapeutic intervention for various mental health conditions, ongoing
research is needed to better understand its mechanisms of action and potential risks. As our
knowledge continues to evolve, there may be opportunities to develop safeguards or refine
treatment protocols to expand access to PAT for a wider range of individuals.

In the meantime, honesty and open communication with healthcare providers remain essential
for making informed decisions about treatment options. By staying informed and working
closely with qualified professionals, individuals can navigate the complexities of PAT and
explore options that are safe and suitable for their unique needs.

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