The statistics on mental health are shocking. The World Health Organisation indicates that disorders caused by mental health or substance use have increased by 13% over the past decade. Approximately 20% of the world's population of children and adolescents have a mental health disorder. Almost 1 million people die from suicide every year, which is one of the leading causes of death in young adults. Depression and anxiety alone cost the global economy an estimated 1 trillion US dollars annually.
Despite this growing burden on society and healthcare, treatments remain insufficient and inadequate. Take depression for instance. The most commonly prescribed anti-depressant drugs are selective serotonin reuptake inhibitors (SSRIs). As the name suggests, SSRIs work by blocking the reabsorption of serotonin. This neurotransmitter carries signals between the brain and the nerve cells, and plays a key role in regulating mood, sleep and other bodily functions. While SSRIs can be effective for many people, they take weeks or even months to work and can cause severe side effects. Not only that, SSRIs have no impact on approximately one third of all patients.
And it doesn't end with depression. Eating disorders, such as anorexia, have the highest mortality rates of any psychiatric condition. Yet long-term recovery rates are comparatively low. Traditional anti-psychotic and anti-depressant drugs are often ineffective in cases of chronic Post Traumatic Stress Disorder (PTSD). And there is no licensed drug at present to treat Borderline Personality Disorder (BPD).
What do psychedelics have to do with mental health?
The therapeutic and medicinal use of psychedelics is nothing new. Indigenous communities have utilised the healing power of plants and fungi, from the South American brew of ayahuasca to the psilocybin or 'magic' mushroom, for centuries. It took the Western world a little longer to tap into the benefits of hallucinogenic drugs. Not until the mid-20th century did psychedelic therapy really start to kick off, with a recent analysis of 19 studies completed between 1949 and 1973 indicating 'clinically judged improvement' for 79% of patients.
However, the progress made came to an abrupt halt, as governments across the world reacted to the 1960s' counter-culture movement with the illegalisation of all hallucinogenic substances. While some researchers went underground to continue their studies, a lack of government funding and approval all but ceased further development in the field. Psychedelic research slowly began to rekindle at the turn of the century. As attitudes started to shift, advances in neuroscience and brain imaging technology helped gain more insight into the potential of the once demonised drugs.
The surge in studies supporting the benefits of psychedelics has even led to the establishment of several research centres backed by leading educational institutes, such as London's Imperial College and Baltimore's Johns Hopkins. In fact, the popularity of psychedelics has reached an all-time high, with the drug market expected to soar to over 11 billion US dollars by 2029.
How are psychedelics transforming mental health care?
The economic drain of mental health is primarily attributed to patients who are 'treatment resistant'. And this is precisely where psychedelics can make an impact. The Center for the Neuroscience of Psychedelics, recently founded at one of the world's most prestigious hospitals, Massachusetts General, aims to make this term obsolete. By exploring the drug's effects on the brain, researchers hope to optimise current treatments and create new forms of therapy. The centre's first study will explore the effects of psilocybin on rumination, which is a key feature of many mental health disorders, including depression.
While earlier studies lacked empirical data, instead relying on anecdotal evidence, more controlled research methods have started to push the promise of psychedelics to the fore. Studies such as Mass Gen's are increasing across the field, particularly within the US. And, unlike previous investigations, many are now looking into the long-term viability of using psychoactive substances. A 2022 report examined the safety and efficacy of using psilocybin to treat major depressive disorder over 12 months. The results found that the anti-depressant effects of psilocybin were substantial and long-lasting, with treatment response at 75% and remission at 58% after a year of initiating the trial. In addition, no serious adverse events were reported during the follow-up and none of the participants used psychedelic drugs outside of the study.
And it's not just in the US that things are starting to change. In 2023, Australia became the first country to officially recognise psychedelics as medicine. As of July, authorised psychiatrists will be able to prescribe MDMA and psilocybin for patients with treatment-resistant depression or PTSD. The renaissance is sweeping across Europe too, with numerous trials exploring the benefits of psychedelic-assisted therapy for a range of conditions, from anorexia to anxiety and addiction. In Basel, Switzerland, research is currently underway to evaluate the potential of LSD to treat cluster headaches.
Can microdosing improve mental health too?
Many of the above studies investigated the effects of psychedelics administered as a full dose, in which patients experienced a hallucinogenic high. Yet more and more people are turning to microdosing to enhance their well-being. This practise involves tiny amounts of psychedelics, taken on a regular basis according to a microdosing protocol. Such low doses remove the high, allowing microdosers to enjoy the benefits while functioning as normal.
Research has already indicated that microdosing enhances cognitive performance and creativity, but can it help improve mental health too? While controlled studies are lacking in this area, the signs are promising so far. A 2021 study revealed that adults who microdose reported lower levels of anxiety and depression compared to non-microdosers, with the main motivations cited as health related. This could potentially open up new doors within mental health treatment, although controlled trials are needed to assess the validity of the findings and the long-term effects of microdosing therapy. But with the likes of psilocybin and LSD posing almost no threat of addiction or overdose, psychedelics could indeed offer hope to millions as a safe, rapid and effective solution to the global mental health crisis.