Psychedelics: New perspectives for trauma therapy

Trauma-focused psychotherapies are generally recommended as first-line treatment for post-traumatic stress disorder (PTSD), while selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication, are reserved for second-line treatment. Nevertheless, the significant drop-out rates from both psychotherapeutic and medication treatments, and the number of people continuing to suffer despite one or more attempts at treatment, indicate that the current care on offer is falling short of the needs of many patients. In 1971, the Convention on Psychotropic Substances, coordinated by the United Nations (UN), classified psychedelics as dangerous substances with no real therapeutic value. However, for the past twenty years, research centers have been obtaining exemptions to conduct clinical trials. These substances open up promising alternative therapeutic perspectives in the treatment of severe PTSD. The first phase 3, randomized, multisite, double-blind, placebo-controlled study showed clinically significant improvement in PTSD symptoms in 88% of patients, with 67% no longer qualifying for a PTSD diagnosis. Psychedelics not only reduce traumatic symptoms, but also promote post-traumatic growth. These substances have also been shown to reduce sleep disturbances, social anxiety, alcohol and drug addiction, and eating disorders in patients with PTSD. The degree of “mystical” experiences has emerged as a predictor of long-term changes. Psychedelics combined with psychotherapy have advantages over existing medications used as first-line treatment for PTSD in terms of safety, side effects, effectiveness, and duration of remission. However, the safety profile of psychedelics may vary depending on the context in which they are used. Few lasting negative side effects and serious incidents are reported, but short-term adverse reactions are common. There have been reports, though very rare, of persistent perceptual disturbance due to hallucinogens, characterized by prolonged or recurrent perceptual, mainly visual, symptoms. This usually occurs when psychedelics are taken in a recreational setting. The psychedelic experience is strongly influenced by the psychological disposition of the subject and the setting in which it takes place. The concept of “set and setting” refers to the non-medicated parameters of the experience that shape the response to psychedelics. Psychedelic-assisted therapy begins with a few preparatory interviews, followed by the psychedelic administration session, and then by integration sessions with a therapist.