Ketamine has been getting a lot of media attention in recent months. This attention is not only for its positive impact on people suffering from depression, but also because celebrities, including the late Matthew Perry, have reportedly used the drug to enhance their mental health.
“Research supports the use of ketamine,” says Chris Nixon, LMSW, CAADC, an addiction medicine specialist at Henry Ford Health. “Studies show it can rapidly improve depressive symptoms and suicidal ideation—and it has exploded in popularity as a result.”
Unfortunately, without universal treatment guidelines for ketamine and other psychedelic substances, people are left wondering which drugs are safe and when and how they should be used.
What Are Psychoactive Drugs?
Psychoactive drugs are mind-altering substances. Many of them have been used to improve mental and emotional health for thousands of years. Today, health professionals use these substances to help pave a pathway toward healing.
Sometimes doctors prescribe psychoactive substances without any additional treatment, but most often, they administer substances in combination with therapy and supportive treatments. In every case, the goal is to enhance the effectiveness of more traditional approaches.
While most psychedelic drugs are still illegal in the U.S., research shows they have the potential to treat mental health conditions including addiction, anxiety, depression and post-traumatic stress disorder (PTSD). “When used appropriately, and in a medically supervised setting, psychedelics show great promise for treating a variety of mental health conditions,” Nixon says.
How Do Psychedelics Work Therapeutically?
The truth is, researchers don’t fully know how psychedelics work, but they do have a few theories. Some experts believe psychedelics alter neurotransmitters (chemicals) in the brain. Others believe they encourage the growth of new connections between neurons in the brain (also called brain plasticity). Some speculate that psychedelic substances produce mystical and meaningful experiences that prompt you to think differently. “Psychedelics seem to disrupt the destructive thought patterns that make people feel stuck,” Nixon says.
What Are The Most Common Psychedelic Substances Used In Therapy?
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The only FDA-approved psychoactive substance for the treatment of mental health disorders is ketamine. Esketamine, a nasal spray form of the drug, is approved for depression. While compounded and intravenous forms of ketamine come with severe warnings, they are still used in the absence of FDA approval for the condition they’re treating. “These off-label uses can be especially dangerous,” Nixon says.
Unlike other psychedelic substances, which override the brain’s inhibitory mechanisms, ketamine relaxes these structures in the brain, making patients more open to the power of suggestion.
Several other substances with mind-altering effects are being studied as possible treatments for depression and anxiety. A few of the most common:
- Lysergic acid diethylamide (LSD): Also called “acid,” “blotter” and “mellow yellow,” LSD can alter your mood, perception and conscious awareness.
- MDMA: Commonly known as “ecstasy,” MDMA alters perception and leads to feelings of euphoria and arousal. Studies suggest it may be helpful in the treatment of depression and PTSD.
- Psilocybin: The psychoactive component in “magic mushrooms,” psilocybin produces similar effects to LSD.
How Are Psychedelic Drugs Administered?
Without standardized treatment guidelines—or FDA approval—for psychedelic substances, individual practitioners administer drugs based on their own knowledge and experience. In general, psychedelic-assisted therapy includes three key steps:
- Administration: During administration, the therapist delivers precise, typically small, doses of the purest form of the selected substance. Administration can range from a one-time dose to repeat doses with one to two weeks between sessions.
- Supervision: Once the drug has been delivered, the therapist monitors and supervises the experience to ensure safety and efficacy.
- Integration: After the psychedelic effects wear off, the therapist works with you to integrate (and make sense of) the experience through a series of psychotherapy sessions.
Why Is Medical Monitoring With Psychedelics So Important?
The use of mind-altering substances can pose some risks, particularly for medically vulnerable people. Self-treatment with psychedelics can be unpredictable and even dangerous—and many of these substances (including ketamine) are highly addictive. It’s critical that you receive a specific and pure dose of medication followed by therapy to integrate the experience.
“Some people may experience negative psychological reactions, such as increasing anxiety, panic, paranoia or even a psychotic break from reality,” Nixon says. “Others might suffer from complications related to the increase in blood pressure and heart rate produced by psychedelics.
How Can I Get Psychedelic Treatment?
Currently, the only way to legally and safely try psychedelic therapy in most of the country is to participate in a clinical trial. The one exception is ketamine. “Esketamine (the nasal spray form of ketamine) is now available at clinics across the country, including Henry Ford, but it should always be used in precise doses and under the direct supervision of a skilled therapist,” Nixon says.
Other psychedelic substances, including MDMA and psilocybin, are under FDA review for the treatment of anxiety, depression and PTSD. States including Oregon and Colorado have passed measures to allow therapeutic use of psilocybin.
Reviewed by Chris Nixon, LMSW, CAADC, Director of Addiction Medicine at Henry Ford Maplegrove Center.
