Is it possible that psychedelics can be used as a potential means / method of managing and treating Post-traumatic stress disorder (PTSD)?
Which Options Are the Most Promising?
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced and / or witnessed an incredibly traumatic event. A few examples of such events include, war / combat, natural disasters, a serious accident, rape and sexual violence, a terrorist attack, serious injury, or being threatened with death or violence of any kind. While these are merely a few examples of traumatic events, they all have a high potential / probability of triggering / causing PTSD.
Despite the fact that Post-traumatic stress disorder (PTSD) is one of the most common psychological conditions, with more and more individuals being diagnosed each year, there is STILL a lack of effective methods to both manage and treat this highly prevalent psychological condition. This is simply unacceptable – We are in the year 2022 after all! After all these years one would think (or rather hope) that at least some progress has been made towards finding a beneficial and credible method of treatment or means of properly managing PTSD.
Unfortunately, this does not seem to be the case!
Currently, the most widely recommended option / method of managing and treating Post-traumatic Stress Disorder is psychotherapy. Before you get too excited – DON’T! Using psychotherapy as a means of managing and potentially treating PTSD has not only proven / shown to have a high drop-out rate, but 40–60% of patients who have undergone psychotherapy as a means to manage and treat their Post-traumatic stress disorder continued to experience symptoms afterward. Thus proving to be highly ineffective.
As a result, scientists have been forced to investigate and explore alternative treatment methods and novel therapies, including psychedelics like MDMA, ketamine, psilocybin, and cannabinoids. While research and studies surrounding these therapies are still very new and in its infancy, the initial results have been incredibly promising and mainly positive. Finally!
So, how exactly do these drugs work, and is one better than the others? We explain everything in this in-depth guide to psychedelics and PTSD.
Psychedelics as a means of treating and managing PTSD
As mentioned above, Post-traumatic stress disorder (PTSD) is a highly complex psychiatric disorder that manifests in people who have experienced and / or witnessed a traumatic event. PTSD impacts several different regions of the brain and results in lasting changes to the nervous system. It also causes a vast variety of unwanted symptoms.
Due to its extreme complexity, PTSD has proven to be exceptionally difficult and challenging to resolve. As pharmaceuticals have limited use, psychotherapy is still the mainstay of treatment for PTSD. However, as we highlighted / pointed out in our above discussion, psychotherapy is most definitely not all its cracked up to be and presents with its own set of difficulties and challenges.
PTSD can cause people to ‘retreat’ and become avoidant, ultimately making it profoundly difficult for them to confront and face their own traumatic memories and experiences. This in turn results in a very high drop-out rate, not to mention the countless patients who are left with intense lasting symptoms, even after completing a course of therapy.
These issues have both motivated and prompted scientists and researchers to investigate and find new and effective methods and medications for the potential treatment and management of PTSD. And guess what? It most definitely seems like psychedelics could hold the key and be the saving grace people have been waiting and searching for all along.
The best-studied drug in this category is 3,4-methylenedioxymethamphetamine (MDMA). Early research suggests that it could provide significant benefits in combination with psychotherapy.
Unfortunately, there is far less existing research on other psychedelics, such as ketamine, lysergic acid diethylamide (LSD), and psilocybin as it pertains to the management and treatment of PTSD. However, despite the fairly limited research, these drugs / psychedelics could potentially offer individuals with PTSD some significant benefits. Research also suggests that cannabinoids may be very helpful in this regard, although some people would argue that they are not technically psychedelics.
To better understand how psychedelic therapy could help, let’s take a closer look at PTSD and how it affects the brain.
How PTSD affects / impacts the brain
A 2006 review conducted by J. Douglas Bremner, MD, explains how PTSD causes various prolonged changes to several regions of the brain along with neurochemicals. They include the following:
• The Hippocampus:
The hippocampus plays a crucial role in learning and memory. The Hippocampus is highly susceptible to the effects and impact of trauma as it is readily and easily influenced by external stimuli. With regards to PTSD, overall hippocampus volume may reduce, which results in altered cognitive and memory processing.
• The Amygdala:
The amygdala is one of the brain’s primary emotional centers. It is specifically associated with feelings of fear and anxiety. Amygdala activity tends to increase in individuals with PTSD, thus escalating these emotions.
• The Prefrontal Cortex:
The prefrontal cortex is a vital region of the brain and serves / performs a vast variety of functions. The most relevant function as it pertains to PTSD is its ability to mediate the amygdala. Traumatic stress reduces prefrontal cortex activity, leading to further increases in amygdala activity, fear, and anxiety.
• Neurochemicals:
PTSD can cause abnormal responses in several neurochemicals. These neurochemicals include the stress hormones cortisol and norepinephrine, as well as serotonin, which is responsible for regulating one’s mood.
So, how exactly do various psychedelics help to attenuate these changes?
PTSD Drug Treatment
There are currently only two FDA-approved drugs for PTSD. These medications are sertraline and paroxetine. Both are selective serotonin reuptake inhibitor (SSRI) antidepressants, which increase serotonin levels in the brain. Therefore, they may relieve some, but not all, PTSD symptoms.
The search for more effective PTSD drugs has led scientists to investigate novel therapies, such as psychedelics.
While there are several psychedelics that could potentially aid in PTSD drug treatment, we are going to focus on classical psychedelics such as psilocybin.
• Classical Psychedelics
While there is less evidence surrounding the effectiveness of classical psychedelics such as psilocybin and LSD as it pertains to the management and treatment of PTSD, countless studies have been conducted on the amazing effects and numerous mental, emotional, and physical benefits psilocybin has on other mental health conditions, specifically depression, anxiety disorders, obsessive-compulsive disorder (OCD), and addiction.
We can hypothesize that classical psychedelics may in fact be a useful adjunct to psychotherapy for treating PTSD, especially now that we know about the various positive effects and range of benefits psilocybin has on other mental health conditions.
Psychedelic Treatment for PTSD
The table below summarizes the various options for treating PTSD with psychedelics and how they could provide relief:
Psychedelics
Options for treating PTSD
MDMA
• Acts as a catalyst for psychotherapy
• Raises levels of serotonin, dopamine, norepinephrine, oxytocin, prolactin, vasopressin, & cortisol
• Increases fear extinction
• Reduces amygdala activity
• Increases prefrontal cortex activity
• Reduces fear response and shame
• Increases empathy, openness, and personal trust
• Improves traumatic memory processing
• Produces mild sensory and cognitive alterations.
Ketamine
• May act as a catalyst for psychotherapy
• Acts as an NMDA receptor antagonist to alter glutamate activity
• Facilitates fear extinction and blocks memory reconsolidation
• May improve traumatic memory processing
• Increases synaptic plasticity to build new neural pathways
• Produces rapid but temporary symptom relief
• Induces sensory distortion
• Increases relaxation
• May induce transformation in concept of self and emotional attitude
Classical Psychedelics
• Act as catalysts for psychotherapy
• Act as serotonin (5HT2A) receptor agonists to mimic serotonin’s effects
• Increase insightfulness and introspection
• Reduce amygdala activity during emotional processing
• Increase synaptic plasticity to build new neural pathways
• May reduce avoidance and increase access to traumatic memory
• Can increase empathy
• Induce sensory distortion
• Can induce emotional breakthroughs
• Encourage divergent thinking and capacity for mindfulness
Cannabinoids
• May act as catalysts for psychotherapy
• Target CB1 and CB2 receptors in the endocannabinoid system, with wide-ranging effects
• May increase fear extinction, although chronic use may reduce it
• THC may reduce amygdala activity
• May improve traumatic memory processing
• Aid in temporary symptom management, e.g. anxiety, insomnia, nightmares
• Produce mild to moderate sensory distortion
• Induce relaxation
What Is the Best Drug Protocol to Treat PTSD?
Research into psychedelics for PTSD is just beginning. Therefore, it is currently difficult to say whether one drug for PTSD is better than another.
So far, there is more evidence to support the use of MDMA than other psychedelic drugs. However, that is not to say that the alternatives have no use. It is merely that further clinical trials are necessary to determine the extent of their effectiveness.
Cannabinoids might have some advantage over the other options due to their availability. Medical marijuana is now legal in most U.S. states, including Washington DC, with many listing PTSD as a qualifying condition. This is in stark contrast to the other options on this list, which remain illegal in most places.
The thing all these drugs have in common is that they work best as part of an ongoing psychotherapy program.
For example, in most MDMA clinical trials, the subjects participated in 15 psychotherapy sessions, only 2–3 of which were drug-assisted. There is no evidence that it is effective as a standalone therapy.
Therefore, anyone interested in trying psychedelic drugs to treat PTSD should talk to a knowledgeable physician or therapist first. Better still, individuals could join an ongoing clinical trial in their area and help progress research into psychedelics and PTSD.
