Psychedelic drugs—A New Era in Psychiatry?

Abstract: This article covers the renaissance of classical psychedelic drugs such as psilocybin and LSD plus 3,4-methylene dioxymethamphetamine (MDMA—ecstasy) in psychiatric research. These drugs were used quite extensively before they became prohibited. This ban had little impact on recreational use, but effectively stopped research and clinical treatments, which up to that point had looked very promising in several areas of psychiatry. In the past decade a number of groups have been working to re-evaluate the utility of these substances in medicine. So far highly promising preliminary data have been produced with psilocybin in anxiety, depression, smoking, alcoholism, and with MDMA for post-traumatic stress disorder (PTSD) and alcoholism. These findings have led to the European Medicines Agency approving psilocybin for a phase 3 study in treatment-resistant depression and the Food and Drug Administration for PTSD with MDMA. Both trials should read out in 2020, and if the results are positive we are likely to see these medicines approved for clinical practice soon afterwards.

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Psychedelics of plant extraction such as mescaline (peyote cactus) and psilocybin (magic mushrooms) have been used for millennia in cultures all across the globe, but Western science was not introduced to them until 1897, when Arthur Heffter isolated mescaline. The real breakthrough came with the discovery of LSD in 1943 by Albert Hofmann at Sandoz as a synthetic variant of ergot alkaloids. Following his famous descriptions of his first exposure he persuaded Sandoz to make LSD available to researchers across the world under the trade name Delysid, and Sandoz made it freely available to those interested in researching its properties. Hofmann also identified the active component of “magic” mushrooms as psilocybin. This was also made available by Sandoz as Indocybin. It should be noted that psilocybin is in effect a prodrug, and is converted into the active ingredient psilocin in the body.


Research with LSD, in particular, flourished and the US government, in the form of the National Institutes of Health, is reputed to have funded over 130 grants for its study (but none since the 1967 ban). Before the ban hundreds of papers were published on LSD (and to a lesser extent psilocybin). Citation3 Because LSD, psilocybin, and other hallucinogens mimicked some of the symptoms of acute psychosis, particularly ego-dissolution, thought disorder, and misperceptions, it suggested the possibility that an endogenous psychotogen might cause schizophrenia. It also seemed to allow access to repressed memories and emotions and so “unblock” people failing in psychotherapy. LSD appeared very safe in relation to other psychotropic agents used at that time, especially the barbiturates which were very toxic in overdose, whereas the psychedelics rarely had lasting medical effects, even after overdose. Indeed a long-term follow-up analysis of the impact of the tens of thousands of LSD administrations given in the 1950s and 1960s reported no increased level of psychiatric problems. For a more detailed overview of the history of psychedelics in psychiatry. One more negative note is the fact that some saw LSD as a potential weapon in warfare rather than as a therapeutic advance. This was seen in both the West and in communist countries who developed their own drugs when Sandoz would not supply them.


One area of particular interest was in the treatment of alcoholism. This derived from the personal psychedelic experience of Bill Wilson which led to his becoming alcohol-free, and so also led to the founding of Alcoholics Anonymous. Wilson’s own experience made him convinced of the value of LSD to give alcoholics insight into how they might overcome their drinking addiction. He encouraged the use of LSD in the treatment of alcoholism, and six trials were conducted before the drug was banned. These data were recently subjected to a modern meta-analysis and LSD therapy was found to be at least as efficacious a treatment as anything we currently have today. Of interest to psychotherapists, Wilson also believed that LSD could give unique and immediate insights into the unconscious mind. He wrote to Jung encouraging him to explore this potential but Jung, who was approaching death at the time, didn’t seem especially enthusiastic and apparently replied to the effect that dreams were good enough!....[Full Article]