Psychedelic drugs can be dangerous for patients – 03/19/2023 – Equilibrium

When Charles Nemeroff met his patient, the 32-year-old woman had already seen several psychiatrists. She (whose identity has been withheld for her privacy) initially had paranoid and fleeting thoughts, insisting that her phone was tapped and that people were watching her. She even sold her home to try to escape. After receiving antipsychotic medication, his mania and psychosis subsided but gave way to a debilitating depression.

“When she came to me, she said, ‘I don’t have any feelings. My mood doesn’t fluctuate. I’m completely empty,'” says Nemeroff, director of the department of psychiatry and behavioral sciences at the University of Texas Austin Dell School of Medicine.

The patient had been treated for mild depression ten years ago, but until then had had a rewarding social and professional life. Psychosis followed by major depression was something else entirely. And it was triggered by the use of psychedelics.

“She had a full psychotic episode for the first time in her life,” says Nemeroff, who published the patient’s story in December as a case study in the American Journal of Psychiatry. The woman’s friends, who took the same drugs as her on both days, had no lasting side effects.

The popularity of psychedelics has increased in recent years. According to the National Survey on Drug Use and Health done in the United States in 2020, 1.4 million Americans tried hallucinogens for the first time. This enthusiasm is attributed in part to clinical trials that have shown that drugs, especially psilobicin and ketamine, have real potential for treating some mental health disorders, especially depression.

There is also a shift in the way these drugs are portrayed in popular culture and media, such as in Michael Pollan’s bestseller “How to Change Your Mind” and the Netflix series based on the book, “How to Change Your Mind.” Two US states, Oregon and Colorado, recently legalized psilobicin for medical purposes, and others are expected to follow suit.

With these drugs gaining wider acceptance, it is likely that more and more people will consider taking them, both for medical and recreational purposes. Experts who study these substances strongly recommend that they be used only in medically supervised therapeutic situations, such as in a clinical trial or in a recognized medical treatment that uses ketamine, in part because of safety concerns and also because they are illegal outside of these countries. spaces. Realistically speaking though, many people will use them elsewhere.

The chance of fatal overdose is very low with psychedelics and there is little risk of addiction. Thanks to this, these drugs have been ranked by experts as some of the least harmful recreational drugs. But that doesn’t mean they are risk-free. Because of this, psilocybin clinical trials and ketamine treatments have strict exclusion criteria to protect people with physical or psychological vulnerabilities.

If you’re considering using these drugs, here’s what you need to know about potential dangers.

Serious psychiatric disorders

In terms of important side effects, the main concern of specialists with regard to ketamine, psilocybin and other hallucinogens, such as LSD or ayahuasca, is the possibility of triggering a psychotic or manic episode. Because these drugs (with the exception of ketamine) are not approved for use by the FDA (US Food and Drugs Regulatory Agency), information about their safe use is sparse. Therefore, the concern is mainly based on anecdotal evidence.

The limited data available suggest that the chances of a psychosis developing are low in the general population. A survey of more than 1,000 recreational psychedelic users found no link between drug use and schizophrenia-like symptoms. Another study also showed no link between past use of psychedelics and psychosis or other current psychiatric disorders.

But experts say the risk of psychedelics triggering a psychotic or manic episode is likely high for people with a personal or family history of schizophrenia and bipolar disorder. For this reason, people with this type of history are excluded from psilocybin clinical trials or medical treatment with ketamine.

“I’ve had many patients report to me that they were more or less fine, took LSD, and have since had schizophrenia,” says Bryan Roth, professor of pharmacology at the University of North Carolina at Chapel Hill. “My guess is that they had some underlying predisposition to schizophrenia and they got out of balance when they used the psychedelic.”

Nemeroff agrees: “I think the problem with these very potent drugs is that there are likely to be people who are genetically vulnerable to severe psychiatric illness but who have not yet reached that threshold. These drugs can trigger that vulnerability.”

Confirming these fears, one of the few studies on the use of psychedelics by individuals with bipolar disorder found that a third of people reported a worsening of their symptoms after taking psilocybin recreationally, while 3% had to seek emergency medical help.

In light of this, Roth points out, “Anyone with a serious psychiatric disorder — such as schizophrenia, bipolar disorder — should not take psychedelic drugs.”

cardiovascular problems

The still-emerging legal status of psychedelics also means that there is little research into their possible harmful effects on the body. Experts know that psilocybin and ketamine raise blood pressure and heart rate. Therefore, as a precautionary measure, people with heart problems, such as uncontrolled hypertension, cardiovascular disease and arrhythmias, are advised not to use these substances.

In carefully monitored clinical trials, where dosing is supervised and patients are followed, the drugs “appear to be cardiac safe,” notes Jeremy Ruskin, a cardiologist and professor of medicine at Massachusetts General Hospital. It is not known whether they are equally safe for people who would be at high risk under uncontrolled conditions.

One reason psychedelics appear to be safer than many other drugs is that most users take them infrequently. So there is little fear of cumulative harmful effects. But experts say there is a second hypothetical cardiovascular risk if the drugs are used daily or weekly.

Other security concerns

There are some other notable risks linked to medications or medical history that potential psychedelic users need to be aware of.

First, these drugs potentially alter brain activity, so it’s possible that they trigger seizures in people with epilepsy.

Also, Celia Morgan, professor of psychopharmacology at the University of Exeter in England, says that people who have suffered traumatic brain injury should consult their doctor before using ketamine, because the drug can raise intracranial pressure.

“If you have something in the brain that’s raising your pressure and you then raise the pressure even more, you could end up bleeding terribly,” she explains.

Translated by Clara Allain