What we already know about psychedelics, therapy, design, and how these things have previously interacted.

In order to better understand the problem I’m approaching, conducting secondary research was essential. While there is always more to read out there, this is a short synthesis of knowledge I’ve collected thus far in my research process.

Wilcox, A. (2020, July 24). How LSD is Made: DoubleBlind. Retrieved January 18, 2021, from https://doubleblindmag.com/how-lsd-is-made/

In this article, Anna Wilcox discusses a bit of history and logistics surrounding the formation of the chemical compound known as Lysergic Acid Diethylamide, or LSD.

Albert Hoffman first synthesized the drug in 1938 while exploring the potential of the Ergot Fungus in medicines. It was the 25th compound he had developed and he hypothesized it was a circulatory and respiratory stimulant. It wasn’t until 1943 that he discovered the effects of what he had created.

LSD was legal for scientists to make until 1968 when it was officially criminalized. Up until this point, professionals around the country were studying the potential uses of LSD in many ways. In fact, the psychedelic compound was marketed as Delysid and used by therapists to help facilitate psychoanalysis.

Timothy Leary and Ram Dass, two Harvard professors who were testing the drug at the university while also promoting recreational use, were fired in 1963. Leary attended senate subcommittee hearings explaining the powers of LSD, but moral skeptics worried the drug would lead young people to “drop out”. Dr. Sidney Cohen, another psychedelic expert, argued LSD was only safe when used in an appropriate medical setting.

With the outlaw and schedule 1 drug classification shortly after, LSD production was forced underground. This substance is made both from natural and human-made substances, requiring a suite of laboratory equipment and organic chemistry knowledge. US government agencies also monitor the purchase of chemicals used in the process. This difficulty of production makes home LSD creation much rarer than other drugs.

Halser, M. (2020, November 09). Can Psychedelics Treat Eating Disorders?: DoubleBlind. Retrieved January 18, 2021, from https://doubleblindmag.com/can-psychedelics-treat-eating-disorders/

In this article, Marlene Hasler discusses the use of psychedelics with those experiencing problems with eating disorders. 28.8 million Americans live with an eating disorder and of those 10,000 die each year. Eating disorders are amongst the most challenging mental disorders to treat. Traditional treatments have a high dropout rate and a reported 30%+ relapse rate.

Through research, professionals are finding psychedelics to be beneficial in treating eating disorders. Adele LaFrance published research in 2017 that has led to studies looking at the use of MDMA, Ketamine, and Psilocybin as a potential treatment for eating disorders.

Those with eating disorders have often developed them due to a complex collision of factors and events in a person who is neurobiologically more vulnerable or has experienced trauma. Psychedelics can be used to help patients target and transform their ability to process emotions. Psychedelics hold the potential to reduce fears when approaching painful memories and emotions.

Rahn, B. (2020, August 12). Are there Long-Term Effects of Microdosing Psychedelics?: DoubleBlind. Retrieved January 19, 2021, from https://doubleblindmag.com/long-term-effects-of-microdosing-psychedelics/

While there is little known at the moment due to restricted access to testing, this article discusses the potential effects of long-term microdosing.

A placebo-controlled study in 2018 measured effects within various sessions, but a session like this allows for no insight on the effects past the four weeks follow up meeting. Dr. James Fadiman has responded to the lack of clinical research by collecting thousands of user reports on microdosing. Pharmaceutical companies typically don’t test long-term effects of anything unless it starts harming enough people that others begin to notice.

12% of the US population over the age of 12 takes an antidepressant medication. Those who use antidepressants often face unpleasant side effects such as withdrawal after long-term use. This has led to a discussion about how antidepressants may be altering brain architecture and chemistry over these long stretches of time.

The theory powering long-term microdosing has to do with neuroplasticity — the brain’s ability to change or reorganize neural connections over time. One study published in 2018 found that classic psychedelics like LSD and DMT encouraged new connections in the brain, leading the authors to hypothesize that psychedelics might provide novel approaches to depression treatment.

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361016/

This article discusses the effectiveness of antidepressants for treating depression. Research displayed in this article claims antidepressants to be effective in moderate, severe, and chronic depression, but not mild cases.

The main aim of these drugs is to relieve symptoms of depression (feeling very down and exhausted, restlessness, anxiety, sleep problems, prevent suicidal thoughts, etc.). There are three main kinds of antidepressants used today — tricyclic antidepressants, Selective serotonin reuptake inhibitors, and selective serotonin noradrenaline reuptake inhibitors.

Depression is caused by an imbalance of certain chemical messengers (neurotransmitters) resulting in the improper passage of signals along the nerves. The use of antidepressants aims to increase the availability of these chemicals.

It’s difficult to predict how well a medication will help an individual, therefore, sometimes a number of different drugs have to be tried before landing on one that is suitable for the patient.

According to a study — an extra 20 out of 100 people had improved symptoms with the use of antidepressants, and 27 out of 100 people taking an antidepressant over a long period of time successfully prevented a relapse.

Ly, C., Greb, A., Cameron, L., Wong, J., Barragan, E., Wilson, P., . . . Olson, D. (2018, June 12). Psychedelics Promote Structural and Functional Neural Plasticity. Retrieved January 20, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082376/

This study highlights the beneficial effects of psychedelics on the brain. Neuropsychiatric diseases and mood and anxiety disorders are some of the leading causes of disability worldwide. These conditions place an enormous economic burden on society. Approximately ⅓ of patients don’t respond to current antidepressant drugs and those who do require at least 2–4 weeks of treatment before experiencing beneficial effects.

Atrophy of neurons in the prefrontal cortex plays a key role in the pathophysiology of depression and related disorders and stress only exacerbates these issues. These structural changes in the brain can potentially be counteracted by compounds capable of promoting functional neural plasticity in the prefrontal cortex. Ketamine has shown the most promise during clinical studies and has the potential to serve as a fast-acting antidepressant — even exhibiting efficacy in those who previously were not benefitting from treatment. The therapeutic effects stem from ketamine’s ability to promote the growth of dendritic spines, increase the synthesis of synaptic proteins, and strengthen synaptic responses.

This work suggests that ketamine is not unique in its ability to promote structural and functional plasticity. This is important because of ketamine’s addictive properties that other psychedelics such as DMT, MDMA, and LSD don’t possess.

Cartwright, C., Gibson, K., Read, J., Cowan, O., & Dehar, T. (2016, July 28). [Full text] Long-term antidepressant use: Patient perspectives of benefits and adv: PPA. Retrieved January 20, 2021, from https://www.dovepress.com/long-term-antidepressant-use-patient-perspectives-of-benefits-and-adve-peer-reviewed-fulltext-article-PPA

This article presents information from a study involving participants that have experience with long-term antidepressant use. In this review of 14 studies, it was found that outcomes for depressed patients were poor, with multiple relapses and large variability among them.

In one study, it was found that 60%-63% of patients continuously using adequate dosages of antidepressants experienced a recurrence of their symptoms. Patients not treated with antidepressants after remission had the lowest recurrence rate, at 26%.

Long-term risks come with prolonged antidepressant use. These risks include osteoporosis and fracture, bleeding disorders, hyponatremia, and diabetes mellitus.

Many participants shared their experiences with antidepressants, presenting obvious issues with these pharmaceuticals. “It did, however, take many years of trying different types of antidepressants before I found one that seemed to work for me and had few side effects…”, “I have been on them for so long now that I’m not sure how much of myself is actually me and how much is the antidepressant”

While patients did experience an alleviation of their symptoms while on antidepressants, the negative results often present patients with a tough decision.

Valentish, J. (2019). Acid test: How psychedelic virtual reality can help end society’s mass bad trip.

This source discusses the uses of extended reality technologies within the psychedelic field. VR artists, academics and scientists met for the first “Cyberdelic Incubator” in Melbourne hosted by the Australian Psychedelic Society.

The idea of cyberdelia promotes the creation of technology influenced by pre-digital era values of connection, creativity and respect. This more conscious, self-transformative approach to technology allows for a more genuine connection to people than what you find on social media.

Professionals have begun using extended reality technologies to create experiences that expedite a different kind of journey. For example, using music to shape a visual journey, involving the senses by incorporating a device strapped to the back that delivers bass vibrations into the vertebrae, etc. These experiences allow participants to undo the damage done by smartphones and the addictive apps on them. VR technologies can provide a greater sense of empathy by allowing people to stand in the shoes of others.

Carhart-Harris, R. L., & Moroz, M. (2018, December 17). Employing Synergistic Interactions of Virtual Reality and Psychedelics in Neuropsychopharmacology. Retrieved January 21, 2021, from https://ieeexplore.ieee.org/document/8576882

This article discusses the potential of psychedelics as a catalyst that enhances user immersion in virtual reality spaces. Published studies have shown the benefits of both psychedelic therapy and virtual reality exposure therapy, and the potential for the combination of the two is promising.

Psilocybin, LSD, Ketamine, and MDMA offer relief to those experiencing various psychiatric disorders including treatment-resistant depression, anxiety, post-traumatic stress disorder and addiction. VR allows the ability to hijack the human sensorimotor system while providing a safe and appropriate set and setting for the client partaking in the experience. Immersing a patient in a virtual space helps mitigate the effects of self-consciousness by decreasing the overtly clinical nature of their surroundings while participating in clinical treatment.

Previous approaches to VRET have been combined with the use of the SSRI known as sertraline. While this showed improved efficacy, many participants experienced adverse effects such as nausea, malaise, and sexual dysfunction during the study. 28 weeks after cessation of the treatment, significant deterioration in health was reported. Unlike psilocybin, SSRIs aren’t direct 5-HT2A receptor agonists, meaning they offer none of the benefits such as cognitive flexibility, associative learning, and cortical neural plasticity.

The combination of well designed VR experiences with psychedelic use has the potential to provide clients with long lasting relief for a variety of psychiatric conditions.

Aday, J., Davoli, C., & Bloesch, E. (2020). Psychedelics and virtual reality: Parallels and applications. Retrieved January 21, 2021, from https://journals.sagepub.com/doi/epub/10.1177/2045125320948356

This source discusses the commonalities between psychedelics and virtual reality and the potential benefits of the combination of these two experiences.

Psychedelic drugs and VR are each used to disrupt the rigidity of sensory experiences and enhance outcomes with mental health treatments. Early discourse surrounding VR was linked to psychedelic culture because of the drugs capacity to alter mental experience. Another commonality psychedelic and virtual reality share is the ability to evoke awe in users. This component of these experiences has cognitive and therapeutic implications.

Commonalities among psychedelics and virtual reality present many benefits of combined uses. Due to restrictions in the field, these ideas have received limited scholarly attention. These findings are in line with recent increased scientific interest in the interactions among technology, psychopharmacology, and mental health.

Koslow, T. (2020, May 8). Why Taking Psychedelics While on Antidepressants Could Make Treatment Ineffective: DoubleBlind. Retrieved January 21, 2021, from https://doubleblindmag.com/how-psychedelics-contraindicate-with-ssris/

This article discusses the potential interactions of antidepressants and psychedelics. There is little research regarding the topic, but the preliminary evidence has shown that SSRI use may hinder psychotherapy results. With everything, these interactions will vary by individual as well as by drug types.

More studies need to be conducted to know for certain, but based on data collected by researchers, those who take antidepressants have found the effects of psychedelic drugs to be diminished. When it came to MDMA, users reported blunted effectiveness, but their blood showed a 30% increase in MDMA plasma concentrations, indicating a metabolic interaction between antidepressants and MDMA.

Luckily ketamine use has shown little to no interaction with SSRIs. Users report similar experiences with or without taking antidepressants, and some even report a single dose proving to have lasting effects on depression symptoms. In 2019, the FDA approved the first ever ketamine-based antidepressant, paving the way for psychotherapy in the United States.