Psychedelics: Paradigm shift for mental health?

In parts of public discourse and scientific literature, psychedelic therapies are claimed to transform and revolutionise psychiatry and mental healthcare. Can psychedelics live up to this claim?

Psychedelics alone cannot solve mental health crisis

In public discourse and in parts of the scientific literature, it is claimed that psychedelic therapies could transform and revolutionise psychiatry and mental health care. But can psychedelics really live up to this claim? This was debated at the concluding panel discussion on the first evening of INSIGHT 2021 - moderated by Dr. Andrea Jungaberle, founder of the MIND Foundation - by Prof. Dr. Gerhard Gründer, Dr. Katrin Preller, Dr. Martha Havenith and Dr. sc. hum. Henrik Jungaberle.

Psychedelic therapy options, the advantages and disadvantages of psychedelics for mental health, as well as their benefits for patient groups and the public population - this is what the four speakers discussed at the concluding panel discussion "New Paradigm or Co-Existance? The Potential of Psychedelics in Mental Health". Introducing the discussion, Dr. sc. hum. Henrik Jungaberle - founder of the MIND Foundation -  indicated that: One must always keep in mind who can be helped with psychedelic medicine and how. However, solutions obtained through psychedelics must also work outside the psychedelic state. Dr. Jungaberle is therefore also sceptical about handing out mind-expanding drugs in principle. Psychedelics alone could not solve the mental health crisis. Dr. Martha Havenith, Max Planck Research Group Leader at the Ernst Strüngmann Institute for Neuroscience (Frankfurt, Germany), notes that in the best case psychedelics could help to better manage the "hard work" inside the person. This way, the process could also have a positive outward effect on the condition of treated persons.

Dr. Katrin Preller, winner of the Pfizer Research Award and the Young Investigator Award of the Swiss Society for Biological Psychiatry, notes at this point, however: First and foremost, patients must be willing to change of their own accord. A changed mental state alone cannot bring about this change. Prof. Dr. Gerhard Gründer, head of the Department of Molecular Neuroimaging at the Central Institute for Mental Health, explains: In a controlled medical environment, psychedelics have the potential to make life much easier for both patients and physicians. In his opinion, healthy people could also benefit from psychedelics in principle, but the data on this is still absolutely insufficient at the moment. In Gründer's opinion, however, the benefits of psychedelic medicine for people with mental problems should first be investigated more thoroughly before considering further steps.

More studies on psychedelic medicine urgently needed

Dr. Andrea Jungaberle brings up the keywords "medicalisation" and "prescription" during the discussion. After all participants have first thought intently about possible answers, Gründer takes the floor and explains the reticence: "This is a minefield." He knows he might meet resistance with his answer, but the topic must be considered in a differentiated way. He himself had experienced patients who had the exact opposite of the desired effect and who had become psychotic after treatment with psychedelics. Dr. Henrik Jungaberle notes that there are already some studies that point to a benefit of psychedelic medicine for healthy people as well, but due to the limited data, no clear picture can be drawn yet. Therefore, the founder of the MIND Foundation states that, in his opinion, prescribing and treating the general public with MDMA would do more harm than good. Psychedelics could have a positive effect especially if the basic attitude and the environment of the people who are treated with it are basically stable.

Dr. Preller sees medicalisation and prescription as two different issues. In the medical environment, psychedelics should definitely be used if it shows a benefit for patients. Legalisation in public, however, is a different issue. The neuropsychologist can imagine that the sale and administration in "daylight", i.e. in a controlled and legally defined environment, could bring many benefits, but this is a decision that politicians have to make. Dr. Havenith agrees here, saying that there are indications from the Netherlands, for example, that psychedelics can be handled safely if this takes place in a legal, controlled environment. In her opinion, the discussion should also take place in Germany in the light of public opinion.

Treatment with Psychedelics: A medical revolution?

Finally, the speakers explore a crucial question: "Do psychedelics amount to a revolution in the psychiatric field?" Dr. Havenith notes that she believes psychedelic medicine should become the leading method of action in the future, at least for some areas. People with depression, for example, could particularly benefit from psychedelics, as antidepressants are often accompanied by serious side effects. Dr. Gründer says that the world of psychiatry would definitely look different with psychedelic medicine, but it is not foreseeable how long this change will last. Currently, psychiatry is often a very sterile environment that urgently needs to change and adapt to the needs of individual patients. However, psychedelics are by no means suitable for all patient groups. For people with schizophrenia, for example, this approach would be completely unsuitable. Therefore, a coexistence between traditional treatment methods and new approaches is of utmost importance.

Dr. Henrik Jungaberle adds that psychedelic medicine is more of an evolution than a revolution, as this treatment method is not suitable for all patient groups. People still have to be treated individually in the field of psychiatry, there is no universal solution here. For a small group of patients, however, psychedelic therapies could amount to a revolution. Dr. Katrin Preller adds that an increasing use of psychedelic treatment approaches would also have an impact on another level: It could be shown that pharmaceuticals are not the only method of treatment in psychiatry. This could have a massive impact on providing patients with the best possible therapy on an individual basis. She concludes: Psychedelics represent a revolution for all individual patients who can be helped in this way.

Reference: INSIGHT Conference 2021; Panel I: New Paradigm or Co-Existance? The Potential of Psychedelics in Mental Health; 09.09.2021, 8:20 PM - 9:00 PM.