Psychedelic-assisted therapy for anxiety and depression in the face of death: A critical review with an anthropological lens
Journal of Psychedelic Studies, 2019, 3, (1), 14–18.
Psychedelics have been investigated for their therapeutic applications in end-of-life care as early as 1960. Recently, there have been four main groups conducting clinical trials for either lysergic acid diethylamide or psilocybin for the treatment of anxiety and depression in patients with terminal illnesses. The recent trials have higher methodological quality and demonstrate the profound impact of psychedelics for this particular patient presentation. However, a number of gaps, including understanding the meaning of death and dying in Western society; the nature of the psychedelic experience and how this lends itself to assisting those who are facing death; and how suffering and psychological distress are defined and understood in current psychiatric and medical frameworks. This article provides a critical evaluation of the recent publications and suggests how anthropology may contribute knowledge to this emerging field.
Keywords : psychedelics, anthropology, LSD, psilocybin, death and dying
Hallucinogens, primarily lysergic acid diethylamide (LSD) and psilocybin, have been used for the treatment of anxiety and mood disturbance associated with terminal illnesses since as early as 1960, with four clinical trials occurring in recent years (Reiche et al., 2018). A systematic review of these clinical trials revealed 11 studies – 7 involving LSD, 3 using psilocybin, and 1 investigating the use of dipropyl-tryptamine (Reiche et al., 2018). The majority of psychedelic studies was conducted in the 1960s and 1970s, and showed a great deal of promise for psychedelics as therapeutic agents (Dutta, 2012; Gasser, Kirchener, & Passie, 2014; Reiche et al., 2018). Recently, there have been four main groups investigating the therapeutic application of LSD or psilocybin for patients with terminal illnesses at varying stages (Gasser, Kirchener, et al., 2014; Griffiths et al., 2016; Grob et al., 2011; Ross et al., 2016). This paper explores the recent trials into psychedelics for death-related anxiety and depression, in the context of current medical and psychiatric ideology. In this arena, the field of anthropology can elucidate the cultural meanings behind death and dying and methodologies that may uncover the human and experiential aspects of the psychedelic experience.
REVIEW OF LITERATURE
The recent clinical trials conducted by Grob et al. (2011), Gasser, Kirchener, et al. (2014), Griffiths et al. (2016), Ross et al. (2016), and their respective colleagues explore the use of LSD or psilocybin for the treatment of depression, anxiety, or adjustment disorders in individuals with terminal illnesses. These studies contain higher methodological quality, more stringent assessment procedures, and higher reported safety compared to the studies of the 1960s and 1970s (Reiche et al., 2018). Early studies suggested the effectiveness of hallucinogens in treating distress in cancer patients; however, they contained no control or comparison conditions to demonstrate that the effects were any better than placebo (e.g., Grof et al., 1963; Kast, 1967; and Richards et al., 1977 – cited in Griffiths et al., 2016). It is well established that set (participant characteristics) and setting (environmental factors) lead to great variability in psychedelic experiences. It is therefore worthwhile evaluating the procedures and processes involved in the recent trials. The following section will outline the processes undertaken in the recent psychedelic studies into anxiety and depression associated with life-threatening illnesses, conducted since 2011.
Recent studies used either LSD or psilocybin, compared with either a very low dose of the active substance (e.g., Griffiths et al., 2016) or a placebo with mild physiological effects such as niacin (e.g., Grob et al., 2011). Data assessments were carried out at several time points, including well in advance of the first dose; immediately post-treatment sessions; and again days, weeks, and even several months following treatment sessions. Follow-up interviews were conducted up to 12 months following participation in LSD psychotherapy (Gasser, Kirchner, et al., 2014). Patients also took part in an extensive battery of psychometric measures for a range of constructs, including mood states, depression, state anxiety, trait anxiety, altered states of consciousness, psychiatric ratings, mystical experience, quality of life, and existential distress (Griffiths et al., 2016; Grob et al., 2011; Ross et al., 2016). Patients participating in the recent clinical trials were diagnosed with either cancer or other lifethreatening diseases at various stages, and also met the diagnostic criteria for a mood, anxiety, or adjustment disorder (Gasser, Holstein, et al., 2014; Griffiths et al., 2016; Grob et al., 2011; Ross et al., 2016). All participants also met the diagnostic criteria for a mood, anxiety, or adjustment disorder. The majority of participants was white, college-educated, had no prior hallucinogen use (or had not used hallucinogens for more than 30 years).
The results demonstrated long-lasting anti-depressant and anxiolytic benefit from 1 to 2 administrations of either LSD or psilocybin (Reiche et al., 2018). There were no serious adverse effects reported, and only some reports of minor short-term undesirable experiences (e.g., headaches, nausea and vomiting, transient psychological distress, discomfort, and heightened anxiety at some points; Griffiths et al., 2016). No studies reported any indications of severe anxiety reactions or a “bad trip.” In fact, many of the research subjects recommended that future protocols should provide the opportunity for additional psychedelic sessions, and found the placebo sessions to be relatively unappealing (Grob et al., 2011) – it appeared that the most negative part of the study was not tripping enough. The anti-depressant response rate for psilocybin was around 80% at 6 months post follow-up (Griffiths et al., 2016; Ross et al., 2016). The clinical response for anxiety was equally as high. To put this into perspective, there are no other known pharmacological agents that can lead to immediate anti-depressant and anti-anxiolytic effects, with enduring benefits, after a single administration (Ross et al., 2016). A meta-analysis of commonly prescribed anti-depressant medication for comorbid depression and medical conditions found that for cancer patients, the anti-depressants performed only as well as the 40% placebo response (Ross et al., 2016). Themes emerging from the participants’ reports of their psychedelic experiences included “examining how their illness had impacted their lives, relationships with family and close friends, and a sense of ontological security : : : [they] reported powerful empathic cathexis to close friends and family members and examined how they wished to address their limited life expectancy” (Griffiths et al., 2016, p. 17).