A psychedelic trip to recovery: How psychedelics can help treat PTSD

The medicinal benefits of psychedelics, including MDMA, are currently being explored by researchers from both UBC campuses.

In 2015, The Ubyssey first published an article introducing the potential use of MDMA, also known as ecstasy, to treat symptoms of post-traumatic stress disorder (PTSD). In the seven years since, there has been increasing evidence showing the application of psychedelics in treating PTSD. The work of Dr. Zach Walsh and his colleagues from UBC Okanagan’s department of psychology, as well as research groups working in the Vancouver community, are at the forefront of this research.

‘A debilitating disorder’

PTSD is a condition characterized by an onset of symptoms after a traumatic event. Some of these symptoms include intrusive memories and flashbacks, negative emotions, irritability and hyperreactivity, according to the government of Canada’s “Federal framework on posttraumatic stress disorder.” The document details that the diagnosis of PTSD requires symptoms that make it harder for the individual to function and be present for longer than one month.

According to The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), the gold standard for psychiatric diagnosis, PTSD can arise from firsthand experiences as well as indirect exposure to trauma.

With approximately 9.2 per cent of Canadians predicted to suffer from PTSD in their lifetime, a better understanding of this disorder has become a focal point for researchers.

Walsh emphasized the strain that PTSD can place on patients as well as those around them.

“Beyond PTSD, we know there’s heightened risk of suicide, of relationship conflict, all the other things that go with PTSD. So it is something very important for society to treat not only for those who suffer but for their loved ones as well,” Walsh said.

But despite the difficulty of living with PTSD, treatment options are limited.

Current treatments include cognitive reprocessing therapies, such as cognitive behavioural therapy, eye movement desensitization and repressing therapy and some selective serotonin reuptake inhibitors (SSRIs) that are generally used to treat depression, according to Walsh.

“The thing with PTSD is that, while there are some really effective behavioural treatments, there are still a lot of people who either can’t access those or they try them and they don’t work,” said Walsh. He added that SSRIs “are not terribly effective.”

“So we need more treatment options for PTSD. And if we can add something that’s going to help some folks, that’s huge, because it’s a difficult-to-treat, very debilitating disorder.”

A psychedelic promise

Walsh was involved in a 2019 study showing that psychotherapy, also known as talk therapy, administered alongside MDMA was more effective in reducing symptoms in patients suffering from treatment-resistant PTSD compared to psychotherapy administered with a placebo.

Further support for this treatment strategy has been provided by a 2021 article published in Nature Medicine which also tested MDMA-assisted psychotherapy in comparison to psychotherapy accompanied by placebo in patients with severe PTSD.

The success of this treatment is thought to be rooted in the patient reprocessing their trauma, which Walsh explained, is needed for symptoms to “resolve.”

Psychotherapy often involves a form of exposure therapy in which patients revisit cues attached to the traumatic memory with the aim of removing the “conditioned fear” that has become associated with it, according to a 2020 review from the International Journal of Neuropsychopharmacology. MDMA is believed to assist in this process by reducing fear responses in patients as they revisit their trauma. In psychotherapy, it is also important for therapists and patients to establish a relationship, which MDMA may contribute to by facilitating trust and increasing introspection.

Yet another theory, suggested in a 2021 article in Frontiers Neuroscience, is that psychedelics in general may induce a neurological state that makes the brain more malleable to external influences like psychotherapy.

Although the mechanism by which MDMA might be working is not yet known, the research so far “has been remarkably promising,” according to Walsh.

The Centre for Clinical Excellence

One particular group that would benefit from the development of an additional treatment option for PTSD includes veterans and first responders who, by nature of their profession, can be exposed to highly traumatic events.

According to the government of Canada, an estimated 10 per cent of war zone veterans are predicted to suffer from PTSD. Similarly, research has shown that first responders are at a higher risk of developing PTSD, with one 2005 study from The British Journal of Clinical Psychology revealing that up to 22 per cent of paramedics will suffer from the disorder.

A project that aims to facilitate further research into PTSD treatment, as well as other areas of research to support veterans and first responders, is the Legion Veterans Village (LVV) and its Centre for Clinical Excellence.

According to Rowena Rizzotti, the project lead of LVV, the purpose of the project is “to bring together the consortium of researchers, scientists and clinicians that were particularly interested in how we best support veterans and first responders and their families relative to mental health, relative to PTSD, but also into innovative interventions relative to their physical rehabilitation.”

To explore additional treatment options for PTSD, LVV is working with Knowde Group, a multinational contract research organization specializing in investigating the potential uses of plant-based and progressive therapeutics, which include psychedelics.

Jaspreet Grewal, co-founder and CEO of Knowde Group, explained that Knowde Group aims to investigate psychedelics through a series of clinical trials to “validate the safety and efficacy, as well as a dosing for specific diseases.”

Amongst the LVV Centre for Clinical Excellence’s leadership team is Dr. Ashok Krishnamoorthy, a clinical associate professor in psychiatry at UBC.

When asked about the barriers that veterans face in accessing treatment for PTSD, Krishnamoorthy said the main barrier is access. He mentioned long wait times, limited outreach to screen for PTSD, a lack of education around recognizing PTSD symptoms and stigma surrounding mental illnesses. For health care workers, secondary trauma, which occurs following exposure to someone else’s firsthand traumatic experience, is another barrier.

Krishnamoorthy also noted the difficulties in treating PTSD, especially chronic PTSD, as it can be accompanied by “some other comorbid issues like mental depression, risk of suicide, substance use disorders [and] cognitive problems.”

Regarding the use of psychedelics, Krishnamoorthy commented on the need for further research. “Some of the studies are showing some exciting results. But [it needs] to be replicated, it needs to be replicated enough. And that’s where the Centre for Research and Clinical Excellence [comes] into play.”

“It needs to be replicated with good, quality research with adequate power and number [of] patients and also sustainability of that effect and benefit, but definitely it looks promising in terms of filling in a particular gap in the PTSD treatment.”

Though the LVV offers support focused on first responders and veterans, additional research centring on other populations who suffer from PTSD is necessary to provide better support for the diversity of Canadians with this disorder.

According to one review from the Harvard Review of Psychiatry, resources are lacking for other demographics living with PTSD, including survivors of child abuse, sexual assault and natural disasters. The authors stressed the importance of communicating and translating data from one research focus to others in order to broaden the benefits.

A conditional acceptance

Although research so far has been showing promising results, psychedelics might not be suitable for all PTSD patients.

The 2019 study on MDMA-assisted therapy reported side effects of MDMA use including dizziness, jaw clenching, nausea and loss of appetite. Psychedelics are also highly psychoactive substances, which may lead to accidents if not utilized properly.

However, according to Walsh, if used under proper supervision in the clinical setting, psychedelics should be safe to use therapeutically. “From a toxicity perspective, they’re incredibly safe, so it’s very difficult to overdose,” he said.

“In terms of clinical application, the risks are quite small; the worst is that it’s unpleasant. And then people come out the other side, you know, pretty much unscathed is my experience,” said Walsh.

“Again, [PTSD is] not something where we’ve got adequate treatment. So that’s why it’s so exciting when there’s a new opportunity.”