The Mood Disorders Support Group, Inc.—A Chapter of Depression and Bipolar Support Alliance (DBSA).

The Mood Disorders Support Group, Inc.
  • Notifi
    • Home
    • About Us
    • Support Groups
      • Support Group Overview
      • Join our Support Group
      • Support Group Schedule
      • Alternative Groups
        • DBSA Online Support
        • Eastern Long Island
    • Culture & Values
      • Support Group Guidelines
      • What Happens When Something Goes Wrong
      • Incident Report
    • Resources
      • Newsletter
      • Events
      • Useful Resources
      • Suggested Books
    • Donate
    • Contact Us
    • search

The Mood Disorders Support Group, Inc.—A Chapter of Depression and Bipolar Support Alliance (DBSA).

The Mood Disorders Support Group, Inc.
  • Notifi
    • Home
    • About Us
    • Support Groups
      • Support Group Overview
      • Join our Support Group
      • Support Group Schedule
      • Alternative Groups
        • DBSA Online Support
        • Eastern Long Island
    • Culture & Values
      • Support Group Guidelines
      • What Happens When Something Goes Wrong
      • Incident Report
    • Resources
      • Newsletter
      • Events
      • Useful Resources
      • Suggested Books
    • Donate
    • Contact Us
    • search

The Mood Disorders Support Group, Inc.—A Chapter of Depression and Bipolar Support Alliance (DBSA).

The Mood Disorders Support Group, Inc.
  • Home
  • About Us
    • About MDSG
    • MDSG-NY Board
  • Support Groups
    • Our Support Groups
    • Support Group Registration
    • Schedule
    • Alternative Groups
      • DBSA Online Support
      • Eastern Long Island
  • Culture & Values
    • Support Group Guidelines
    • What Happens When Something Goes Wrong
    • Incident Report
  • Resources
    • Newsletter
    • Events
    • Useful Resources
    • Suggested Books
  • Contact Us
  • search
  • Donate Now

Three Key Questions for the Psychedelic Renaissance

Home / Newsletter MOODS / Three Key Questions for the Psychedelic Renaissance
By MDSG-NY
May 9, 2022
0 Comments

Three Key Questions for the Psychedelic Renaissance

David Hellerstein, MD

Director, Depression Evaluation Service, NY State Psychiatric Institute

Professor of Clinical Psychiatry, Columbia University

Every week seems to bring news about the psychedelic renaissance. 

Recent papers in the New England Journal of Medicine and JAMA Psychiatry report that psilocybin benefits major depression. Laws in Oregon and elsewhere are changing to decriminalize psychedelic use. The FDA has fast-tracked the development of psilocybin for treatment of depression. Clearly, we are in an amazing time, a renaissance of psychedelic use and research. 

In 2019 our Depression Evaluation Service at Columbia Psychiatry and the New York State Psychiatric Institute became a site for a Phase 2B study of psilocybin in treatment-resistant depression. As a researcher doing studies of psilocybin, it is wonderful to be part of this renaissance, and at the same time quite worrisome to see unrealistic expectations generated by such breathless news. 

As I see it, there are three key questions for psychedelic compounds as possible treatments of psychiatric disorders:

  1. Do they work?
  2. How do they work?
  3. Which drug works best for which conditions, for which patient?
  1. Do they work?

Whether based on personal experience or media reports, many people will say, “Yes of course they do!” But if you look at the scientific literature, as we did in a 2022 review published in Psychopharmacology, recent psychedelic clinical trials are small, and have many flaws. There are few high quality double-blind placebo-controlled clinical trials, the gold standard to determining drug ‘efficacy’. 

As of July, 2021 there have been only 14 modern published studies of classical psychedelics (LSD, psilocybin, ayahuasca) enrolling a total of 315 patients conducted world-wide. Of these, only 8 studies, enrolling 226 subjects, were double-blind.

To really show that psilocybin alleviates depression, or that LSD is effective in OCD, we need more, and much larger, clinical trials, meeting FDA standards to test benefits and side effects.

And psychedelic studies are very difficult to do. For one thing, psychedelic treatments are very labor-intensive. They are combined treatments of medication and psychotherapy and require many hours of preparation and therapist time. Furthermore, it is difficult to do placebo-controlled psychedelic studies. Regardless of which drug is used as a comparison—sugar pill, niacin (which causes flushing), or amphetamines (which cause stimulation but don’t make you trip)—patients, therapists and research staff can almost always guess which treatment is being received. 

  1. How do they work?

Classic psychedelic drugs—LSD, psilocybin, and ayahuasca—act on the serotonin system: they stimulate so-called 5HT2A receptors, which are highly concentrated in brain areas related to thinking, working memory, and attention. While psychedelic effects such as visions and distorted perceptions generally fade within several hours, psychological effects often persist long afterward. But why?

Neuroimaging expert Robin Carhart Harris believes psychedelics increase ‘neuroplasticity’—and introduce ‘entropy’ into overly rigid brain circuits. People with depression seem to have overactive, reverberating brain circuits, and spend much time ruminating, preoccupied with negative thoughts and feelings. Do psychedelics ‘reset’ these dysfunctional brain circuits—and if so, how? 

Yet it is not impossible that the therapeutic benefits of psychedelics are only placebo effects! Certainly, patients come into treatment with vast expectations. Could psychedelics, which induce powerful sensory experiences, actually be hyper-charged placebos?

At this point, it is fair to say that we are only starting to answer these questions. 

  1. Which drug is best for which condition?

Despite decades of wisdom from psychedelic users and advocates, we have precious little scientific guidance. Here are a few key questions:

  • what dose is most effective—how many milligrams of psilocybin or LSD for which disorder?
  • how many doses are needed to get the best initial effect?
  • which psychedelic is best for which disorder—depression, OCD, anorexia, PTSD, addiction, end-of-life existential anxiety? 
  • How can we best sustain remission in order to keep people well?

Dozens of studies must be done to sort these issues out. 

It is also worth noting that we don’t know much about side effects and serious adverse events (such as suicidality) in people with psychiatric diagnoses. We need better research on psychedelic treatment of people with depression in the real world, not only in highly selective clinical trials

*

Today, clinical trialists and other researchers are at the very beginning of an amazing period of discovery. We desperately need top-quality studies following the FDA framework required for drug approval. But that’s only part of it. We also need profound scientific investigations—in cell cultures, in organoids, and in animal models—to truly understand and optimize the use of such drugs. And we need to be cautious before jumping wholeheartedly on the psychedelic bandwagon.

*    *    *

March Item of Interest
01 Apr, 2022
Review of “The Road Back”
09 May, 2022

Related Articles

“ STINKIN THINKIN” by Tory Masters

Happy New Year! Now What?

SAMHSA’s WORKING DEFINITION OF RECOVERY

Recent Posts

  • “ STINKIN THINKIN” by Tory Masters
  • Happy New Year! Now What?
  • SAMHSA’s WORKING DEFINITION OF RECOVERY
  • Out of the Past and Into the Future
  • Review of “The Road Back”

Suggested Books

Categories

  • Newsletter MOODS

Meta

  • Register
  • Log in
  • Entries feed
  • Comments feed
  • WordPress.org

Social

Recent Comments

  • NormanNok on David K.
  • roket slot on Is there a fee to attend a meeting?
  • construction scaffolding for sale on David K.
  • Santos on How do I become a facilitator?
  • lewis scaffold tower on Do I need a diagnosis to attend a meeting?

Archives

  • March 2023
  • January 2023
  • July 2022
  • May 2022
  • April 2022
  • January 2022
  • November 2021
  • September 2021
  • August 2021
  • June 2021
  • March 2021
  • January 2021
  • November 2020
  • September 2020
  • July 2020
  • May 2020
All information in the newsletters/posts is intended for general knowledge only and is not a substitute for medical advice or treatment for a specific medical condition.

The Mood Disorders Support Group, Inc.

The Mood Disorders Support Group, Inc.

We are a 501(c)(3) non-profit organization providing support for individuals with mood disorders as well as their families and friends since 1981.

P.O. Box 2359 New York, NY 10163

  • Email: info@mdsg.org
  • Join Our Support Group

Quick Links

    • Newcomer Packet
    • MDSG-NY Board
    • FAQ
    • Group Schedule
    • Volunteer Login
    • Group Feedback
    • Our Events
    • Contact us

Find Us On

© Copyright 2025, The Mood Disorders Support Group, Inc.
Powered by 5th.digital
Terms of Use Privacy Policy
© Copyright 2021, Mood Disorders Support Group
Terms of Use Privacy Policy
Thursday, 9, Mar
“ STINKIN THINKIN” by Tory Masters
Friday, 13, Jan
Happy New Year! Now What?
Wednesday, 13, Jul
SAMHSA’s WORKING DEFINITION OF RECOVERY
Wednesday, 13, Jul
Out of the Past and Into the Future
Monday, 9, May
Review of “The Road Back”
Monday, 9, May
Three Key Questions for the Psychedelic Renaissance

Welcome back,