Objectives of this learning scenario, developed by NYU Langone’s High School Bioethics Project, are to understand post-traumatic stress disorder (PTSD) and the symptoms it causes, learn how the chemical psilocybin, found in psychedelic drugs, can potentially help people who have PTSD, and discuss the ethical implications of using drugs that are often used recreationally as therapeutics.
Curriculum Integration Ideas
This tool may be used in life or social sciences classes where there are psychology units for pharmacology.
Overview of PTSD
After a person experiences a traumatic or life-threatening event such as a natural disaster, a car accident, or military combat, he or she may develop PTSD. While it is typical to have anxiety about the traumatic event weeks or months after it happens, people with PTSD find it difficult to perform daily functions for an extended period of time. Sometimes treatment can cure PTSD, while other times it simply goes away on its own.
PTSD Treatment Types
There are two types of treatment for PTSD. One is psychotherapy, which is the use of psychological methods usually based on regular and personal interaction to help a person change in the ways that he or she would like. The main type of psychotherapy used to help patients with PTSD is cognitive processing therapy. The goal of this type of therapy is to teach a patient with PTSD how to evaluate and change the upsetting thoughts that they are having in the wake of their trauma. Therapists believe that when a person changes their thought patterns, he or she can change the way he or she feels. If a patient has experienced a traumatic event, psychotherapy can change the way he or she thinks about or sees the world. Patients often blame themselves for what happened, and therapists help patients try to look at their experiences from a new perspective.
Most of the time, patients are taken to an office where they are met by a mental health professional. In other situations, patients attend group therapy sessions in which all the patients present have PTSD.
The second way to treat PTSD is with antidepressant medication. Antidepressants affect the hippocampus, an area of the brain involved in memory formation, to counteract the effects of stress. There are two types of antidepressants: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). The four main antidepressants effective for treating PTSD are sertraline (Zoloft®), paroxetine (Paxil®), fluoxetine (Prozac®)—all SSRIs—and venlafaxine (Effexor®), an SNRI. Additionally, three antipsychotic drugs are used to help treat PTSD: olanzapine, quetiapine, and risperidone.
Can Psilocybin Help Treat PTSD?
While therapy, antidepressants, and antipsychotics help many patients, these methods often fall short. Studies have suggested that antidepressants do not work well for people who have had multiple traumas over the course of years or chronic PTSD. A new study found that the antipsychotic risperidone worked no better than a placebo in alleviating typical PTSD symptoms in patients who had the disorder long-term or who continued to experience symptoms after being treated with antidepressants.
Because these drugs can also cause intolerable side effects, many patients are left to experience PTSD with no sign of relief. Many of these patients turn to substance abuse, develop anger management issues, or commit suicide. A study analyzing data from the National Comorbidity Survey showed that out of six anxiety diagnoses, PTSD was significantly associated with suicide attempts.
There is some evidence in animal studies to show that psilocybin, the psychedelic compound found in “magic mushrooms,” may act by stimulating nerve cell regrowth in parts of the brain responsible for emotion and memory. A . Opens in a new tab found that psilocybin stimulates neurogenesis—the growth and repair of brain cells in the hippocampus, which is the brain’s center for emotion and memory. In the study, mice that were given psilocybin overcame fear conditioning far better than mice that were given a placebo. The study supported the hypothesis that psilocybin can help break the traumatic cycle that occurs in patients with PTSD.
. Opens in a new tab, a psychiatrist at NYU Langone, conducted a . Opens in a new tab , and found that one-time treatment with psilocybin very quickly brought relief from distress that had lasted more than 6 months in 80 percent of study subjects.
In Dr. Ross’s study, half of the participants were randomly assigned to receive psilocybin. The rest received a control drug of niacin, which is known to produce a “rush” similar to that associated with a hallucinogenic drug experience. Halfway through the seven-week study period, all of the participants switched treatments. Neither the researchers nor the patients knew which patients had first received psilocybin or which received the control. All of the patients, mostly women, had advanced gastrointestinal, blood, or breast cancers and had been diagnosed as having serious psychological distress related to their disease.
Patients noted that after being treated with psilocybin, they felt their quality of life improve. They noted that they wanted to engage more with external activities, had more energy, experienced improved relationships with their family members, and performed better at work. The researchers concluded that if psilocybin could reduce psychological distress in terminally ill cancer patients, it could apply to less extreme medical conditions related to psychological distress as well.
Dr. Ross says that the findings “…have the potential to transform the care of cancer patients with psychological and existential distress, but beyond that, it potentially provides a completely new model in psychiatry of a medication that works rapidly as both an antidepressant and anxiolytic and has sustained benefit for months.” Dr. Ross has hope that the drug will become legal in the next five years. “If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients.”
The Debate About Psilocybin and PTSD
There are reasons why psilocybin could be a safe and effective treatment for PTSD. What are the benefits and risks of approving such a treatment?
Benefits of Approving Psilocybin to Treat PTSD
Supporters of using psychedelic drugs to help patients lessen their anxiety feel strongly that these drugs should be made available in a safe and supportive medical setting. In Dr. Ross’s study, the majority of participants reported having a positive experience that helped them feel less afraid. If these drugs can have such a success rate, then what could possibly be the reason for them not being legal?
Drugs can be either chemically or psychologically addictive. When the cells in a person’s body cannot function without a certain drug, that person is chemically addicted to the drug. In contrast, when someone is psychologically addicted to a drug, they think that they desperately need it, but their body doesn’t actually physically need it to function. Psilocybin is not chemically addictive like drugs such as nicotine and is also not known to have strong negative effects.
Utilitarianism is a doctrine used in ethics that says that “an action is right insofar as it promotes happiness, and that the greatest happiness of the greatest number should be the guiding principle of conduct.” When a drug is in the process of being approved, the U.S. Food and Drug Administration (FDA) uses this doctrine to determine whether it will lead to the greatest overall happiness. Supporters believe that because the drug is not that bad for you and has shown to have positive effects, the good definitely outweighs the bad.
Risks of Approving Psilocybin to Treat PTSD
The strongest argument against the use of psilocybin for PTSD is the chance of a “bad trip,” a scary or anxiety-inducing experience when a patient feels the psychoactive effects of the drug. This usually happens when the patient feels unsafe or uncomfortable in some way. A bad trip has the potential to mentally scar the individual who experiences it.
People who take psychedelic drugs have also reported experiencing flashbacks, or feeling as if they are experiencing a trip on a psychedelic drug when they are not. This can be dangerous in certain situations, like when operating a motor vehicle. Also, while it has not been shown that psychedelic drugs cause any serious health concerns, there are physical effects of psychedelic drug use that can be dangerous. These effects include an increase in blood pressure, an increase in body temperature, loss of appetite, nausea and vomiting, and muscular issues. There are also studies that show that patients do not experience any strong positive effects from psilocybin use.
For psilocybin to be approved for this use, it will need to be tested in clinical trials. There are many potential dangers that may arise during clinical trials of new drugs. For example, how can a patient who has never taken a psychedelic drug consent to taking it if they don’t know the ways in which it could affect them? This can cause problems from a legal perspective, especially concerning patient safety and protection.
Class Discussion: Weighing Approval of a New “Miracle” Drug
Teachers should read the following two paragraphs aloud before splitting the classroom into two groups:
A new pill has been made that helps people lose five pounds every time they take it. The weight loss community is going crazy about this new miracle drug—begging for the FDA to finally approve it so that people can lose weight instantly and feel more confident.
But there are drawbacks—taking the drug increases the risk of many diseases, including heart disease. The drug also makes you age faster. Lastly, the drug takes away all appetite, so much so that it is difficult for a person taking the drug to get their daily nutrients from food.
Split the classroom into two groups. Half the class will act as lawyers arguing for the drug’s approval, and the other half will serve as the FDA listening and responding with concerns. Whose arguments will be stronger?
This brief was written by Bella Ratner as part of the 2017 Summer Internship Program at NYU Langone’s Division of Medical Ethics.