Psychedelics Bring Patients Face-to-Face with Underlying Issues

More than “just another bauble in the tool chest,” psychedelics when incorporated into treatment thoughtfully have the potential to reshape psychiatry, Andrew D. Penn, RN, MS, NP, CNS, APRN-BC, a Psych Congress Steering Committee member, associate clinical professor at the University of California, San Francisco, and attending nurse practitioner at the San Francisco Veterans Administration, said during a preconference session at the virtual Psych Congress 2020.

“This is so much more than just finding a new pill to reduce symptoms,” Penn said during his discussion with Psych Congress cochair Charles Raison, MD, professor at the University of Wisconsin-Madison and Emory University in Atlanta.

“This is about healing. With psychiatry, we’ve tried valiantly to find ways to heal people, but mostly what we’ve succeeded in is reducing symptoms—which is not a bad thing. It improves people’s functioning and reduces suffering, but we’ve fallen short at healing. That’s what these medicines give us an opportunity to do, and also challenge us to rethink psychiatry. Right now, we mostly look at ameliorating symptoms.”

Penn said he received a significant amount of skepticism regards the use of psychedelics in psychiatry a decade ago, but that doubts have often come from a fundamental misunderstanding of how and why psychedelics are used in treatment.

“If you look at these sessions, these are not easy sessions,” Penn said. “This was not somebody tripping out and having a good time. These are sessions where people are really going deep and looking at very painful stuff, and coming out making sense of it. And that heals them in a way that daily medication and symptom amelioration did not.”

It is a misnomer to say that all drugs are equally dangerous and hedonic, Penn said.

“It’s quite clear that these are not reinforcing—in fact, they can be quite challenging—and in that challenge lays the opportunity for healing,” he said. “Anybody who knows anything about psychedelics approaches them with deep reverence because they know there’s a good chance you’ll get your butt kicked at any given time or session. That’s why you have to hold these experiences with a lot of care and a lot of caution.”

Dr. Raison recalled a story of a patient who, after taking antidepressants for a period of time, began to experience a feeling of dullness. She stopped the medication and a little more than a month later, her symptoms of depression returned.

“This is the thing about antidepressants: They don’t rewrite the story,” Dr. Raison said. “They make the story feel irrelevant. It gives people the sense they are a different person.”

The use of psychedelics in psychiatric treatment, on the other hand, bring patients face-to-face with the underlying narratives that drive their depression.

“These agents generate narratives that collide with narratives of our lives, usually in surprising ways,” Dr. Raison said. “The ability to understand these as narrative interventions is really interesting.”

— Tom Valentino

Reference

“Medicine Meets Imagination: Envisioning a Future of Psychedelic Psychiatry.” Presented at Psych Congress 2020: Virtual; September 9, 2020.