Approaching Psychedelics for Depression With Both Caution and Optimism

In this video from the 2023 Psych Congress NP Institute, Rakesh Jain, MD, MPH, a distinguished member of the Psych Congress steering committee, delves into the nuanced terrain of psychedelic therapy for depression. While acknowledging its potential benefits, Jain urges caution, particularly for patients living with bipolar disorder. Through insightful analysis, he navigates the delicate balance between optimism and vigilance in harnessing the power of psychedelics for mental health.

Join us at the 2024 Psych Congress NP Institute in San Diego, California, March 20-23. For more information and to register, visit the meeting website.

Read the Transcript

Psych Congress Network: When would you recommend exercising additional caution when considering psychedelics for major depression treatment?

Rakesh Jain, MD, MPH: Hello friends and colleagues, this is Rakesh Jain, a proud member of the Psych Congress steering committee, and I am looking forward to talking with you about psychedelics and depression. But I am going to take a different look at this pretty complex issue. While there is no doubt that psychedelics could really benefit a lot of people with major depression at all stages of the depression, initial all the way to TRD, there is also good reason for you and I to be cautious. Some patients may actually be considerably harmed by psychedelic therapy, and we've got to talk about that so that we can make sure we help the most number of patients and hopefully avoid harm to everybody.

But what are some of the criteria, some of the risk factors to consider? The first one I would like to bring to your attention is the presence of mixed symptoms or bipolar in the person who has major depression. The data does show that in such patients there is real risk of worsening. So, by all means, when you decide when psychedelic therapy is available, that you screen out patients with unstable bipolar disorder, particularly if it's mixed.

There is reason to believe there are other patients who may not do very well on psychedelics, and those might be patients who are psychologically simply not prepared to do what comes along with psychedelic treatments, which is the ability to endure a significant amount of insight. So, for example, if you have a patient who's enduring currently, acute symptoms of post-traumatic stress disorder, perhaps even has comorbid substance misuse condition, it may be ideal to hold off on psychedelic therapy for them. What if the environment the patient is in is simply not conducive to them doing good integration work? Guess what? Psychedelic therapy isn't appropriate for them.

Now, having offered you all these cautions, I do not wish for you to think that I'm not optimistic about the potential of psychedelics in major depression. I, in fact, am hugely optimistic. But by the same token, there is an element of caution that is necessary. Psychedelics are very powerful agents and they can powerfully help. But in some situations, like the few that I discussed with you, we need to be watchful.

I hope this was helpful to you and we will certainly continue this conversation in terms of Psych Congress offerings over the upcoming weeks and months and years. Till next time, goodbye.

Rakesh Jain, MD, MPH, attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a “National Institute/Center for Disease Control Competitive Traineeship”. His research thesis focused on the impact of substance abuse. He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.

Dr Jain served a 3-year residency in Psychiatry at the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. He followed that by obtaining further specialty training, by undergoing a 2-year fellowship in Child and Adolescent Psychiatry. In addition, Dr Jain completed a postdoctoral fellowship in Research Psychiatry at the University of Texas Mental Sciences Institute, in Houston. He was awarded the “National Research Service Award” for the support of this postdoctoral fellowship.