Psychedelics — substances that cause dramatic changes in thought and perception — could play a unique role in alleviating existential distress in patients with life-threatening illnesses like cancer, according to a recent review.
Facing existential distress in end-of-life care
“Existential distress relates to the kinds of concerns people often have as they face end-of-life, or cancer recurrence,” said Dr. Daniel Rosenbaum, one of the article’s co-authors, in an interview with The Varsity.
The feelings of hopelessness, demoralization, and burden associated with existential distress can cause depression, anxiety, and significantly reduced quality of life in patients facing life-threatening illnesses.
Some psychotherapies have been developed to treat existential distress and help end-of-life patients restore their sense of dignity and meaning in life; however, no medication or pill currently exists for alleviating this form of suffering — until recently as research has shown promising potential in psychedelic therapies.
Classic psychedelics include various compounds that bind to and activate 5-HT2A receptors in the brain, such as psilocybin — which is found in certain mushrooms — and lysergic acid diethylamide, also known as LSD. They can induce mystical, transcendent experiences and deep feelings of positivity, which makes them ideal to treat existential distress, according to Rosenbaum.
How psychedelics could address this problem
Studies from as early as the 1950s have suggested potential applications of psychedelics in psychotherapy. However, research has been bogged down by challenges in designing methodologies that could test the efficacy of psychedelic medicines.
There were also ethical and safety issues — some studies were completed without informed consent, and caused lasting harm to participants. By the mid-’70s, these issues, combined with controversy around the spread of recreational psychedelic use, caused most of the research in this area to be discontinued.
A ‘psychedelic renaissance’ is breaking this decades-long gap in research, accompanied by contemporary methodologies that strive to overcome the shortfalls of their predecessors. For example, today’s studies recognize the importance of components such as psychotherapy sessions before and after the drug treatment, as well as the creation of a safe and comfortable environment for the treatment sessions.
These factors can be crucial to how patients respond to the treatment and as such, must be carefully managed.
Modern studies on the promise of psychedelics
Notably, two studies from Johns Hopkins University and New York University found that psilocybin therapy reduced anxiety and depression levels in patients with life-threatening cancers and various psychiatric disorders. Patients also reported other beneficial effects, such as a reconnection to life, increased confidence, and acknowledgement of cancer’s place in life.
The treatment caused some temporary increases in heart rate and blood pressure, but these were generally well-tolerated and did not appear to cause any severely adverse symptoms. Careful participant screening in most contemporary research also helps to ensure that participants do not have any family history or personal predisposition for psychosis, and are able to undergo the treatment safely.
Moreover, the benefits of psychedelic therapy were shown to have an immediate and lasting impact. Beneficial effects were sustained for six months or longer after a single treatment. The drug’s rapid onset may also be advantageous compared to conventional antidepressant medications, which may take several weeks to have an effect.
“If someone is suffering from profound depression or anxiety, we may not have sufficient time for the alleviation of certain kinds of suffering with conventional medication treatments,” Rosenbaum said.
Next steps of psychedelic research
Further research in psychedelic-assisted therapy is underway at various institutions in Canada and around the world. A trial at the Princess Margaret Cancer Centre in Toronto is currently studying the treatment of depression in palliative care patients using intranasal ketamine.
MDMA-assisted psychotherapy for the treatment of post-traumatic stress disorder is another area of interest, with research ongoing at Ryerson University and a multi-site study from the Multidisciplinary Association for Psychedelic Studies taking place in cities across the United States, Israel, and Canada, including studies in Vancouver and Montreal.
“It’s an exciting time for the field in Canada,” Rosenbaum said. “I think, in the coming years, we will start to see a number of new trials.”