Psychedelic mental health claims may be promoting risky self-medication

Psychedelic drugs have promise for treating several mental health problems, but people shouldn’t self-medicate with them because they can sometimes trigger a lasting psychotic breakdown, said Jonathan Iliff at University College London, speaking at New Scientist Live on 7 October.

Drugs such as psilocybin, the active compound in magic mushrooms, are being investigated for treating a range of conditions, including depression, post-traumatic stress disorder (PTSD) and anorexia, under medical supervision.

The drugs have shown promising results in some trials, but are still classed as experimental in most countries as larger trials are needed to confirm safety and effectiveness – although Australia has recently approved the use of psilocybin for depression and MDMA for PTSD.

But growing media coverage of this approach is encouraging some people with mental health problems to take the drugs unsupervised, says Iliff, a doctor and neuroscientist.

Psychosis, when people experience delusions and hallucinations, is a well-known side effect of cannabis, but occasionally also happens after using psychedelics. Because it is fairly rare, studies have failed to establish a link for the latter, but there are some reports in medical journals of individual cases, says Iliff.

As a psychiatrist for the national health service in London, he has treated some people admitted with acute psychosis triggered by taking magic mushrooms. “One such chap on my ward had taken it to try and treat himself and, in the process, had made things worse,” says Iliff. “And he was still convinced that he should take more of the magic mushrooms in order to be more well. He had lost touch with reality completely.”

Iliff has also treated someone with psychosis that lasted for 14 years and was  apparently triggered by magic mushrooms, a condition called hallucinogen persisting perception disorder.

When Iliff and other researchers carry out a trial of psychedelics for depression, for instance, they generally avoid recruiting anyone with a history of psychosis or with a close family member who is so affected, to reduce the risk.

Researchers also combine the treatment with talking therapy, both before and after taking the drug. “There’s a huge amount of preparatory therapy done to prepare people,” says Iliff. “There is loads of further therapy to come to terms with the experiences that they’ve had. Now, the average 21-year-old hears the message in the media, and then they don’t do all of that.”

Allan Young at King’s College London, who is also involved in psychedelics research, says: “No treatment is without harms – what matters is the balance between benefits and harms.”

“It doesn’t mean we should not be researching [psychedelics] at all, but we need to do it with due care and attention,” he says.