Psychedelic Psychiatry and the Consult-Liaison Psychiatrist: A Primer

Psychedelic compounds have a long and complex history with psychiatry, having been widely used in clinical settings a half century ago before being outlawed in the United States in 1970 due to concerns about abuse potential and their association with the counterculture movement. In recent years, a resurgence of research has revealed early evidence supporting psychedelic-assisted therapy for treating alcohol use disorder, nicotine use disorder, posttraumatic stress disorder, and depression. The literature indicates that psychedelic-assisted therapies may have treatment potential for mental illness and addiction, though adverse events from nonmedical use are rare. Current data suggest that, if administered thoughtfully by trained professionals in medical settings, psychedelic-assisted therapy could reduce suffering from mental illness and addiction.

Study at a glance

Abstract

BackgroundPsychedelic compounds such as lysergic acid diethylamide (LSD), psilocybin, and 3,4-Methylenedioxymethamphetamine (MDMA) share a long and complex history with psychiatry. A half century ago, psychedelics were widely employed by psychiatrists in investigational and clinical settings, with studies demonstrating promising findings for their use in the treatment of mental illness and substance use disorders. However, concerns were also raised about their abuse potential and other adverse effects. Owing to these worries and psychedelics' association with the counterculture movement, psychedelics were largely outlawed in the United States in 1970, bringing research on their therapeutic potential to a halt. However, in recent years, a resurgence of psychedelic research has revealed compelling, though early, evidence for the use of psychedelic-assisted therapy in treating alcohol use disorder, nicotine use disorder, posttraumatic stress disorder, and depression.ObjectiveHere we provide an overview of psychiatry's complicated relationship with psychedelics, while reviewing contemporary findings on psychedelic-assisted therapy, safety of psychedelic-assisted therapy, and risks of nonmedical use. We also make the case that psychiatry should consider preparing now for the possibility of Food and Drug Administration approval of psychedelic-assisted therapies in the near future. We conclude by discussing how growing societal interest in psychedelics could impact the work of consult-liaison psychiatrists, while also exploring how consult-liaison psychiatrists might contribute to future delivery of psychedelic treatments.MethodsWe reviewed literature on psychedelic-assisted therapies and adverse events resulting from nonmedical psychedelic use.ResultsWe found a small, but rapidly growing literature indicating that psychedelic-assisted therapies may have treatment potential for mental illness and addiction. Our search also revealed a variety of rare adverse events stemming from nonmedical psychedelic use.ConclusionsDespite past concerns about psychedelics, current data indicate psychedelic-assisted therapy may potentially reduce suffering owing to mental illness and addiction if administered thoughtfully and cautiously by trained professionals in medical settings.