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Magic mushrooms for mental health? Shaky basis for story’s proposed “‘paradigm shift”

Rating

3 Star

Psychedelics Promise a ‘Paradigm Shift’ in Treating Mental Illness

Our Review Summary

Psilocybe cubensis aka "magic mushrooms"

Psilocybe cubensis aka “magic mushrooms”

Can psychedelic drugs such as psilocybin, the active ingredient in magic mushrooms, Ayahuasca, an Amazonian brew, or MDMA, the active ingredient in the party drug Ecstasy help people who are addicted, anxious or depressed?  That’s the question increasingly asked by researchers who are testing these psychedelic drugs in small numbers of patients to see if they bring any relief.

As the article nicely points out, mental health problems like addiction or depression are thought of as chronic, lifelong diseases, but what if that’s an ineffective approach for many people? What if anxious or depressed people were, instead, treated by a small number of episodes of  profoundly perspective-altering drugs, which rewires one’s underlying personal philosophy and brings relief that way?  Would this not represent a dramatic paradigm-crushing approach to treating mental illness?

While the story raises these questions in an intriguing fashion, details on the research are fleeting and there’s not enough context to give readers a balanced view of the issues involved. As the story points out, early results suggest that these substances might be worth substantial increases in research in treating mental illnesses. But the current evidence base is characterized by tiny numbers of subjects and is almost anecdotal in nature, so a bit more caution about the likelihood of a “paradigm shift” in this area would have been welcome.

Editor’s note: Two ratings in this review — see the “Independent Sources” and “Availability” criteria — have been changed from Not Satisfactory to Satisfactory and the star score has been changed from 2 to 3 stars. See the specific criteria, as well as the comments section, for an explanation of the changes. 

 

Why This Matters

There are many people who have addictions, are uncontrollably anxious or suffer severe depression who are not well served by the current armamentarium of conventional prescription drugs and so increased research on a range of psychoactive substances derived from plants or fungi seem a promising area of research.  Assurances that such research can be done in controlled, monitored situations by competent scientists may help revamp an area of drug therapy that was up to now written off as dangerous, addictive and generally pushed to the margins of society.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Not discussed at all. Presumably without patentable drugs derived from these substances, they could be very economical, yet we have no idea if the substances used in these experiments underwent substantial processing or packaging which, of course, would all affect cost.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

Unfortunately the details on the various studies cited are few and far between, though the links to the actual studies are helpful for those wishing to dig deeper.  Because of the lack of quantification of benefits permeates the piece, it can only rate as Not Satisfactory.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Obviously the harm potential of these drugs is probably what gave them a bad reputation in the first place–particularly in their potential for abuse–so it would have been useful to hear which adverse effects were experienced by these users in these small experiments. It was good that the story stipulated that the drugs were used under controlled and supervised conditions, and so the obvious question arises: is that how these drugs would be used in the wider population, and if not, would that not alter the harm/benefit potential of the drug?

As we circle back to re-evaluating these drugs, focusing on one specific area (anxiety/depression), it seems a little too easy to forget they are powerful drugs that affect multiple chemical and who knows what other systems in the brain. Informed consent documents for future studies will be tricky.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

We learn that the studies were small, done under strictly controlled situations, and usually involved patients with specific conditions. But there’s no specific caution about the limitations of the existing research, or the fact that the “paradigm shift” suggested by the article might not pan out. And details about the studies are spotty. Some of the claims pertaining to ayahuasca, for example, seem to be based on an interview with an ethnobotanist book author whose evidence mainly consists of anecdotes such as:

“One time I accompanied a friend who was addicted to antidepressants for 30 years down to Peru, and then he came out a free man and isn’t depressed anymore.”

The story mainly argues for more research, a point that we can agree with, but overall it seems a bit unbalanced in favor of the possibilities without sufficient acknowledgment of the potential that the research might go nowhere.

Does the story commit disease-mongering?

Satisfactory

No obvious disease mongering.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The only expert quoted is the author of the Canadian Medical Association Journal review article that seems to be the news hook for the story. It would have been interesting to hear a second opinion.

Editor’s note: This review originally stated that that there was no independent source quoted, which is incorrect. The story quotes Dr. Charles Grob who was not involved with the review article that’s the launching point for the story. The rating has been changed to Satisfactory. 

There is also no information about the potential conflicts around such research, and even though such conflicts may be unlikely given the source of drugs studied, a sentence to confirm the independence of the research would have raised the credibility of the article.

Does the story compare the new approach with existing alternatives?

Satisfactory

Although it mentions that mental health problems are often treated with drugs like serotonin-specific reuptake inhibitors, it doesn’t discuss how the psychedelic drugs compare to those drugs or each other, or other types of non-drug therapy. We’ll give the benefit of the doubt here, though we wished for more detail.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

Magic mushrooms and MDMA may be ‘available’ in our society, but hardly through channels that one would consider reliable or trustworthy. While we might want more details on how to obtain these substances, in the interests of public service, it may be just as well that the story didn’t delve into this issue too far.

Does the story establish the true novelty of the approach?

Satisfactory

The story establishes that what is ‘novel’ here is the research, as we know many of these substances have been around for decades, or in the case of the Ayahuasca, probably thousands of years. There’s especially some novelty in studying the drugs’ usefulness in treating anxiety in terminal patients. But otherwise, the idea of quick fixes in the forms of pills containing psychoactive substances for these serious and chronic problems is not all that new.

Does the story appear to rely solely or largely on a news release?

Satisfactory

This shows no hallmarks of having been generated by, or dependent upon, a news release.

Total Score: 6 of 10 Satisfactory

Comments (5)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Frank Discussion

September 12, 2015 at 6:14 pm

Unfortunately, it is this commentary that is guilty of ‘disease mongering’ as there are no clinical studies showing an increased risk of suicide, violent behavior and such that prompted the hysteria of the 60s and 70s, where doctors claimed LSD caused genetic deformities literally based on their confusing the chemical diethylamide with thalidamide because they kind of sounded similar. The only actual study showed that psilocybin and LSD users do not exhibit a higher rate of suicides or violence than that of the rest of the population. Have suicides and violent behavior occurred? Yes. But not as often as occurs with many accepted drugs used to treat anxiety and depression. Do the drugs need to be tested more? Certainly. Do they show significant promise? Certainly. To uncritically make remarks such as “Obviously the harm potential of these drugs is probably what gave them a bad reputation in the first place” places Health News Review on the level of old wives tales “people have known for yeas that if you touch a toad you will get warts.”If you want to retain any sort of credibility, please do more research to avoid being guilty of deriding good science based on extremely bad science.

Reply

    Kevin Lomangino

    September 13, 2015 at 10:22 am

    Thanks for the comment, Frank, which we’ll post despite the fact that you haven’t attached a real name to your opinions. I’ll overlook that violation of our comments policy in order to offer this response: Our review says nothing about suicides and violent behavior, nor did we “deride good science based on extremely bad science,” so you seem to be attacking a straw man here with your complaints. Our criteria call for discussion of potential harms and adverse effects in any story about a medical intervention, and I think it’s pretty well established that these drugs carry potential for adverse effects. That’s all we were asking for. Even some mention of the research you cited would have counted toward a Satisfactory rating. I don’t think we’re putting our credibility at risk by asking for this kind of information in a news story.

    Kevin Lomangino
    Managing Editor

    Reply

Doug Main

September 17, 2015 at 3:45 pm

I wrote this article. Many of your points are well-taken, but I think you’ve been unfair in several ways. Particularly egregious is that three people could review this and not realize that I quoted two outside sources, Grob and Griffiths (second and third opinions). How could you possibly miss that?

I also wrote it in a couple hours under deadline pressure and I’m summarizing and an entire review of decades of research — not just one study on one specific drug/treatment, in which I surely would’ve gone into more detail. Sure, I could’ve talked about the costs, which are negligible compared to daily SSRI or other continuous treatments. I did mention that these are illegal, and thus can’t be legally obtained. So I didn’t go into it, which you acknowledge is “just as well.” But you still ding me for it? I said several times these were small studies, as in the case of the study with 10 alcoholic patients.

As for safety, I noted that “psychedelics should never be used carelessly, and that the ‘set and setting’ (meaning the dose, mood, environment, company and surroundings) where a person takes them are of paramount importance.”

You write that “Obviously the harm potential of these drugs is probably what gave them a bad reputation in the first place–particularly in their potential for abuse–so it would have been useful to hear which adverse effects were experienced by these users in these small experiments.” I think this reveals a bias on your part, in that none of these substances are addictive, and that their “bad reputation” has a lot to do with the “war on drugs” and the troubled politics that I bring up in the beginning of the piece. I also note that “when studied under controlled and supervised conditions, these chemicals have not been found to cause lasting negative health consequences,” which is true.

This type of review makes sense for an in-depth article on a single (legal) drug, but I think the format doesn’t particularly work for what I was trying to do here, in a short piece.

Reply

    Kevin Lomangino

    September 18, 2015 at 9:18 am

    Doug,

    Thanks for responding. Your points are also well taken. We work on a deadline like you and sometimes make mistakes, which we correct as soon as possible.

    The Independent Sources criterion should clearly have been ruled Satisfactory. I regret the error and have updated the rating and comments.

    Similarly, there’s a mismatch between our comments and the rating on “Availability.” We should have given you the benefit of the doubt on that one. Again, I’ve updated the rating.

    The “Harms” rating was also close but I think it should stand. It would have been easy enough to report on some of the adverse effects reported in the studies. I appreciate that you did make a nod in the direction we were looking, but I think the bar for reporting on this should be set higher than “lasting negative health consequences.” And if the bad reputation of these drugs is a product of the War on Drugs, a brief mention of that fact with some supporting evidence would have cleared it up.

    Lastly, I disagree that our format isn’t a good fit for your piece. Our criteria are our stake in the ground for what people need – whether epic tome, brief, blog, or TV piece. Even in a short piece, there are ways to get this information across. If you are mainstream media, these are peoples’ mainstream needs. I don’t think readers differentiate their needs based on the length of the piece or its format.

    Thanks for engaging and allowing us to correct the errors you identified.

    Best regards,
    Kevin Lomangino
    Managing Editor

    Reply

Doug Main

September 26, 2015 at 4:17 pm

Fair enough, thanks for your reply and revised rating, Kevin.
All best,
Doug Main

Reply