PPT
Psychedelic-Driven Pharmacological Therapy in Mental Illness
(Psychopharmatherapy)
SUBJECTIVE EFFECTS
Psychedelic substances are drugs that produce sensory and perceptual changes in the user. These can range from life altering religious experiences, deep states of meditation, to mild hallucinations and an increase in introspective abilities. Some of these drugs are stimulating, some increase empathy (called empathogens), and some cause dissociation. They all vary in safety from low-to-no risk to moderate-risk. As always these should never be consumed without the guidance of a medical professional and in a controlled clinical, positive setting.
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The following are general guidelines, and that like with all things, context matters. Alcohol generally isn't dangerous, unless you're behind the wheel, attempting to operate machinery, or performing a task requiring fine motor coordination. The same rules apply here. What is outlined below is based on anecdotal reports and peer-reviewed research, and in no way acts as a guarantee that any of these things will hold true these substances are used without proper medical guidance.
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EFFECTS OF THE SEROTONERGICS
Low to Medium Dose Effects
Most standard psychedelics (generally these are serotonergic in nature) produce a sensation of mild stimulation and happiness. Often people feel like they are experiencing normal things with the renewed interest of a child. Immersion in the present moment is often enhanced, with the user appreciating their surroundings, company, food, and music more than they normally would or could. As the effects become more intense the brain often projects 2D or 3D patterns onto walls and surroundings, producing "pseudohallucinations", or hallucinations that the individual knows are not real.
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MRIs performed on people who have ingested substances of this class show altered activity in all areas of the brain, and increased communication between distant areas of the brain. This partially explains the hallucinogenic effects. Put simply, it allows, for example, the part of the brain normally involved with vision to interact with the part of the brain used while being creative.
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As effects start to become more pronounced, individuals may start to feel disconnected from reality, and it is at that point that pseudohallucinations begin to become so intense that the person begins to feel as though they are seeing more hallucinations than real surroudings. When the participant relaxes and submits themself to the experience, these pseudohallucinations can become real hallucinations that make the user feel as though they have entered another world. Responsible administration of psychedelic substances always involves planning and experienced guidance, and there are many strategies for ending experiences early if they become too intense that can be implemented by a professional.
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It is at this point that many people, in what is often called the psychic phase, begin to experience feelings of wellbeing, connectedness, and unity with the world around them, as their brain produces an immersive and "real" experience for the user.
Higher Dose Effects
Ego Suppression
Ego death occurs when one's sense of self is lost. With the right setting and supportive individuals, this can be the gateway to many of the significant positive outcomes associated with psychedelic therapy. It can be described as "becoming what you see" or "letting go of yourself to the experience". While difficult to explain, it involves forgetting about the "I" that observes the world through the senses, and instead becoming one with the participant's perceived surroundings and the experience as a whole.
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Existential Self-Realization and Rebirth
An existential experience, commonly called a "rebirth experience" and associated with ego death, is an overwhelming state achieved by the administration of high doses of psychedelic substances. This can be a comforting experience, and is also not something that people often experience by accident. It is usually preceded by intense visual hallucinations that gradually result in the user "forgetting", in a sense, about their current surroundings and experiencing full immersion in another world. With a proper setting and professional guidance, these experiences can be enlightening and allow people to view their lives from renewed perspectives upon their return. The rebirth occurs as one's self or mental self-awareness returns to the conscious mind, as if the mind is re-entering the body with renewed perspective.
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* Current studies suggest that it would require several hundred doses of the classic psychedelics (DMT, LSD, Psilocybin) to produce a risk of medical harm.
A Notable Exception: DMT
DMT is a classic serotonergic psychedelic. Along with some of its derivatives it has a very short duration of action and high-intensity effects, that have separated common experiences into two categories: sub-breakthrough and breakthrough, in which a breakthrough experience involves a rapid loss of ego, immersion into 3D hallucinations that override visual perception, and often existential experiences. A sub-breakthrough experience is often similar to the lower-dose effects of other psychedelics but is generally shorter in duration.
Interesting Exceptions: DiPT and 5-MeO-DMT
While most classic psychedelics produce a dominant visual component, there are notable exceptions to this principle.
DiPT
The DiPT class of drugs tends to produce auditory or acoustic hallucinations, in the form of "effects" applied to normal auditory input. These effects can include easily recognizably musical effects like reverb, tremolo, or pitch shifting.
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5-MeO-DMT
This derivative of DMT produces an experience of similar intensity to that of DMT (albeit with about twice the duration), but in an entirely different form. Most individuals who have used 5-MeO-DMT describe the breakthrough experience as consisting primarily of "perceptual hallucinations". Unlike tactile, or touch-based hallucinations, perceptual hallucinations involve the recruitment of all senses except for vision to produce a psychedelic experience.
EFFECTS OF THE CATECHOLAMINERGICS
Hallucinogenic amphetamines like MDMA, MDA, and MDAI exert hallucinogenic effects at low doses and stimulating effects at high doses, which are often accompanied by strong empathy enhancements. These empathy enhancements garnered this substance popularity as a club or bonding drug due to its ability to allow intense, profound introspection and a strong feeling of personal empathetic connection.
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Mescaline has a slow onset of action after ingestion and produces a stimulated hallucinatory state not unlike that of the serotonergic psychedelics, with the key difference being the major factor of the accompanying stimulation.
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Heavily substituted amphetamine compounds like the DOx family often produce a phase of stimulation followed by several hours of hallucinations, the intensity of which depends on the dosage. These substances can have very long durations of action and for this reason are likely less fit for therapeutic applications.
EFFECTS OF THE DISSOCIATIVES
These drugs produce experiences that are typically described as derealizing or dissociating. Derealization describes a loss of focus on the present moment - and can be a common experience in every day life, albeit to a much lesser extent. Depersonalization describes the feeling of being outside of one's body. Both of these can combine to produce a dissociative experience. Low level doses mimic alcohol intoxication and produce inhibition suppression and motor impairment.
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As dose increases, the individual will likely feel like they are watching themselves do things, may not recognize their hands as theirs, or appear to zone out when not moving.
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Higher level doses can produce a sort of "zoning-out" in which the user loses touch with the world around them and, in some cases and with some substances, enters another world, in which visual hallucinations are ancillary and tactile experiences dominate in conjunction with a deep meditative state. More on this can be found in the section below.
One theory suggests that by disconnecting the brain's voluntary control of the body, the patient's consciousness "expands" into the other areas, allowing imagination, thought, and sensory perception to be under the umbrella of one neurological influence.
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PCP is a notable exception to the above rules, as it is generally considered much more stimulating and is the only dissociative reliably associated with psychotic episodes, and for this reason shows low therapeutic potential.
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GHB is a notable exception as it is more commonly associated with sedation and sleepiness than the others in this class.
Holing and K-Holes
Dextromethorphan and Ketamine are known to cause "holes". Very large doses produce a "holing" (hole-ing) effect in several dissociative drugs, in which the person feels as though they have slipped through a hole into another dimension. This experience is often much less visual and more tactile, and usually only occurs with the eyes closed. Tactile experience of this type often involve feeling that the body has changed shape, becoming massive, elongated, compressed, or otherwise altered (for example some people feel like they become a 2D geometric shape, for example, or that they are moving rapidly through space). These experiences are heavily out-of-body, and can produce a distinct yet conceptually related form of a "rebirth" experience as the individual returns to full consciousness.
EFFECTS OF KAPPA AGONISTS
Kappa agonists like Salvinorin A can produce vivid and immersive hallucinations. Unfortunately the receptor responsible for producing these effects also produces the human emotion of "dysphoria", or deep sadness and dissatisfaction, making this class of drug poorly suited for psychiatric evaluation.
SET AND COMPANY
This site does not advocate for personal or recreational use of psychedelics at this time, and therefore discourages this by anyone when not in the company of a medical professional.
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Psychedelic drugs, despite their therapeutic potential, have some limitations, as do all therapies. In particular, as previously mentioned, they should not be used by people with mental health conditions, but in particular by those with psychotic disorders. These experiences can be challenging and complex, and using alone is one of the biggest predictors of negative experiences. Using alone, without medical guidance, and while depressed or otherwise mentally ill can lead to worsening symptoms. The medications are half the cure, the other half is how they are used.
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The administration of these medications in the research studies listed in the Research Timeline were importantly and necessarily performed under the supervision of a medical or mental health professional in a positive and safe therapeutic environment.