The pandemic has posed a challenge to the mental health of the population. Although most of us have not needed treatment to deal with frustration and temporary depression, some have developed formal depressive and anxiety disorders.
Fortunately, there are effective interventions: lifestyle, sleep, exercise and mindfulness meditation are examples. In more serious cases, there is also psychotherapy as well as antidepressants, which have demonstrated their usefulness and safety for decades. However, these interventions also have their limitations, and they still leave many people suffering and unable to function.
As a group of psychiatrists specializing in severe and persistent mental disorders, we follow with interest the most recent developments in therapies assisted by psychedelic treatments, in which we actively participate. As recently reported in the media, Health Canada has decided to authorize the use of psilocybin (magic mushrooms) and MDMA (ecstasy) as an emergency treatment for patients who have not responded to traditional approaches. This openness by the federal government to the therapeutic potential of these substances will make it possible to continue to better study these molecules in a myriad of refractory psychiatric disorders. However, we must remember the importance of a rigorous approach, based on solid scientific evidence.
On the one hand, studies recently published in major scientific journals are encouraging. It appears that psilocybin (studied in major depression and end-of-life distress) and MDMA (studied in post-traumatic stress disorder) assisted psychotherapy approaches are indeed effective, with participants experiencing improved marked with their condition. As psychiatrists and researchers, we are therefore optimistic and encouraged by the advent of these new treatments in our therapeutic arsenal. However, questions persist: will the results mentioned above, obtained with small groups of hyper-selected participants, be confirmed on a large scale? What are the risks of administering these substances outside of a strict, supervised research context? Will these compounds be used judiciously and justified by all physicians?
And what will be the place of these new treatments in the Quebec health system? Psychedelic treatment therapies require intensive psychological follow-up, and Quebec currently suffers from a problem of accessibility to psychotherapy. Several experts believe that mental health is underfunded compared to its weight in the overall health of the population, a fact aggravated by the pandemic. Accessibility to cutting-edge treatments must be supported, without losing sight of the importance of an appropriate care offer for all.
It should also be remembered that there are currently specialized treatments available for refractory cases, when traditional interventions have proven insufficient. […]
It will certainly be desirable for psychedelic treatments to be added to existing approaches to offer other options to current interventions, if science comes to confirm their effectiveness. We have already taken this route at the CHUM, where some of our rTMS refractory patients are treated with ketamine after a rigorous evaluation process. Since Health Canada’s authorization at the beginning of January, we are also working to offer psilocybin treatments to some of them. To broaden access to these treatments, it is crucial to accelerate the research effort in order to properly guide their integration into treatment algorithms and to determine for which clinical populations and at which moment in the care pathway psychedelic treatments will be useful.
So let’s be optimistic about the possibilities available to us with these innovative treatments, but let’s remain cautious and rigorous on the path leading to their use.