As a new industry emerges, therapists need to be educated.
- Psychedelic therapy is predicted to become a $7 billion industry by 2027.
- Emerging research on psilocybin, MDMA, ibogaine, and LSD is showing a lot of promise in treating a variety of conditions.
- Therapists will not be able to write a script and send patients on their way, which will create a new training model.
Psychedelic therapy is imminent. Within six years, the market for this new wave of therapeutics is predicted to reach nearly $7 billion. With advocates and investors like Tim Ferriss leading the way, protocols for implementing psilocybin, MDMA, LSD, and ibogaine into treatments for depression, PTSD, addiction recovery, and existential distress are being crafted right now.
How will psychiatrists adapt to these new substances?
This is no easy question. Unlike antidepressants currently on the market, you cannot visit a psychiatrist or general practitioner and receive a script within 10 minutes—a longstanding issue in modern psychiatry, especially given that antidepressants don't work better than talk therapy (or as this meta-analysis shows, work better in conjunction with psychotherapy) and carry with them many physical risks. One of the most prominent side effects is weight gain, which has the potential to lead to a whole series of further physical and mental health problems.
Psychedelics are also not without risks. Early results from esketamine—this ketamine variant is not actually a psychedelic but has been generally lumped into the same category and provides a cautionary tale—have not been overly encouraging:
"Through an analysis of adverse events reported to the FDA, the authors found several adverse events related to the use of esketamine nasal spray, such as dissociation, sedation, feeling drunk, completed suicide, and especially suicidal and self-injurious ideation."
This isn't to write off the protocol, which has shown efficacy in trials (though not without issues either). Anecdotal reports have been positive for some depression sufferers. More importantly, the emerging ketamine clinics across North America feature robust protocols that run counter to many current antidepressant-driven psychiatric evaluations. We should continue to explore this line of therapeutics, just more carefully.
The future of psychedelic-assisted psychotherapy | Rick Doblin
The Multidisciplinary Association for Psychedelic Studies (MAPS) foresaw the possibility of psychedelic therapy decades ago. The organization's founder, Rick Doblin, argued against the scheduling of MDMA in the mid-80s. The group's training protocols for MDMA, ayahuasca, ibogaine, and LSD are holistic and include screening sessions, pre-treatment meetings, day-long sessions, and post-treatment integration.
You cannot ingest psychedelics and go about your day. Unlike SSRIs and SNRIs, they don't take weeks for you to feel the effects. This is an entirely different model than current psychiatry protocols. If psychedelic therapy is going to be integrated into psychiatry, mental health professionals need training. They'll have to adapt. Cutting corners will be impossible.
Besides overcoming the hurdle of federal regulations (which is quickly happening), psychedelics should be subject to Risk Evaluation and Mitigation Strategies (REMS), writes Paul Tulls in Nature. This means these novel therapies will be administered according to current FDA guidelines.
"The effect would be to bundle the delivery of the drug with the therapy component, and potentially certify practitioners. A source working on one of the trials says that discussions are under way with the FDA over whether therapists who administer the drugs ought to be trained, what that training might involve and whether therapist certification should be required."
Credit: Microgen / Adobe Stock
This will not be without its challenges. As Tullis writes, some therapists have been skirting federal law by offering psychedelic therapy for 30 years, reminiscent of LSD sessions in the 1950s and MDMA therapy in the 1970s. In fact, LSD was subjected to over 1,000 studies before being criminalized, though it's admittedly hard to offer a placebo. (Niacin has worked in some trials.) The comprehensive protocols being developed now have early pioneers to thank.
Psychedelics are also entering an industry with standard practices. Some therapists are likely to remain skeptical; others might not train properly before administering the drugs, which could create problems for the entire industry should some patients experience adverse effects. Psychotherapy will always be necessary before and after administration. In an industry where many are accustomed to writing scripts, not providing in-depth existential explorations with their patients—and many patients are accustomed to quick visits that result in refills—a giant learning curve is necessary.
While many are hopeful that psychedelic therapy will have broad appeal, the more likely result is a slow integration with specialized clinics (such as with ketamine today). There will undoubtedly be players with no history of psychedelics involved only for economic gain; we're already seeing it with tens of millions of dollars pouring into companies. The competing forces of revenue maximization and psychedelic ritual are likely to create friction.
Regardless, this emerging industry requires funding to get off the ground. We just need to temper expectations with the real-world consequences of the psychedelic model—a hard sell in a world accustomed to quick returns. And we'll need therapists willing to explore uncharted territory on its own terrain, not the ground they're accustomed to walking on.
Stay in touch with Derek on Twitter and Facebook. His most recent book is "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."
A Penn State study finds today's middle-aged are experiencing much higher stress levels than 30 years ago.
- A study based at Penn State found the middle-aged are much more stressed than other age groups.
- While most generations average a 2 percent increase in stress levels from 1990, those aged 45-64 show a 19 percent uptick.
- The reasons include concern for their children, fears of unemployment, and a deluge of information.
When I was young, I used to walk to school uphill in the snow in both directions, even in June. It would take three hours to get there and five to return home. Kids today, they don't know suffering.
That's all a lie, of course, though I do recall my grandfather expressing a similar sentiment. He was also likely joking—sarcasm is a family trait—but there is a persistent notion that things get easier in every generation. As we grapple with the highest unemployment numbers since the Great Depression, we now know that's not true.
New research from Penn State claims what my Gen X peers have long suspected: middle age really is harder now, at least when compared to that Golden Era of the nineties. Kurt Cobain perfectly captured our existential duress 30 years ago. We're still dealing with cultural and economic trends that are adding more stress to our lives.
The team found a slight increase among all age groups when comparing the tens to the nineties. For respondents aged 45-64, that number jumped much higher. On average, people reported a 2 percent increase in all stressors, says David Almeida, professor of human development and family studies at Penn State. That equates to an additional week of stress every year. A different story unfolded with Gen Xers and younger Boomers.
"What really surprised us is that people at mid-life reported a lot more stressors, about 19% more stress in 2010 than in 1990. And that translates to 64 more days of stress a year."
Nirvana - In Bloom (Official Video)
While this research pulls from data that's a decade old, consider a 2019 study by LinkedIn that found Gen Xers are significantly more stressed than neighboring generations. In that study, the top five stressors were work-life balance, confidence in job future, sense of purpose, work politics, and access to tools that let you do your job.
The meme war between Millennials and Boomers has always relied on a strange dynamic, considering that the former earn 20 percent less than the latter despite being better educated. Gen X sits in the middle: earning less (relatively) than their parents while bringing in more than their children. Life is not defined by money alone, yet it is an important factor when discussing stress levels: job satisfaction, being overworked and underpaid, and feeling insecure in your employment are some of the biggest stressors in modern life.
For this study, the team at Penn State collected data from 1,499 adults in 1995 and compared it with responses from 782 adults in 2012. Each participant had been interviewed every day for eight consecutive days, in which they were asked about life stressors: relationship and friendship issues, finances, work problems, prospects for the future. The interviewers assessed how much impact these stressors had on other aspects of their lives.
Almeida expected to see higher rates of dissatisfaction in young adults. He was surprised that the most affected demographic was middle-aged respondents. He doesn't believe it's all about them, however. He puts at least part of the burden on concern for their children, who, as mentioned above, face a tougher job market.
And it's not going to get easier. As Washington state congresswoman Pramila Jayapal recently stated, we keep discussing getting back to "normal" when many Americans haven't experienced normal for decades. We need to discuss what the economy looks like a year from now: the jobs that will be available, the industries we need to say goodbye to, and a plan for finally addressing income inequality. Instead, we're forcing low-wage workers to return to unsafe working conditions in hopes of a normality that never really worked for them anyway.
Almeida also speculates that the rapid pace of change due to technology could be adding additional stress, especially to Gen X. The entire "optimization market" overwhelms us by constantly making everyone feel behind. An entire class of supplements purported to enhance creativity, boost memory, and improve overall brain performance is estimated to reach $5.32 billion by 2026. With such an emphasis on "optimizing" every aspect of employment and life, the fear of falling behind creates elevated levels of stress.
The daily deluge of information, which often leads to smartphone addiction, is cognitively draining. Almeida suspects this is yet another factor negatively impacting the middle-aged right now. Gen Xers sit at the intersection of a technology-light childhood while also recognizing its role in today's workforce. Navigating the middle terrain is rough.
Everyone's stress levels are rising. Twenty-eight percent of working parents that are currently sheltering at home are experiencing a "trauma-related mental health disorder." The World Economic Forum believes the second half of 2020 will be even worse for stress and depression. The above 2 percent number for most age groups will likely increase in the coming months.
And there's Gen X, leading the way again, as if we were built for this moment. How sturdily remains another story. Now give me my two dollars.
It's not just an old superstition — it's your stressed-out brain.
- Your brain's fight-or-flight response system is behind the appearance of premature gray hairs.
- The sympathetic nervous system essentially burns out melanin-producing hair follicles.
- New research may lead to a greater understanding of the connection between stress and body changes.
It's not your imagination, it turns out. Stress can turn a person's hair gray. It's said that if you look at before and after pictures of any eight-year U.S. president the impact of the office on hair color is clear, though in fairness, it may be that candidates dye their hair and then at some point stop doing so. Nonetheless, scientists from Harvard have not only verified the conventional wisdom on our graying noggins, but have also figured out why stress is so brutal to our follicular pigmentation.
The new research from Harvard scientists is published in the journal Nature.
An unusual chance to see stress at work
"Everyone has an anecdote to share about how stress affects their body, particularly in their skin and hair — the only tissues we can see from the outside. We wanted to understand if this connection is true, and if so, how stress leads to changes in diverse tissues. Hair pigmentation is such an accessible and tractable system to start with — and besides, we were genuinely curious to see if stress indeed leads to hair graying."
It turns out that stress activates nerves associated with our basic fight-or-flight system, and these nerves permanently damage pigment-regenerating melanocyte stem cells in hair follicles, causing them to cease production of melanin that normal provides color to hair follicles.
Hsu's team studied the issue using mice, and was somewhat stunned at their findings. "When we started to study this, I expected that stress was bad for the body — but the detrimental impact of stress that we discovered was beyond what I imagined," recalls Hsu.
The scientists stressed the mice using a combination of three methods:
Who’s in charge here?
Image source: Helga Lei/Shutterstock
Hsu and her colleagues first suspected an immune system reaction was at the root of graying hairs only to discover that mice without immune systems still turned gray in response to stressors. The next suspect was cortisol produced by the adrenal glands — however, this proved not to be so. "Stress always elevates levels of the hormone cortisol in the body," says Jsu, "so we thought that cortisol might play a role. But surprisingly, when we removed the adrenal gland from the mice so that they couldn't produce cortisol-like hormones, their hair still turned gray under stress."
It’s the sympathetic nervous system
Image source: Judy Blomquist/Harvard University
Finally, the researchers investigate the possibility that the system responding to stressors was the mice's sympathetic nervous systems, the part of the nervous system that kicks into action with the fight-or-flight impulse. The sympathetic nervous system is a vast network of nerves that connects, among other places, to hair follicles in the skin. In response to stress, the system sends a rush of the chemical norepinephrine to the follicles' melanocyte stem cell, causing them to quickly burn through and deplete their stores of pigment.
Say Hsu, "After just a few days, all of the pigment-regenerating stem cells were lost. Once they're gone, you can't regenerate pigments anymore. The damage is permanent." Great for survival, not so good for hair color.
A big hint of a much greater insight
Sympathetic system nerves are magenta above. Melanocyte stem cells are yellow.
Image source: Hsu Laboratory, Harvard University
"Acute stress," says lead author of the study Bing Zhang, "particularly the fight-or-flight response, has been traditionally viewed to be beneficial for an animal's survival. But in this case, acute stress causes permanent depletion of stem cells."
The research, done in collaboration with other Harvard researchers, presents a new appreciation of the effect the sympathetic system can have on the body's cells during stress.
One of these collaborators, Harvard immunologist Isaac Chu, notes, "We know that peripheral neurons powerfully regulate organ function, blood vessels, and immunity, but less is known about how they regulate stem cells. With this study, we now know that neurons can control stem cells and their function, and can explain how they interact at the cellular and molecular levels to link stress with hair graying."
Given this finding regarding the direct impact of stress on follicular stem cells, the question of what it else it may affect becomes an obvious one. As Hsu sums it up, "By understanding precisely how stress affects stem cells that regenerate pigment, we've laid the groundwork for understanding how stress affects other tissues and organs in the body."
This importance of the study therefore goes way beyond graying heads. "Understanding how our tissues change under stress is the first critical step," says Hsu, "toward eventual treatment that can halt or revert the detrimental impact of stress. We still have a lot to learn in this area."
Can dirt help us fight off stress? Groundbreaking new research shows how.
- New research identifies a bacterium that helps block anxiety.
- Scientists say this can lead to drugs for first responders and soldiers, preventing PTSD and other mental issues.
- The finding builds on the hygiene hypothesis, first proposed in 1989.
Are modern societies trying too hard to be clean, at the detriment to public health? Scientists discovered that a microorganism living in dirt can actually be good for us, potentially helping the body to fight off stress. Harnessing its powers can lead to a "stress vaccine".
Researchers at the University of Colorado Boulder found that the fatty 10(Z)-hexadecenoic acid from the soil-residing bacterium Mycobacterium vaccae aids immune cells in blocking pathways that increase inflammation and the ability to combat stress.
The study's senior author and Integrative Physiology Professor Christopher Lowry described this fat as "one of the main ingredients" in the "special sauce" that causes the beneficial effects of the bacterium.
The finding goes hand in hand with the "hygiene hypothesis," initially proposed in 1989 by the British scientist David Strachan. He maintained that our generally sterile modern world prevents children from being exposed to certain microorganisms, resulting in compromised immune systems and greater incidences of asthma and allergies.
Contemporary research fine-tuned the hypothesis, finding that not interacting with so-called "old friends" or helpful microbes in the soil and the environment, rather than the ones that cause illnesses, is what's detrimental. In particular, our mental health could be at stake.
"The idea is that as humans have moved away from farms and an agricultural or hunter-gatherer existence into cities, we have lost contact with organisms that served to regulate our immune system and suppress inappropriate inflammation," explained Lowry. "That has put us at higher risk for inflammatory disease and stress-related psychiatric disorders."
University of Colorado Boulder
This is not the first study on the subject from Lowry, who published previous work showing the connection between being exposed to healthy bacteria and mental health. He found that being raised with animals and dust in a rural environment helps children develop more stress-proof immune systems. Such kids were also likely to be less at risk for mental illnesses than people living in the city without pets.
Lowry's other work also pointed out that the soil-based bacterium Mycobacterium vaccae acts like an antidepressant when injected into rodents. It alters their behavior and has lasting anti-inflammatory effects on the brain, according to the press release from the University of Colorado Boulder. Prolonged inflammation can lead to such stress-related disorders as PTSD.
The new study from Lowry and his team identified why that worked by pinpointing the specific fatty acid responsible. They showed that when the 10(Z)-hexadecenoic acid gets into cells, it works like a lock, attaching itself to the peroxisome proliferator-activated receptor (PPAR). This allows it to block a number of key pathways responsible for inflammation. Pre-treating the cells with the acid (or lipid) made them withstand inflammation better.
Lowry thinks this understanding can lead to creating a "stress vaccine" that can be given to people in high-stress jobs, like first responders or soldiers. The vaccine can prevent the psychological effects of stress.
What's more, this friendly bacterium is not the only potentially helpful organism we can find in soil.
"This is just one strain of one species of one type of bacterium that is found in the soil but there are millions of other strains in soils," said Lowry. "We are just beginning to see the tip of the iceberg in terms of identifying the mechanisms through which they have evolved to keep us healthy. It should inspire awe in all of us."
Check out the study published in the journal Psychopharmacology.
Stress affects everyone, but there's something you can do about it.
- Stress can physically impact your brain, your ability to learn, your immune system, your cardiovascular system, and your gastrointestinal tract.
- Spending 90 minutes in nature can reduce brain activity associated with depression, lower blood pressure, anxiety, and boost your immune system
- There are ways to manage stress, but, if you feel like you can't manage your stress, you should reach out to a health professional.
Stress can do a lot to the body, so if you're stressed it's important to find a healthy way to mediate the impact of that feeling you're feeling.
Why? Though there are instances in which stress can indeed temporarily improve and sharpen memory, stress is generally seen to be a detriment to memory. The area of the brain in which your short-term memories are converted into long-term memories is highly susceptible to stress. Chronic stress also weakens the muscle of the brain and sees it decrease in weight.
Stress can also impact your ability to learn, cause mood disorders, and impact your spatial memory — i.e., the part of the brain that records information about one's environment. Furthermore, it can lead to the suppression of your immune system and there is a positive link in research between stress and cardiovascular disease. There's a gender difference worth noting with the latter, too, as women — as the authors of an EXCLI Journal article note — "begin to exhibit heart disease ten years later than men, which has been attributed to the protective effects of the estrogen hormone." Stress also can impact the gastrointestinal tract in a variety of ways.But just because stress can do all these things doesn't mean that stress will do all these things, especially if you take the following steps.
It's worth noting that these examples are generalized examples. The reason for this is that if you look at the scientific literature concerning coping with stress, you'll come across one exceedingly specific examples after the other, i.e., Chinese students studying, African-Americans with Type 2 diabetes, mothers with children who have type 1 diabetes, being a consultant physician in Saudi Arabia, and many more. It certainly doesn't invalidate the advice that follows, but it's a dynamic worth noting.
1. Take a stroll in nature.
We've written about it before, but it's worth emphasizing again: Spending 90 minutes in nature can reduce the activity in your brain associated with depression, lower blood pressure, anxiety, boost your immune system, and so much more. Even 5 minutes makes a difference.
2. Do regular exercise.
Even if you're only spending 30 minutes a day on exercise, it will have an impact. A string of Doctors from Spain noted in a paper published in 2015 that "Regular exercise has multi-system anti-aging effects." One reason could be that exercise — as noted in another paper published in 2015 — "enhances protein stability, creating a cellular environment capable of resistance to exercise-induced stress".
So practice your jump shot. Conquer the treadmill while listening to 'Beautiful Anonymous'. Do push-ups when you wake up. You might just take the necessary physical steps to ease your sense of stress in the process.
3. Talk to your physician.
Not in the mood to exercise? Not in the mood to go outside? If so, you might find what William Shanahan, a consultant psychiatrist, told The Financial Times to be worth your attention: "[People] have to get past the view that because they have shown some vulnerability and a sense that they're bleeding in public that somehow the sharks are going to come and swallow them alive … Probably the first person to talk to is your general practitioner, actually. Keep it simple."
People are capable of managing their stress, but they don't have to carry the burden alone. Keep it simple.