|
Psilocybin-assisted psychotherapy and the mental health needs of homebound older adults and those with life-threatening illness
Psilocybin, occurring in nature as the psilocybin mushroom, has emerged as the most promising pharmacological treatment to alleviate anxiety associated with life-threatening illness. Anxiety associated with cancer is the first treatment indication being pursued by psilocybin researchers. What is psilocybin? Let Roland Griffiths explain here. Griffiths is an addiction pharmacologist, psychedelics & spirituality expert and recipient of the 2015 Nathan B. Eddy Award from the College on Problems of Drug Dependence. Could psilocybin-induced mystical experience also help homebound older adults, a patient population with unmet mental health needs that are too-often treated with benzodiazepines like diazepam or lorazepam and even harmful antipsychotics in some cases? Fourteen months after receiving psilocybin in a landmark study at Johns Hopkins University, 94% of those who received the drug said the experience was one of the top five most meaningful experiences of their lives; 39% said it was the single most meaningful experience. |
Going Down Quietly?
Who looks after the mental health
needs of homebound older adults?
40 Yrs of Unaffordable, Inaccessible,
and Inefficient Mental Health Care
PsychologyToday: What's wrong with anti-anxiety drugs?
Mental Health, Addiction, and Drug Policy: Politics and Faux Morals Trump American Health Psychedelics Expert Interviews and America's Mental Health & Addiction Tragedies Antipsychotics Often Prescribed to Seniors for Unapproved Indications American Psychological Association: Could the psychedelic drug psilocybin help ease the existential distress common in people with cancer? |
Does the Mystical Experience Occasioned by Psilocybin Unlock the Power of Awe?
|
According to the American Medical Association, "between seven key emotions–amusement, awe, contentment, compassion, pride, love and joy–research found that four specific emotions—joy, pride, contentment and awe—predicted lower levels of IL-6, a pro-inflammatory cytokine.
Interestingly, awe had the strongest negative relationship to IL-6, even when researchers controlled for the other six positive emotions, personality measures and a third method of measuring emotions." |
My Generation Psychiatry Advisor: Loneliness Common in Elderly With Chronic Illness Loneliness, Chronic Illness, and Growing Older Psychedelics and Immunomodulation: Novel Approaches and Therapeutic Opportunities America's RxProblem: Lack of Mental Health & Substance Abuse Treatment Options and How it is a Barrier to Recovery and Resilience, Increases Stigma Mental State of the Union: Naive Drug Policy and No Mental Health Care |
Much is left to be learned about the effect of hallucinogens on positive emotion–joy, pride, contentment, and awe–and how it modulates the immune system, inflammation, HPA-axis, and other areas of health.
Loneliness, a key negative emotion in homebound adults, may warp our genes and our immune systems, resulting in inflammation. In an NPR story reporting a study on loneliness, Naomi Eisenberger, a neuroscientist at the University of California, Los Angeles stated, "the shock of social isolation could fuel inflammation in the body. And the immune system may affect a region of the brain processing fear and anxiety. Inflammation can change people's experiences of the social world and what they're thinking."
America, don't fight mental illness and addiction with one arm behind your back. A special legal classification must be created to facilitate research of sacred hallucinogens.
America, don't fight mental illness and addiction with one arm behind your back. A special legal classification must be created to facilitate research of sacred hallucinogens.
|
"We have had a nearly 50-year hiatus in any serious investigation, except for some heroic investigators at a few universities... We need to study these drugs." –Jeffrey Liebermen, M.D., Past President of the American Psychiatric Association, author of Shrinks, the Untold Story of Psychiatry
|
|
Unlike benzos, opioids, and muscle relaxants, psilocybin is not addictive and would carry a low risk of diversion to the community if limited to a strictly regulated psychotherapeutic or spiritual settings.
|
Source: Johns Hopkins University. Click for link.
|
The author of Depression in Homebound Older Adults: Recent Advances in Screening and Psychosocial Interventions, gives reasons why current medication has not worked in our older loved ones who are homebound:
"Antidepressant medication use among older adults has significantly increased in recent years. A significant proportion of depressed homebound older adults take antidepressant medications (e.g., from 11.5% in 2000 to 39.5% in 2007 regardless of diagnosis), mostly prescribed by their primary care physicians; however, many have limited response to medication alone and remain symptomatic.
Most depressed homebound older adults prefer psychotherapy to pharmacotherapy, perhaps because only the former can teach skills to cope with their multiple chronic medical conditions, disability, social isolation, and limited financial resources.
However, referring homebound older adults to specialty mental health services for psychotherapy seldom succeeds due to inaccessibility, shortage of geriatric mental health providers, and cost. Providing in-person psychotherapy is especially expensive for homebound patients, given the costs associated with travel (of clinicians to homes or disabled patients to offices). Despite the high rate of depression among homebound older adults, their mental health needs are largely unmet. This will be important as baby boomers increasingly become homebound (Choi 2013).
Would specialty mental health services even work?
|
Are they accessible? Are therapies as efficient as possible so that Medicare would be willing to pay for them?
Current drug therapies do not work well in homebound older adults and our current healthcare system leaves most areas of the United States without adequate behavioral healthcare. |
Click for link.
|
The American mental health system is trying to do things right by conducting rigorous research on non-drug therapies.
|
However, if thought leaders in the United States do not focus heavily on therapies that are affordable, decent mental health care will never be available to most Americans. Medicare and insurance companies simply will not want to pay for inefficient and unpredictable therapies.
Reality: Mental Health Care is Simply is Not Available to Rural and Low Income Americans, a Population that Needs it the Most |
Psilocybin Research
"If you can treat anxiety and depression in people that are dying, why do they have to be dying? If people have chronic anxiety about something or depression, it may be that we'll find treatment so that people don't have to be on antidepressants for years and years and years."
–David Nichols, PhD, Former Distinguished Chair in Pharmacology, Professor Emeritus, Purdue University |
Therapy with hallucinogens could greatly reduce the number of sessions required, saving the taxpayer a large amount of money in a single payer mental health care system.
|
A study published by JAMA found that a nurse led program to help depressed homebound holder adults only helped patients with moderate to severe depression.
|
Participants: Medicare home health patients age ≥65 who screened positive for depression on routine nurse assessments.
Intervention: Depression CAREPATH (CARE for PATients at Home) requires nurses to manage depression during routine home visits by weekly symptom assessment, medication management, care coordination, education, goal setting. Training totaled 7 hours (4 on-site, 3 web). |
|
What about patients with mild or subclinical depression and anxiety? How do we prevent this from progressing to more serious forms of depression?
|
Click for link.
|
Lack of parity and a shortage of behavioral health providers have healthcare professionals trying telemedicine and meaning-centered group therapy.
In May 2015, the American Society of Clinical Oncology (ASCO) highlighted the work of Anthony Bossis and fellow NYU psilocybin researchers Stephen Ross and Jeffrey Guss. In a recent article for ASCO Post, chair of psychiatric oncology at Memorial Sloan Kettering Cancer Center William Breitbart detailed the importance of spirituality and meaning in palliative care. Bossis discusses these issues along with powerful patient experiences in the presentation below.
In May 2015, the American Society of Clinical Oncology (ASCO) highlighted the work of Anthony Bossis and fellow NYU psilocybin researchers Stephen Ross and Jeffrey Guss. In a recent article for ASCO Post, chair of psychiatric oncology at Memorial Sloan Kettering Cancer Center William Breitbart detailed the importance of spirituality and meaning in palliative care. Bossis discusses these issues along with powerful patient experiences in the presentation below.
Various healthcare disciplines must work together–and all treatment options utilized–to meet the mental health needs of our older loved ones.
- Overprescribing the Appalachians and Anatolians ft. Stephen Loyd, M.D.
- Beware of Nature's Medicine. Side Effects May Include Boundary Dissolution, Altruism
- HUGE Speaker for "Breaking Through," TEDMed 2015: Mindfulness, Psilocybin, & Spirituality Psychopharmacologist Roland Griffiths
- Surgeon General Announces Review of Federal Drug Policies: First-of-its-kind report to “present the state of the science on substance use, addiction and health."
- FDA-Approved Drug Therapies and Classic Hallucinogens to Treat Alcoholism: Barriers, Background, and the Latest Research
Click for link.
"In the treatment of depression roughly half of patients will respond to an antidepressant, such as an SSRI. Another group will respond to psychotherapy, such as cognitive-behavioral therapy. But what we don't know yet is who will respond to which treatment, and unfortunately we are in a situation of basically treating by trial and error. For example, someone can be on an SSRI for 8, 10, or 12 weeks before we recognize that it is not helpful. That is an awfully long time for someone with a very serious, often life-threatening illness to be on a medication without our knowing whether it is helpful."
–Thomas Insel, M.D., Past Director of National Institute of Mental Health (NIMH)
–Thomas Insel, M.D., Past Director of National Institute of Mental Health (NIMH)
|
|
"We think it looks like we're tapping into the basic biology of the human condition in which these salient experiences of interconnectedness emerge. And if you really sit back and reflect on it in the history of humankind, those are the kinds of experiences that really form the bedrock foundation of most of the world's religions and the world's ethical and moral traditions."
–Roland Griffiths, Psychopharmacologist Johns Hopkins University School of Medicine, recipient of 2015 Nathan B. Eddy Award, College on Problems of Drug Dependence, Speaker at TedMed2015: Breaking Through
Sources:
Breitbart W, Rosenfeld B, Pessin H, Applebaum A, Kulikowski J, Lichtenthal WG. Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being inpatients with advanced cancer. J Clin Oncol. 2015 Mar 1;33(7):749-54.
Choi NG, Sirey J, Bruce ML. Depression in homebound older adults: recent advances in screening and psychosocial interventions. Curr Transl Geriatr Exp Gerontol Rep. 2013;14:16–23.
Olfson M, King M, Schoenfeld M. Benzodiazepine use in the United States. JAMA Psychiatry.2015;72:136–42.
Psychopharmacology of Psilocybin in Cancer Patients. Sidney Kimmel Comprehensive Cancer Center.
Psilocybin Cancer Anxiety Study. New York University.
–Roland Griffiths, Psychopharmacologist Johns Hopkins University School of Medicine, recipient of 2015 Nathan B. Eddy Award, College on Problems of Drug Dependence, Speaker at TedMed2015: Breaking Through
Sources:
Breitbart W, Rosenfeld B, Pessin H, Applebaum A, Kulikowski J, Lichtenthal WG. Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being inpatients with advanced cancer. J Clin Oncol. 2015 Mar 1;33(7):749-54.
Choi NG, Sirey J, Bruce ML. Depression in homebound older adults: recent advances in screening and psychosocial interventions. Curr Transl Geriatr Exp Gerontol Rep. 2013;14:16–23.
Olfson M, King M, Schoenfeld M. Benzodiazepine use in the United States. JAMA Psychiatry.2015;72:136–42.
Psychopharmacology of Psilocybin in Cancer Patients. Sidney Kimmel Comprehensive Cancer Center.
Psilocybin Cancer Anxiety Study. New York University.
Click images below for more information:
Click for link.
Click for link.
Miller (clockwise from upper left) checks what her patient Calla Osborne, 92, had to eat by reading notes kept by Osborne's daughter; Miller explains to John Toombs, 78, that canned soup can be high in sodium; Divina Gaskin, 71, tells Miller about the side effects of her pills; Miller checks in on Gordon Laymon, 76, who lives alone.
|
|
|
|
|
|
Click for link.
Click for link.
|
Click for link.
|
Click for link.
|
|
|
|
|
|
|
|
Mental Health Shortage: Options for Self-Medication in America Favor Addiction
Unhappy with your psychiatrist or psychologist? Wonder why one person can't take care of your needs? Instead, the American mental health system has to have both psychiatrists and psychologists who operate on different paradigms and are inaccessible, unaffordable, and unavailable. Their profession is so magical and secretive that it cannot be questioned by patients and other healthcare professionals, leading to misdiagnoses, overdiagnosis, and the worst abuses seen in healthcare, including billions of dollars in fraud against the U.S. Department of Justice. Add onto that patients who self-medicate with alcohol, opioid analgesics, and benzodiazepines because terrible healthcare, mental health, and drug policy in the United States leave no other options.
Unaffordable Healthcare and Insurance: Even Doctors Suffer
Mental Health Fraud Against Taxpayers and the Most Vulnerable
Information below is from Cognitive Psychiatry of Chapel Hill and was originally entitled, Unhappy with Psychiatry, Blame Healthcare. The post has since been removed. We still find the information they provided to be helpful.
Unhappy with your psychiatrist or psychologist? Wonder why one person can't take care of your needs? Instead, the American mental health system has to have both psychiatrists and psychologists who operate on different paradigms and are inaccessible, unaffordable, and unavailable. Their profession is so magical and secretive that it cannot be questioned by patients and other healthcare professionals, leading to misdiagnoses, overdiagnosis, and the worst abuses seen in healthcare, including billions of dollars in fraud against the U.S. Department of Justice. Add onto that patients who self-medicate with alcohol, opioid analgesics, and benzodiazepines because terrible healthcare, mental health, and drug policy in the United States leave no other options.
Unaffordable Healthcare and Insurance: Even Doctors Suffer
Mental Health Fraud Against Taxpayers and the Most Vulnerable
Information below is from Cognitive Psychiatry of Chapel Hill and was originally entitled, Unhappy with Psychiatry, Blame Healthcare. The post has since been removed. We still find the information they provided to be helpful.
RSS Feed
