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.
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American Psychological Association: Could the psychedelic drug psilocybin help ease the existential distress common in people with cancer?
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."
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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.
"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).
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.
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
"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
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).
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.
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- 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
–Thomas Insel, M.D., Past Director of National Institute of Mental Health (NIMH)
–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
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.
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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.
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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.