- Psychedelics and guided therapy may benefit the treatment of depression, anxiety, substance use disorder, and PTSD.
- Success of preliminary studies have led researchers to imagine a potential role for psychedelics in skilled nursing care settings.
- Some believe psychedelics may potentially be used in ways that improve cognition, mood, and quality of life for people living with dementia.
- Ongoing studies must investigate questions regarding proper dosages, safety and supervision, ethics around consent, and other critical issues.
After being banned internationally in the 1970s, psychedelics have experienced a recent resurgence in Western medical research. What do we know? And could these powerful ancient compounds be integrated into care for people living with dementia?
A small but growing evidence base suggests that “classical” psychedelics like psilocybin, LSD, DMT, as well as compounds like MDMA and ketamine may be effective therapies in controlled medical settings, with researchers observing preliminary benefits in the treatment of depression, anxiety, substance use disorder, PTSD, and in palliative care for patients facing terminal cancer.
The mechanisms underlying these benefits remain somewhat nebulous. However, the compounds are generally believed to contribute to greater cognitive flexibility and increased communication across brain regions. Given that many mental health conditions are marked by persistently inflexible patterns of thought, feeling, and behavior, treatments that disrupt the neural systems that encode and overdetermine such patterns and provide opportunities for people to “rewire their brains” in ways that provide long-term relief is compelling.
Indeed, research strongly suggests that it is not the mere drug itself that matters as much as the supportive presence of a “guide” who can help the patient interpret and integrate their experience and develop new habits of mind within a therapeutic window of greater openness. (For a deeper dive into the ancient shamanic roots of this dynamic, see this recent paper).
New Directions for Psychedelics—Including Dementia Care
The success of preliminary studies has served to re-legitimate psychedelic research in Western medicine.
Treatments are now being explored for patients with conditions such as eating disorders, migraine and cluster headaches, and opioid addiction. Some researchers, including our colleagues at Johns Hopkins Center for Psychedelics and Consciousness Research, have begun exploring whether there may be benefits for people living with dementia.
From a cognitive perspective, there is some evidence that the neuroplastic/anti-inflammatory properties of psychedelics can potentially confer benefits for those with progressive neurodegenerative illness. Given the 100 percent fail-rate of anti-Alzheimer’s drugs over the past several decades—especially those narrowly targeting beta-amyloid—such out-of-the-box thinking is welcome.
However, as we have previously addressed, it is unlikely that a heterogeneous, age-related syndrome like Alzheimer’s is itself “curable,” and it is important to not over-inflate the clinical potential for treatments like psychedelics. Instead, we might think more imaginatively about how these treatments could yield benefits adjacent to cognition—for instance, supporting the psychosocial wellbeing of older adults living in long-term care.
Helping to Treat Agitation, Behaviors, and Delirium?
Those who work in skilled-care settings are intimately familiar with the limitations of current pharmaceuticals in managing resident behaviors. Our aging Western cultures are facing a massive crisis involving the overuse of anti-psychotics, with 1 in 5 nursing home residents currently subjected to this class of drugs to treat agitation, behaviors, and delirium.
Whereas anti-psychotics have proven largely ineffective and quite dangerous, it has been proposed that micro-doses of psychedelic treatments that disrupt ego and allow temporary unbinding from acute physical/mental suffering (as well as inflexible, habitual patterns of cognitive activity) could theoretically help foster greater calmness in people living with dementia.
In light of the deleterious consequences of anti-psychotics, investigating the potential mood-altering effects of psychedelics—which are generally well-tolerated, non-addictive, and non-hallucinatory at low dosages—would appear a valuable direction for inquiry.
Enhancing the Benefits of the Arts?
One irony in the dementia field is that while drugs have failed spectacularly despite billions of dollars of investment, one consistently effective “intervention” in long-term care is the arts. Storytelling, music, dance, gardening, pet therapy, and other activities we often jokingly call “socialceuticals” (since they are almost comically superior to current drugs for dementia) connect to the quintessential humanity of the cognitively frail, allowing for rich expression, the forging of bonds with caregivers, and improved QOL.
Psychedelics, of course, are known for their capacity to enhance sensorial experiences, elicit feelings of the sacred, sublime, and numinous, and deepen a sense of unity and inter-connection. It is thus worthwhile considering whether micro-dosages of psychedelic compounds could, in long-term care settings, help deepen the qualitative experience of “socialceuticals” like listening to or singing songs, observing nature, engaging with art works, interacting with animals, or bonding with other residents.
Obviously, in the absence of data, the promise of psychedelics is, at present, mostly speculative or theoretical. Much must be learned about proper dosages, safety and supervision protocols, ethics around consent, how to address adverse reactions, staff training, and other questions that crop up around modern treatment regimens for these ancient compounds.
We must also be cautious of market forces—specifically, companies, entrepreneurs, and bad actors with vested interests who hype treatments as quick-fix commodities. Thankfully, rigorous studies are being undertaken internationally, and what we learn in the next decade should help light the path forward (or not).
In the meantime, we can still, as citizens, bring the arts into long-term care environments—and also to our elder relatives in general—and help provide the “altered states” that we know are protective, enjoyable, and supportive of QOL for all of us.
We have written more extensively about this subject in our latest book, American Dementia: Brain Health in an Unhealthy Society.