TrueLife - Psychedelics in the Treatment of Bipolar & Mental Illness

Episode Date: March 25, 2023

One on One Video Call W/George https://tidycal.com/georgepmonty/60-minute-meetingSupport the show:https://www.paypal.me/Truelifepodcast?locale.x=en_US🚨🚨Curious about the future of psychedelics? Imagine if Alan Watts started a secret society with Ram Dass and Hunter S. Thompson… now open the door. Use Promocode TRUELIFE for Get 25% off monthly or 30% off the annual plan For the first yearhttps://www.district216.com/https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-022-00265-5Abstract:This is a narrative review about the role of classic and two atypical psychedelics in the treatment of unipolar and bipolar depression. Since the 1990s, psychedelics experience a renaissance in biomedical research. The so-called classic psychedelics include lysergic acid diethylamide (LSD), psilocybin, mescaline and ayahuasca. Characteristic effects like alterations in sensory perception, as well as emotion- and self-processing are induced by stimulation of serotonin 2A receptors in cortical areas. The new paradigm of psychedelic-assisted psychotherapy suggests a therapeutic framework in which a safely conducted psychedelic experience is integrated into a continuous psychotherapeutic process. First randomized, controlled trials with psilocybin show promising efficacy, tolerability, and adherence in the treatment of unipolar depression. One on One Video call W/George https://tidycal.com/georgepmonty/60-minute-meetingSupport the show:https://www.paypal.me/Truelifepodcast?locale.x=en_USCheck out our YouTube:https://youtube.com/playlist?list=PLPzfOaFtA1hF8UhnuvOQnTgKcIYPI9Ni9&si=Jgg9ATGwzhzdmjkg

Darkness struck, a gut-punched theft, Sun ripped away, her health bereft. I roar at the void. This ain't just fate, a cosmic scam I spit my hate. The games rigged tight, shadows deal, blood on their hands, I'll never kneel. Yet in the rage, a crack ignites, occulted sparks cut through the nights. The scars my key, hermetic and stark. To see, to rise, I hunt in the dark, fumbling, fear. Hears through ruins maze, lights my war cry, born from the blaze.

The poem is Angels with Rifles. The track, I Am Sorrow, I Am Lust by Codex Serafini. Check out the entire song at the end of the cast. Ladies and gentlemen, welcome back to the True Life podcast. Hope everybody's having a beautiful day. Hope the sun is shining. I have been trying to get this show off the air for a few days. had a little run-in with our good friend called severe dehydration.

So excuse me if I cough a little bit or I got some dark circles under my eyes. Back in action, though, and excited to get to this. I want to introduce this particular podcast by talking about the title of the podcast is the psychedelics in the treatment of unipolar and bipolar depression. But I put an emphasis on bipolar because that is. is a sort of mental illness that has fascinated me. I grew up with a family member who has mental illness. I grew up with a lot of mental illness in my family.

If you're like me, you've become a very interesting person because the people in your family are very interesting. And I got to see firsthand what it's like to live with someone who suffers from bipolar disease. I've seen the mania, seen the depression. I've seen the destruction and I have seen the person's struggle incredibly hard with their life.

And so it's been something that's always fascinated with me. I think it's important to say, I'm not a doctor by any means. I'm going to go through this article. I'm going to give my opinion on some things. But my opinion is just that. It's just an opinion. I've read quite extensively from like the DSM-5.

I've spoken to lots of different people and I've grew up with people who've had this particular disease. So I hope you'll enjoy. going through this article with me. I'm just kind of read through some parts, give some ideas about it. And my heart goes out to anybody who suffers with bipolar disorder or has been in a family that has it or is affected by it. And my thought is that potentially we can find some solutions to this particular mental illness. And so here we go. Psychedelics in the treatment of unipolar and

bipolar depression. Several studies investigating the anti-depressant effects of classic psychedelics, including LSD, psilocybin, and mescaline were performed in the 50s to the 70s. These studies did not typically follow a double blind in placebo control design. That's because there's really no way to do that. If you take psychedelics, it's pretty easy to find out who's on them and who has the placebo. Thus, the overall efficacy in reducing depressive symptoms by 80% giant number. In a total of over 420 patients, there's a key number there, should be interpreted carefully, rather as a positive signal than as robust clinical evidence. The international ban on psychedelics also ended clinical research with these molecules until the current revival in the 2000s. Soon, also clinical studies using psychedelics and psychiatric conditions with effective symptoms,

were initiated. In one of the first such investigations, the effective of a single dose of psilocybin as an adjunct to psychotherapy was tested on anxiety and depression in 29 patients with cancer. This particular study, it seems to me, is beginning to work with people at the end of life. So it's not actually bipolar, but you can imagine someone who is going through a terminal case of cancer or finding themselves on the cusp or knocking on heaven's door. You know, you begin to have, have some pretty big questions. So that's where it kind of began. In this double-blind study with an active placebo-controlled crossover design using

niacin, which is an interesting placebo, right? They're going to use niacin, which gives you the body flush. Cilocybin led to a clinically significant reduction, which was still measurable in 60 to 80% of the patients at the 6.5 month follow-up. I want everyone just to think about that four minute. If you take something and you still have a measurable result in 60 to 80% of the people after a half a year at a one-time use, do you think that that's better than something you have to take every single day? I don't know. But it does seem like an incredible stat.

And I think that that is why there's so much going on in the world. of psychedelics in medicine. You're beginning to see these incredible stats, like 60 to 80%. It's pretty impressive. The authors identified the psilocybin-induced mystical experience as a main mediator of the therapeutic effect. Weakness of the study were functional unblinding due to obvious psychedelic effects.

We kind of covered that there. And a small non-representative sample, both of which are typical for this phase of clinical psychedelic studies. In another study with 51 terminally ill cancer patients, a high dose of psilocybin compared to the placebo-like low dose of psilocybin also led to a decrease of depressed mood and anxiety with about 80% of patients. I'm going to skip down here to another part that I think is really relevant. Just bear with me here. We're getting to it.

Here we go. Okay, so here we go. Unfortunately, systematic studies are still limited to unipolar depressed patients. as patients with bipolar disorder have been excluded from recent psychedelic trials due to safety concerns. The concerns stem mostly from qualitative user reports in case studies, which documented the occurrence of switches to mania after ingestion of psychedelics. So I want to read some of these case studies of psychedelics being a trigger for mania. And then I'm going to give some thoughts on that. One case study of a 20-year-old woman described the occurrence of psychotic mania

about 36 hours after a single ingestion of psilocybin-containing mushrooms, which could be stabilized first with lithium and aproposal, and which was later successfully switched to lomotrogen due to adverse effects. The patient had a positive family history of bipolar disorder, father and paternal grandmother, and was suffering depression and PTSD. but was unmedicated at the time of the episode. Okay, so I want everyone to think about this particular case study,

and we're going to get into more of them, but you're going to see a pattern here. The case studies claim that the psychedelic was a trigger for the mania, but I want you to see in here all these other things that the person had. They were suffering from PTSD. They had depression. You know, they were unmedicated at the time. So it doesn't seem to me that this particular,

and again, I'm not a, doctor, just my opinion. But it doesn't seem like these actually tell us that psychedelics were a trigger for the mania. Let's go to the next case study. Iawasca and DMT were also reported to induce mania with psychotic features in patients with bipolar disorder or a positive family history of bipolar disorder. A 40-year-old male psychiatrist with known bipolar disorder, he had one single previous manic episode.

So, again, we're relying on someone else's diagnosis of his bipolar disorder. And I'm not sure how they diagnose one single previous manic episode. He was hospitalized with mania and psychosis after self-medicating for depression. He took up to one gram daily of vaporized DMT for six months and then added the M-A-O inhibitor, phenylene, three weeks before the hospitalization. Wow, those are some pretty big doses, right? And then you add in the M-AO inhibitor, which is going to allow the, it's going to allow for less deterioration of the psychoactive substance.

Again, he was given lithium and dosage of palpidine clinozapine. Wow, this guy was on some deep stuff. Okay, let's go to the next case study here. Another 25-year-old male with known bipolar disorder and history of cannabis abuse was hospitalized with mania with psychotic features, which occurred two days after ayahuasca ingestion. Remission was achieved with a combination of binpidol, olazepin, and lorazepam. So do you guys see the sort of pattern that's happening here? another 25-year-old male with known bipolar disorder and history of cannabis use was hospitalized with mania with psychotic features.

But it seems to me, let me get this cat out of the way. Come here, buddy. You sit over here. Okay. It seems to me that it's not these particular psychoactive substance that are the trigger. It seems to me that a lot of the people may be using these for self-medication. and then going into the hospital when they have an episode. What we don't see in here, when I look at all these different case studies,

what we don't see is the, we don't see the other things they're reflected with. We don't know all of the other variables in the equation. But this particular article, to me at least, is making it sound like these particular psychoactive substance are the trigger for the biophobic. bipolar disorder. Now, I know that in my family, and in other cases I've read, alcohol, other drugs can be the trigger. So I think that what research can be done that would really help is figuring out what exactly is happening in the brain. And where we go from there, like, we understand that the activation of the 2A receptor is something that happens with all psychedelic

substances or the majority of them. We're seeing an increase. to neurotransmitters. But I think that that's also what's happening in the brain of someone who's in a manic state. You know, it's almost like someone in a mania is already experiencing a flood of neurotransmitters, already experiencing like a dopamine high or adrenaline high. And so it's just very difficult to say that the psychedelic substance or the trigger for that. They may be, I don't know, but my idea, and it's just, an idea, is that if we had a study with people that have bipolar and they were willing to use

psychedelics as a potential medication, and I realize the reason there's not these studies is because it is dangerous. It is particularly something that could be a trigger, although I don't know, I don't think it's a trigger, but that's easy for me to say I'm not a doctor. I think that maybe if these psychedelic substances are a trigger, then that's just the beginning phase of it. What we should be studying is maybe the psychoactive substance is the beginning of balancing out the bipolar disorder. Because we're seeing increased functionality. We're seeing increased connection in the brain. So wouldn't it make sense that if the psychoactive substances,

are making greater connections. The first step is probably going to be a manic episode. It's probably going to link up all the centers of the brain in a way that the brain is used to functioning in a manic episode when it's that way. And if you think about it like this, for those people who have been familiar with the psychedelic environment, you begin to understand that the come-up, whether it's through psilocybin or LSD or MDMA,

they have this sort of come-up period to them. And once you've done it enough, you realize that the come-up period is a shifting in brain patterns. And you begin to see in the first hour, you begin to see yourself thinking differently. You begin to start seeing your environment differently. So someone who's bipolar, when they take the psychedelic substance,

their brain is going to switch over to a different mode of thinking, a different mode of functioning. And that might be the default mode they turn to in a manic state. Now, I know what you're thinking. Well, great, George. What happens when they turn back into a depressive state? I think that the psychedelic substances, if we could measure them, my hypothesis would be that in the first few courses, like let's say you did a psychedelic dose, maybe the best. best way to do it would be a, and I'm just spitball in here, if you did one dose a month,

and like let's say you did like a five gram dose, you take the first five gram dose, that may induce someone into a sort of manic state. What you would look for is what is the regression back to the normal state of the bipolar person? What is the regression to the depressive state? Is that manic state that was triggered by a psychedelic substance? Is that going to trigger a depressive state faster? Is it going to trigger a depressive state longer? Or is there something that we can measure in there to see it? I think what you would probably begin to see after a three to six month course of psychedelic therapy with integration would be a balancing out of the mania and the depression. I think it would stabilize it, especially when we look at the way in which

integration and psychedelic therapy is happening with PTSD. You know, I think that on some levels, PTSD is lighting up the depressive centers or choking off the ability to make connections the same way depression and bipolar people is. You would definitely need some. You would need an amazing lab with some amazing doctors. And these are just all my hypotheses. But I think that if you can see what's happening in the brain of people, people with PTSD and psychedelic therapy, I think that you could use that same sort of information

you learn from there. And there's been tons of studies on PTSD and psychedelic substances. I think that you could take that information and apply it to people that have the bipolar disorder. Because I think what you're seeing in the brain, at least in the depressive times, is that actual depressive point, right? And so let's talk about how, I want to also talk about how integration with psychedelics PTSD could possibly present an alternative therapy for people with bipolar disorder. And I realize, again, I realize I'm not a doctor and I realize the insurance claims to do something.

This would be bananas. But just think about someone who, if you know someone who has bipolar disorder, you can talk to them when they're in a. mania and you can talk to them when they're in a depressive state and they're like two different people. But I think if you could talk to someone who has bipolar disorder and you can catch them on the third hour of a psilocybin trip, I think you could talk to both parts of the brain. I think you could talk to someone who is somewhat balanced out at that point in time. You would need brain scans to do it and you could see what parts of the brain are lighting up. Now that set and setting may be a little bit of an issue for someone who has this disease,

but I think it's totally doable. And I think you can measure brain activity and then you could have that conversation with that person. And once you could get that person, once you could have a coherent conversation with someone who is in between a manic state and a depressive state, I think you could begin to build a bridge right there. And you could begin to get that person to become aware of, hey, this is how I feel when I have mania. This is how I feel when I'm depressive. Hey, here's the way the people around me are affected by it.

And I think that would be a very valid part of integration is getting the person to understand how the people around them are reacting when they're in their different states. Because that can be a variable that they use to understand where they're at in their feelings. That could be a variable they could use to understand where they are in their thought process. We do it all.

As someone who doesn't have bipolar disorder, you and I do it all day long by looking at the looks on other people's faces, by looking at the facial cues, by looking at the way in which the crowd reacts to us or the individual words react to us, or better yet, the way our words affect other people. If you look at someone who is in the midst of a mania

or a manic episode, the language they use is it's either incredibly flowery, dreamy rhetoric about potential things that may happen but probably never would happen. But it's so captivating. It's almost immeasurable in its scope of possibilities. It's this beautiful dream that is so passionate, you're pulled into it. And then on the flip side of that and the depressive state, it's usually, no words at all. But I think the people that find themselves in the midst of a manic episode could really benefit from understanding the cues around them. And I think that would be accomplished

with the psychedelic integration. I think that, and let me give you guys a foundation for why I'm saying the things that I have. I grew up in a household where my father was suffers bipolar. And the manic episodes that happened were at times the most tremendous, amazing, flowery rhetoric. And it was like sitting down and listening to a Barack Obama speech about hope and change. Like the possibilities of what was about to happen in our lives was mesmerizing. One minute, I'm getting ready to go to a ribbon-cutting ceremonial in Gibraltar for a new story. start up and the whole world is watching. And it's amazing to a kid who's nine or ten years.

We told these fantastic ideas and the amount of details that first with these ideas. In some ways, I wish everybody could experience a speech of that nature. I wish that people could experience the form, the cadence, the all-around feeling. because someone who's in a manic episode, it's infectious. You want to be around it in a weird sort of way. And so that's the foundation for some of the ideas I'm giving in this particular idea about psychedelic substances and the use of psychedelics. I have noticed in people that I have spoken with,

I have noticed in case studies that I've read, and I've noticed in myself almost a form of mania that happens when you're all. on psychedelics. It's the, you know, it's, it's, it's what Merseille, Merseillead, Merseilleat calls the terror before the sacred. It's this almost Godlike feeling of being connected to the world. And I think that that feeling, that sort of divine beauty that rises up from the interior of your soul at the height of a psychedelic experience, maybe the closest thing someone who doesn't have bipolar disorder, that might be the closest you can get to experience in the mania.

And if that's true, the mechanisms of action that are happening in the brain could be very similar. And so I think that that that in itself is worth potentially studying. I think that finding out the brain patterns when someone's at the height of a psychedelic experience could be used and extrapolated to find out what's happening in the brain of a person who's in a manic episode. And if you can come, it kind of brings back the idea of maybe people who are treating people with bipolar episodes should go through the closest thing to a manic episode. And that might be the height of a psychedelic experience.

I know I'm kind of birdwalking here, but this is just me trying to figure out, you What is going on with people I love that have bipolar disease? How might that be mediated by a psychedelic experience and kind of combining the two of them? But let me get back to the idea of integration because I think someone who has bipolar disorder would greatly benefit from a psychotherapist who has themselves found or been through the height of a psychedelic experience. I think that would give them insight into that person's brain. It may not allow them to feel what that person feels, but I think it would provide more than empathy.

You know what I mean by that? More than empathy is not just putting yourself in someone's shoes, but putting yourself in someone's position in a heightened state of awareness. There's a difference there. And I think that the height of a psychedelic experience provides that for them, especially if someone who has bipolar were to able, maybe they started up with a microdose or maybe they started off with something like that. I really think that the integration that could be done between a psychotherapist who's experienced psychedelics,

someone who has bipolar disorder and has a psychedelic experience, I think that one could find a bridge there. I think there could be common ground for both people to move forward and understand what's happening in the brain. being aware of what's happening, even if it's just the beginning of a conversation, I think that that blazes the trail for someone who has bipolar disorder to begin walking down. Now, there's definitely other medicines. Most people who have bipolar disorder are, you know, sometimes taking lithium, which is, in my opinion, a horrible thing to take. But there's definitely a series of different medications people are taking.

which would have to be thought about, which would have to be laid out and figured out if there's any sort of contractations or something like that. But it's an interesting, it's a very, to me, it's fascinating, it's interesting. And it encompasses all the different ideas of social processing, mindfulness and acceptance, emotional processing, psychological adverse effects. But I guess one of my goals of trying to get this particular piece out there is, I think it would benefit people. And I realize that the studies are not being done for insurance reasons.

I understand the studies are not being done because it could potentially make things worse. But the truth is doing nothing is still making a decision. And doing nothing is a huge problem for people with mental illness. And I think there's people out there that would volunteer for the program. I think that liability could in some ways be done away with a waiver. And I think that there's a lot of people that would be willing to step up and go through this process. And in my opinion, the people that need psychedelic therapy most are kind of the people that we're not allowing into the studies. And I think it may come down to money.

It may come down to insurance. And it may come down to liability. But I'm hopeful that we can get people that need the treatment partnered up with really good people who are willing to work with them. Because I think that that's what's missing. In some ways, I think that this psychedelic emergence, this next wave of psychedelics, if you will, has the potential to help the people that need it most. But we have to have the courage to help those people. And so I'm excited to see this new wave coming out. I'm excited to see some different types of practitioners out there.

And I'm excited to see the courage of the people who have mental illness stepping forward and seeking out the therapy that they need. So that's what I got for today on this particular set of bipolar disorder and psychedelics. I'll probably go into it. This has been helpful for me. I hope it's helpful for other people. And I really encourage other people to get out there and understand the mental illness that you, you may have the mental illness that may be in your family and do everything you can to try to help people around you that may be suffering. And remember, everybody you meet is suffering

or fighting a battle that you have no idea about. So be nice to them. All right? That's all I got for today. Ladies and gentlemen, thank you for your time. Aloha.