In a psychiatrist's office in the sleepy Swiss town of Solothurn, patients are taking part in extraordinary individual therapy sessions that can last up to eight hours.
The patient can sit on a stool or lie on a mat while listening to music or exchanging a few words with the psychiatrist. But for most of the session silence rules as a long-time feared and banned drug pushes them deep into a meditative state.
It's a long way from LSD's previous life as a drug of choice for the 1960s counterculture, a role that led governments around the world to ban the substance. But LSD along with other hallucinogenic drugs such as ecstasy, psilocybin, and ketamine are being reborn as possible tools in the battle against depression and other mental illnesses.
"The ban on these substances was generally a political decision because of the counterculture and hippies," said Peter Gasser, the psychiatrist conducting the LSD trials. While he says many psychiatrists are wary of the drug, he believes its use in therapy could be "meaningful and good and effective." Reports coming out of the research community in recent months have indicated these drugs could be effective in treating mental illness.
An article in August in Nature Reviews Neuroscience, for example, said psychedelic drugs create changes in the neural circuits and potentially affect the glutamate transmitters that are involved in memory.
Conditions such as depression "are serious, debilitating, life-shortening illnesses, and as the currently available treatments have high failure rates, psychedelics might offer alternative treatment strategies that could improve the well-being of patients and the associated economic burden on patients and society," Franz Vollenweider and Michael Kometer of the University Hospital of Psychiatry in Zurich wrote in the article.
These medications aren't without risk, however, with potential side effects ranging from nausea and weakness to psychotic reactions. Last year in Germany, two patients reportedly died during a therapy session in which psychedelic drugs were used. Indeed, experts caution against their use in people with conditions such as schizophrenia, borderline personality disorder and serious addiction.
Despite such concerns, the aim for many of these researchers is to remove some of the restrictions on hallucinogenic drugs. They envision a day when doctors would be able to prescribe them to patients, albeit under very controlled circumstances.
"It would be nice to emerge from the dark ages, superstition and paranoia, and have these substances available in responsible use," says Vancouver-based psychologist Andrew Feldmar, who plans to study the impact of MDMA, also known as ecstasy, on post-traumatic stress disorder.
The Swiss are among the most active in probing the little-understood world of hallucinogenic drugs. Along with the LSD trial, there is another looking at whether MDMA aids those suffering from treatment-resistant post-traumatic stress disorder, and other research examining the use of ketamine for depression.
Hallucinogenic drugs have a long history in Switzerland. The alpine country is the home of chemist Albert Hofmann, who first created LSD in a Basel laboratory in 1938 and discovered its hallucinogenic properties five years later.
As well, Switzerland tends to be more flexible when it comes to using drugs for treatments. The Swiss, for example, allow heroin addicts to receive that substance on a prescribed basis in special clinics as part of efforts to reduce crime. Mr. Feldmar is turning to Switzerland to provide MDMA for his study because it's the only place where he could procure a reliably pure form of that substance. He is currently waiting for an import permit.
While drugs such as ecstasy or LSD are illegal in Switzerland, the authorities are willing to approve their use for trials on a case-by-case basis.
Dr. Gasser's study started to probe the effects of LSD on patients in 2008. The use of LSD in therapy is not new. In the short period between LSD's discovery and eventual ban in the 1960s, it was used in many therapists' offices and included such converts as film star Cary Grant.
"This substance was intensively researched," Dr. Gasser says. "And then there was that long interruption so we don't know much more today." The treatment under Dr. Gasser's study consists of two therapy sessions with either LSD or a placebo containing traces of LSD. After the sessions, the patients stay at the clinic overnight in case there are complications.
So far, the trial is halfway through with six patients treated. There were no adverse reactions observed, such as bad trips, according to Dr. Gasser. Those who took the LSD reported feeling better, although as Dr. Gasser observes they still have serious illnesses and don't feel 100 per cent again after therapy. The LSD proved more effective than the placebo as patients who received the latter felt there was little improvement in their condition.
The challenge has been finding people willing to participate in the study. Few doctors sent patients his way to be treated with LSD. Instead, trial volunteers contacted Dr. Gasser themselves after hearing about the study in the media. Five more patients are currently being prepared for the trial.
Dr. Gasser is aware the study's small size will provide more of a hint than concrete statistical evidence. Still, he is optimistic it is a first step in bringing LSD back from its forbidden land.
Over at the University Hospital of Psychiatry, researchers are probing ketamine, an anesthetic that is also illegally sold on the street as "special K." Using healthy volunteers rather than sick patients, they are measuring the effect that drug has on the brain. There are plans to start offering ketamine to patients with treatment-resistant depression.
Erich Seifritz, a director at that hospital, believes ketamine is a good drug to study as it is already well known because of its current, regulated use as an anesthetic. He says little is known about other hallucinogenic drugs, such as LSD, because they have been banned for so long. Even when they were actively used, studies from that time were not well designed, according to his colleague, Dr. Vollenweider.
As a result, Dr. Seifritz is concerned other researchers may be pursuing their exploration of hallucinogenic drugs too quickly. He would prefer such tests start with animals, proceed to healthy people and later to actual patients.
"Of course we must bring progress into medicine," Dr. Seifritz said. "But in psycholytic research, if you want to do it in a scientific and sound way, you have to do it following the highest physical and psychological safety standards."
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