ATMA Journey Centers

Do you know anyone that has unsuccessfully tried to treat depression with SSRIs?

This experience is more and more common since SSRIs have become a front-line treatment for depression, anxiety and other mental health conditions.

While SSRIs are effective for many people with depression, they carry possible side effects, only treat symptoms not the root cause and some studies have questioned their overall efficiency.

What other options are there?

In recent years psychedelic therapy has emerged as a promising breakthrough treatment option that addresses mental health problems at their root cause.

As promising as this sounds, psychedelic treatments also carry risks and aren’t a fit for everyone.

As a mental health practitioner you should be aware of the potential benefits and risks of  psychedelic therapy and whether it’s a good option for your clients.

Let’s dive into the benefits and drawbacks of SSRIs vs psychedelic therapy.

The Benefits of SSRIs

SSRIs are a widely used tool for treating a variety of conditions including depression and anxiety. Some studies have doubted their effectiveness while many consider them to be essential. Taking SSRIs comes with benefits and risks.

A benefit of SSRIs is that people usually take them on a daily basis. Psychedelic therapy may involve one or several 6-8 hour psychedelic sessions as well as pre-session psychotherapy and integration afterwards. The simplicity of taking a pill every day makes SSRIs a simple routine although as we will see later is far more effective in combination with other treatment options.

What do they do? They are intended to restore emotional stability, support a return to healthy daily routines, ease restlessness, anxiety, sleep issues, and deter suicidal thoughts.

So how effective are they? Most studies on SSRIs have found they are 20-30% more effective than placebo with the effectiveness increasing with the severity of symptoms.

Since most cases of depression are mild, SSRIs may not be an effective choice.

If you decide a client may potentially benefit from SSRIs, it must be balanced against their drawbacks and limitations.

Now, The Drawbacks of SSRIs

First of all, around 30% – 50% of clients are unresponsive to SSRI treatment and 10% – 30% are considered entirely resistant to treatment, so SSRIs don’t work for everyone.

SSRIs may come with side effects, including

  • Nausea, vomiting or diarrhea
  • Headache
  • Drowsiness
  • Dry mouth
  • Insomnia
  • Nervousness, agitation or restlessness
  • Dizziness
  • Sexual challenges, including decreased libido and erectile dysfunction, 
  • Changes in appetite, causing weight loss or gain

Also, SSRIs have a delayed onset.

It can take weeks to months to receive the full effects which is a significant challenge for clients experiencing suicidal ideation.

SSRIs carry a risk of suicide during that onset period and when changing medication, especially for teenagers.

If a client gets through the onset period and finds the SSRI tolerable and effective, it may lose its effect after months or years. If this happens their dose may be increased or they may change medication.

All of this said, perhaps the most important drawback of SSRIs is that they don’t address the underlying cause of depression. Trauma-informed approaches to depression and other mental health conditions offer possible lasting relief if the underlying trauma is addressed.

On their own SSRIs are valuable tools for the benefits they offer but weighed against the drawbacks, there are treatment options that may suit your clients better or can be done in combination.

SSRIs are often taken in combination with Cognitive Behavioural Therapy and other therapeutic modalities for greater effectiveness. 

Considering the drawbacks and limitations to this particular treatment for depression, what does psychedelic therapy have to offer?

The Benefits of Psychedelic Therapy

Since their introduction in the 1980s, SSRIs have been a primary treatment of depression and anxiety. Psychedelics are promising to shift that. 

The research on psychedelic therapy is clear.

In a randomized clinical trial run by Johns Hopkins, participants diagnosed with Major Depressive Disorder had a 71% reduction in their depression, a significant change. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8901083/

Similarly, the MAPS phase III clinical trial treated participants with severe and moderate, treatment resistant PTSD with MDMA assisted therapy. 12 months after the initial dose, 80% of participants no longer qualified for a PTSD diagnosis. 

These results were significant enough to earn psilocybin and MDMA assisted therapy FDA “breakthrough” status.

While MDMA studies have focused on PTSD, psilocybin studies have focused on depression, addiction and end-of-life anxiety.

Note that SSRIs can attenuate the effects of psilocybin mushrooms. This dampening effect may last as long as 3 months after discontinuing antidepressant use.

Legal options for access to psychedelic therapy in Canada include Ketamine therapy at specific clinics, and access to psilocybin and MDMA through the Special Access Program but there are some important considerations before seeking psychedelic therapy.

The Drawbacks of Psychedelic Therapy

As a mental health practitioner it’s important to understand the benefits and the drawbacks of psychedelic therapy.

First of all, psychedelic therapy is not a fit for everyone. In rare cases, people with a history of psychosis can have a temporary reemergence of psychosis after psychedelic use.

Also, there are contraindications with some psychedelics for people with heart conditions and certain types of medication.

Clients must be screened for all possible exclusion criteria prior to psychedelic therapy.

Perhaps the biggest challenge with psychedelic therapy is access. 

Legal psychedelic therapy can be costly since insurance doesn’t yet cover psychedelic therapy. One exception is Alberta Blue Cross in Canada which covers Ketamine therapy. Progress has been made by advocacy groups in the U.S. and Canada so widespread insurance coverage may be coming soon.

Another consideration for psychedelic therapy is the time requirement.

Because of the uniquely intense and potentially destabilizing nature of psychedelics, psychedelic therapy requires significant care. 

Proper preparation and integration afterwards is on the time scale of weeks and a psychedelic session itself can be 6 to 8 hours.

If a client is not getting relief from their symptoms of depression or anxiety from SSRIs they will need to discontinue use before psilocybin therapy can begin. That period of time may be challenging. Alternatively, Ketamine assisted therapy can be done while using SSRIs. 

What about safety?

While the FDA has acknowledged the breakthrough potential of psychedelic therapy, they are still undergoing research and the specific mechanisms of action are not fully understood. That said, the protocols developed by MAPS and Johns Hopkins for MDMA and psilocybin therapy have been studied and evaluated safe and effective.

Could your clients benefit from psychedelic therapy?

 

The journey in becoming a psychedelic therapist demands dedication and a commitment to lifelong learning. 

 

At ATMA we provide comprehensive guidance and support, from training to real-world practice in our specialized training programs to help you become a confident, skilled psychedelic practitioner. 

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