The Pros and Cons of Psychedelics in Psychiatry

10.25.2021 Life
Dr. Daniel Amen
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In recent times, there has been a lot of hype surrounding the use of psychedelic drugs as potential treatments for psychiatric issues. The excitement about the possibilities of these mind-altering substances to relieve symptoms associated with a variety of mental health conditions is reaching a fevered pitch. But does the reality live up to the hype? And just how safe are these substances? Although it’s true that some scientific research suggests potential mental health benefits from using psychedelics in a clinical setting, there are downsides too. Extreme caution is needed. Here’s what you need to know.

What Are Psychedelics?

The term psychedelics refers to mind-altering drugs that can expand consciousness and impact sensory perceptions. There are many such substances—some that occur in nature while others are chemical compounds developed in laboratories. Four of the most commonly discussed drugs currently gaining traction in the field of psychiatry are psilocybin, MDMA, LSD, and ketamine.


Have you heard of “magic mushrooms?” These natural substances contain a psychoactive compound called psilocybin that can alter thoughts and perceptions and can cause visual and auditory hallucinations at high doses. The psychedelic effects of psilocybin include feeling like time has slowed down, a sense of euphoria, seeing colors more vividly, thinking unusual thoughts, and seeing stationary objects appear to move.


Commonly known as ecstasy or Molly, 3,4-methylenedioxymethamphetamine (MDMA) is a mood-altering chemical that produces enhanced sensory perception and feelings of closeness to others.


Discovered in the 1950s by Swiss chemist Albert Hofmann, lysergic acid diethylamide (LSD) was made available to the psychiatric research community. By the following decade, over 130 studies on the substance showed that it produced positive results in a range of mental health issues, such as anxiety, depression, and alcohol abuse. In the 1970s, however, following a surge in the recreational use of LSD and instances of “bad trips,” the drug was banned.


Developed more than half a century ago, ketamine is an anesthetic that dulls pain and makes people feel dissociated from their body. This substance can have hallucinogenic effects and has been used as a recreational drug with the nickname “Special K.”

Pros and Cons Microdosing Psychedelics

Emerging research is investigating the use of psychedelics for the treatment of depression, anxiety, post-traumatic stress disorder (PTSD), addiction, and more. In the field of psychiatry, this typically involves microdosing or administering very small amounts of the psychedelic substance. This is intended to produce benefits without causing a “bad trip” or triggering intense hallucinatory effects.

A very important caveat of microdosing psychedelics is that the drugs are administered by a trained mental health professional in a clinical setting. The substances are used as a way to enhance psychotherapy, which is why this practice is referred to as drug-assisted therapy.

Be aware, however, that studies also point to potential downsides related to the use of mind-altering substances. This is why the use of these substances outside the clinical setting is not recommended.

Psilocybin: Research points to potential benefits for the administration of this substance in a clinical setting. A 2021 study in JAMA Psychiatry involving 24 people with major depressive disorder found that psilocybin-assisted therapy produced “large, rapid, and sustained antidepressant effects.” Other research from 2021 in The New England Journal of Medicine on people with moderate to severe depression showed that treatment with psilocybin was equally effective as treatment with a common antidepressant (escitalopram, brand name Lexapro).

Downsides: Some people who ingest magic mushrooms experience negative reactions, such as anxiety, panic attacks, paranoia, feelings of fear and depression, nausea, and numbness.

MDMA: A 2021 randomized, double-blind, placebo-controlled phase 3 clinical trial appearing in Nature Medicine looked at the impact of MDMA-assisted therapy on individuals suffering from severe PTSD. Following the treatment, 67% of participants no longer met the diagnostic criteria for PTSD. The researchers concluded that “MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation.”

Downsides: Blurred vision, nausea, clenched teeth, nausea, sweating, and chills are some of the unwanted effects of taking MDMA.

LSD: In a 2020 study looking at LSD and other psychedelics as possible treatments for depression, the researchers suggested that “low doses of psychedelics could play a role in depression by inducing some kind of cognitive flexibility, which might lead to decreased rumination.”

Downsides: The effects of this mind-altering drug are unpredictable and can vary from one person to another. In high doses, negative effects can include extreme mood changes, psychosis, hallucinations, and flashbacks.

Ketamine: Numerous studies point to ketamine’s positive effects on major depressive disorder. Findings in a 2013 study in the American Journal of Psychiatry showed that in people with treatment-resistant depression, ketamine quickly triggered antidepressant effects. Significant improvement in depressive symptoms among people taking ketamine was also noted in a 2017 review in Mental Health Clinician. In 2019, the Food and Drug Administration (FDA) approved esketamine nasal spray — a derivative of ketamine — as a treatment for depression and treatment-resistant depression.

Downsides: Ketamine may be addictive and may cause high blood pressure, dizziness, and nausea.

How Psychedelics Work On the Brain

Clearly, any mind-altering substance also has an impact on brain function. Here’s what the science shows so far about how psychedelics affect the brain.

Psilocybin: A 2020 brain imaging study in the journal NeuroImage looked at brain scans of people before and after taking psilocybin and found that the drug lowers activity in an area called the claustrum. This brain region is believed to be involved with setting attention and shifting tasks, which may explain why people taking psilocybin experience feelings of connectedness and a lack of ego.

MDMA: MDMA triggers the release of neurotransmitters, including serotonin, dopamine, and norepinephrine. Experts point to the heightened levels of serotonin as the primary basis for the feelings of euphoria that recreational users tend to experience. After this surge of serotonin, however, levels of the neurotransmitter may become depleted, leading to negative psychological effects. Long-term heavy use of MDMA is also associated with changes in regions of the brain associated with impulse control and attention, working memory, and visual information processing.

LSD: Research shows that this psychoactive drug works on a variety of receptors in the brain, including serotonin and dopamine.

Ketamine: Research shows that ketamine alters the way the brain’s neurons communicate. The substance binds to receptors that trigger the release of glutamate, an abundant neurotransmitter in the brain that is involved in memory and learning. A 2019 study in the journal Science suggests that ketamine promotes the growth of synapses in the brain.

Although this research is a good start, there isn’t enough information yet to know how microdosing psychedelics in a clinical setting will affect the brain on a long-term basis. More investigation on the use of psychedelics as a psychiatric treatment is needed to understand their lasting impacts on brain health and to establish how safe they really are.

This article is syndicated and was first published on Amen Clinics and full credit is given to the original author Dr. Amen.

Depression, anxiety, PTSD, and other mental health issues are important parts of wellbeing that need prioritization. Dr. Amen and Amen Clinics offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more about their services and treatments here.

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