In this episode of the Psychedelic Medicine Podcast, Dr. Kurt Rasmussen joins to discuss the potential benefits of non-hallucinogenic psychedelic drugs currently in development. Dr. Rasmussen is the Chief Scientific Officer at Delix Therapeutics and was previously at the National Institutes of Health where he led the Division of Therapeutics & Medical Consequences since 2018. Here, he directed the medications development program and played an integral role in evaluating the safety and efficacy of pharmacotherapies, behavioral therapies, and devices to treat substance use disorders. He is also Fellow in the American College of Neuropsychopharmacology and has over 100 publications and patents to his name.
Dr. Rasmussen begins by discussing the ways psychedelics can bring out physical changes to brain structure, mentioning that this is an important mechanism for the therapeutic effect of these medicines. He mentions that these structural changes are theorized to be relatively distinct from the experiential, hallucinogenic component of psychedelics, and as such it may be possible to develop new drugs which condition the same cascade of events in neuronal structure without leading to intense subjective experiences and major alterations in perception.
But what would the benefits of such drugs be? Dr. Rasmussen explains that the availability of non-hallucinogenic psychedelics could have the potential to significantly increase the accessibility of these substances and their associated therapies—both in populations for whom contraindications exist for traditional psychedelic medicines (such as patients with schizophrenia) and for individuals who may be resistant or fearful of the hallucinogenic experiences that can come with psychedelics. Rather than attempting to replace traditional, hallucinogenic psychedelics, Dr. Rasmussen hopes that these non-hallucinogenic alternatives would be able to serve populations or conditions where current psychedelics are not the best option.
In fact, Dr. Rasmussen suggests that perhaps hallucinogenic and non-hallucinogenic psychedelics could be used powerfully in conjunction with one another, hypothesizing that the personally meaningful journeys conditioned by traditional psychedelics may be more effective for kickstarting healing from a condition like depression, but perhaps the non-hallucinogenic substances could be more convenient maintenance, as they would not require regular intense experiences facilitated by specially trained therapists to continue promoting neuroplasticity.
Dr. Rasmussen does emphasize, however, that a psychotherapeutic component would still be recommended even with non-hallucinogenic psychedelics, as the combination of medication and therapy leads to greater efficacy. But, this also depends on the particular condition being treated. A patient with a mental health condition will likely benefit from the addition of therapeutic work, but a patient who is exploring psychedelic treatment for something like migraines or cluster headaches may only need the structural changes caused by these substances in the brain in order to feel better—another reason why non-hallucinogenic psychedelics may be preference for certain patients with various conditions.
In closing, Dr. Rasmussen reiterates that the exploration of non-hallucinogenic psychedelics is all about increasing patient options and broadening the cools in the psychiatric toolbox to tailor treatments to particular patients and conditions. Whether hallucinogenic on non-hallucinogenic, Dr. Rasmussen sees psychedelic medicine as an important and promising paradigm shift in psychiatry.
In this episode:
- How both hallucinogenic and non-hallucinogenic psychedelics may be used together to reach a greater patient population
- Why the hallucinogenic component of psychedelics may not be necessary for their efficacy
- Contraindications involving the hallucinogenic component of psychedelics
- Potential cardiovascular concerns with regular psychedelic use due to action on serotonin receptor 5-HT2B
- Why it may be desirable to have a range of psychedelic medications which produce different intensities of subjective effects to treat a wider range of patients
Quotes:
"There are changes in your brain as a result of administration of these compounds that occur. It's not just a sensory and emotional experience, but actually there are physical changes in your brain, in different circuits, very specific circuits." [5:28]
"SSRIs and other antidepressants can have effects by themselves, psychotherapy can have an effect by itself, but the real efficacy, the magic is when you combine the two and I have no doubt that these compounds [non-hallucinogenic psychedelics] will benefit from psychotherapy associated with it." [11:07]
"We need more options for patients for sure, and hopefully the psychedelic medications with the hallucinations will help a certain set of patients and hopefully we'll have other non-psychedelic compounds that are neuroplastic that will help patients." [18:25]
"I think different compounds will be affecting different circuitry or different microcircuits… in the brain so that different compounds will have varying levels of efficacy for different indications, and like I said the indications can be from neurology to psychiatry." [25:58]
Links:
Dr. Rasmussen with his puppy Ruby
Dr. Rasmussen on LinkedIn
Delix Therapeutics website
Psychedelic Medicine Association
Porangui
