
DVT Risk Management Beyond The Socks
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I know I am at higher risk of DVT after having hip surgery, any advice beside compression stockings?❞
First of all, a swift and easy recovery to you!
Surgery indeed increases the risk of deep vein thrombosis (henceforth: DVT), and hip or knee surgery especially so, for obvious reasons.
There are other risk factors you can’t control, like genetics (family history of DVT as an indicator) and age, but there are some that you can, including:
- smoking (so, ideally don’t; do speak to your doctor before quitting though, in case withdrawal might be temporarily worse for you than smoking)
- obesity (so, losing weight is good if overweight, but if this is going to happen, it’ll mostly happen in the kitchen not the gym, which may be a relief as you’re probably not the very most up for exercise at present)
- See also: Lose Weight, But Healthily
- sedentariness (so, while you’re probably not running marathons right now, please do try to keep moving, even if only gently)
Beyond that, yes compression socks, but also frequent gentle massage can help a lot to avoid clots forming.
Also, no surprises, a healthy diet will help, especially one that’s good for general heart health. Check out for example the Mediterranean DASH diet:
Four Ways To Upgrade The Mediterranean Diet
Also, obviously, speak with your doctor/pharmacist if you haven’t already about possible medications, including checking whether any of your current medications increase the risk and could be swapped for something that doesn’t.
Take care!
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Curing Hiccups And Headaches At Home With Actual Science
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Quick fixes for bodily annoyances
Do you ever find yourself desperately trying to cure hiccups, and advice on the Internet is like “breathe in through your ears while drinking vinegar upside-down through your nose”?
If so, you’re not alone. So, today we’re going to look at some science-based approaches to dealing with common bodily annoyances.
Hiccups
Unfortunately, most popular advices simply don’t work, and the only near-guaranteed way to cure these is with anti-convulsive medications whose side-effects may be worse than the hiccups.
However, before you head to the pharmacy, there is one breathing exercise that has a very simple scientific underpinning: 4:4 breathing. If you’re unfamiliar, it’s just:
- Breathe slowly in through your nose to a count of four
- Hold your breath for a count of four
- Breathe slowly out through your nose to a count of four
- Hold your breath for a count of four
…and repeat. The slower the better. At first, your hiccups will interrupt this, but just “keep calm and carry on”.
The reason this can work is that breathing is an autonomic function (e.g., it happens without us thinking about it) that, unlike most other autonomic functions, we can all control directly. By taking control of one, others will tend to fall into line with it.
For example, it is normal that your heart rate will tend to slow or quicken as your breathing slows or quickens, respectively.
Your hiccups? Autonomic function. Actually a very, very old evolutionary left-over trait, that’s only useful for protecting lungs while breathing underwater. In other words, it’s the bodily function thinks you’re a fish (or a tadpole-like amphibious creature) in the process of developing lungs. Unfortunately, because hiccuping doesn’t harm our chances of passing on our genes, it never got naturally de-selected so we still have it.
Anyway, the bottom line is: take control of your breathing in the aspects you can directly control, and the aspects you can’t directly control will fall into line. You may need to give it some minutes, don’t give up too quickly.
Headaches
If you ever get a headache and you don’t have painkillers or perhaps they’re not helping or you have another reason for not wanting to take them, there’s “one quick trick” that can cure most headaches in seconds.
First, the limitation: this will only cure headaches that have been caused by increased localized blood pressure in the forehead. However, that’s more than half of most common headaches.
Next, how it works…
We’re mentioning this first, because understanding how it works will give you more confidence in using it.
Your body has a wonderful homeostatic system, which is the system by which your body maintains its “Goldilocks zones” of not too hot or cold, not to acidine or alkaline, not too hydrated or dehydrated, blood pressure not too high or too low, etc. Sometimes, however, it can get confused, and needs a nudge back to where it should be.
One of the ways it maintains blood pressure is biofeedback from receptors in blood vessel walls, called baroreceptors. They are what it sounds like; they measure blood pressure internally.
In certain places, there are clusters of baroreceptors in one place. And if we press on that one place, the body will think “Oh no! Super high blood pressure in this bit!” and reduce the blood pressure immediately.
This is called the baroreflex, and that’s what you need to cure a hypertensive headache.
So, what to do:
With your thumb, carefully feel the upper inside corner of your eye socket. So, at the top, and about ¼ of the way out from the bridge of your nose. You should feel a groove. No, not like the Emperor’s New, but, an actual groove in your eye socket. That’s the supraorbital notch (or foramen), and it allows the supraorbital artery, veins, and nerve to run through.
Press it firmly (you can do both sides at once, assuming you have two thumbs) for about three seconds, and then massage it gently. Repeat as necessary, but it shouldn’t take more than about three goes to have cured the headache.
As a bonus, this is a great party trick for curing other people’s headaches, when the need arises!
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Tiramisu Crunch Bites
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It’s coffee, it’s creamy, it’s nutty, it’s chocolatey, what’s not to love? It has all the well-loved flavors of tiramisu, but this recipe is a simple one, and it’s essentially stuffed dates in a way you’ve never had them before. They’re delectable, decadent, and decidedly good for your health. These things are little nutrient-bombs that’ll keep you reaching for more.
You will need
- Coffee (we will discuss this)
- 150g (5.5oz) mascarpone (if vegan or lactose-intolerant, can be substituted with vegan varieties, or at a pinch, pressed silken tofu)
- 500g (1lb) dates (Medjool are ideal)
- Twice as many almonds as you have dates
- 50g (2oz) dark chocolate (the darkest, bitterest, you can find)
- Edible flower petals if you can source them (some shops sell dried rose petals for this purpose)
Method
(we suggest you read everything at least once before doing anything)
1) Take the mascarpone and whisk (or blend) it with the coffee. What kind of coffee, you ask? Many will use instant coffee (1tbsp granules mixed with enough boiling water to dissolve it), and that is actually healthiest (counterintuitive but true) but if you care for flavor over health, and have the means to make espresso, make it ristretto (so, stop it halfway through filling up an espresso cup), let it cool, and use that. Absolute bonus for flavor (not for health): if you have the means to make Turkish coffee, use an equivalent amount of that (again, cooled).
You will now have coffee-flavoured mascarpone. It’s great for your gut and full of antioxidant polyphenols. Set it aside for the moment.
2) Take the dark chocolate and melt it. Please don’t microwave it or try to do it in a pan directly over the hob; instead, you will need to use a Bain-Marie. If you don’t have one made-for-purpose, you can place a metal or heatproof glass bowl in a saucepan, with something to stop it from touching the floor of the pan. Then boil water in the pan (without letting the water get into the bowl), and melt the chocolate in the bowl—this will allow you to melt it evenly without burning the chocolate.
You will now have melted dark chocolate. It has its own set of polyphenols, and is great for everything from the brain to the gut microbiome.
3) Cut the dates lengthways on one side and remove the stone. Stuff them carefully with the coffee-flavored mascarpone (you can use a teaspoon, or use a piping kit if you have one). Add a couple of almonds to each one. Place them all on a big plate, and drizzle the melted chocolate over them. Add the petals if you have them.
The dates and almonds deliver extra vitamins and minerals in abundance (not to mention, lots of fiber), and also are an amazing combination even just by themselves. With the mascarpone and chocolate added, this winning on new levels. We’re not done yet, though…
4) Chill them in the fridge for about 30 minutes.
Serve!
Learn more
For those interested in some of the science of what we have going on today:
- Make The Heart-Healthiest Coffee ← this is about cafestol content and why instant is heart-healthiest (alas)
- The Bitter Truth About Coffee (Or Is It) ← this is about the health benefits (and some risks, but mostly benefits) of coffee
- Why You Should Diversify Your Nuts ← almonds are a top-tier choice, but other nuts are good too! This recipe could work well with hazelnuts, for example (we wouldn’t call it “tiramisu crunch bites” in that case, though, since the flavor profile would change)
- Which Sugars Are Healthier, And Which Are Just The Same? ← for any worrying “aren’t dates sugary, though?”
Enjoy!
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Genital herpes is on the rise. Here’s what to know about this common infection
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The World Health Organization (WHO) recently released new estimates suggesting around 846 million people aged between 15 and 49 live with a genital herpes infection.
That’s equivalent to one in every five people from that age group.
At least one person each second (42 million people annually) contracts a new genital herpes infection.
So what is genital herpes, and are cases on the rise? Here’s what to know about this common infection.
Peakstock/Shutterstock First, what causes genital herpes?
Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus, which also causes cold sores.
There are two types of herpes simplex virus, HSV-1 and HSV-2 (and it’s possible to be infected by both at the same time).
HSV-1 most commonly spreads through oral contact such as kissing or sharing infected objects such as lip balm, cups or utensils, and presents as cold sores (or oral herpes) around the mouth. But it can also be sexually transmitted to cause a genital herpes infection.
An estimated 3.8 billion people under the age of 50 (64%) globally have HSV-1.
HSV-2 is less prevalent, but almost always causes a genital herpes infection. Some 520 million people aged 15–49 (13%) worldwide are believed to have HSV-2.
The initial episode of genital herpes can be quite painful, with blisters, ulcers and peeling skin around the genitals over 7–10 days.
Not all people have severe (or any) initial symptoms. This means a person might not know they have been infected with a herpes virus.
Herpes is a lifelong infection, which means once you contract the virus, you have it forever. After an initial episode, subsequent episodes can occur, but are usually less painful or even symptom free.
Both oral and genital herpes are particularly easy to spread when you have active lesions (cold sores or genital ulcers). But even with no symptoms, herpes can still be spread to a partner.
And although relatively rare, oral herpes can be transmitted to the genital area, and genital herpes can be transmitted to the mouth through oral sex.
If an expectant mother exhibits a genital herpes infection close to childbirth, there are risks to the baby. A herpes infection can be very serious in a baby, and the younger the infant, the more vulnerable they are. This is also one reason why you should avoid kissing a baby on the mouth.
Changing trends
WHO’s recent figures brought together data from around the world to estimate the prevalence of genital herpes in 2020, compared with previous estimates in 2012 and 2016.
This data shows no significant difference in the prevalence of genital herpes caused by HSV-2 since 2016, but does highlight increases in genital herpes infections caused by HSV-1.
The estimated number of genital HSV-1 infections globally was nearly twice as high in 2020 compared with 2016 (376 million compared with 192 million).
A 2022 study looking at Australia, New Zealand and Canada found more than 60% of genital herpes infections are still caused by HSV-2. But this is declining by about 2% each year while new genital infections that result from HSV-1 are rising.
Genital herpes can be quite painful, presenting as sores and lesions that in severe cases, may take up to a month to fully heal. Christian Moro There’s no simple fix, but safe sex is important
Genital herpes causes a substantial disease burden and economic cost to health-care services.
With such a large proportion of the world’s population infected with HSV-1, evidence this virus is increasingly causing genital herpes is concerning.
There’s no cure for genital herpes, but some medications, such as antivirals, can help reduce the amount of virus present in the system. While this won’t kill it completely, it helps to prevent symptomatic genital herpes recurrences, improve quality of life, and minimise the risk of transmission.
To prevent the spread of genital herpes and other STIs, practise safe sex, particularly if you’re not sure of your partner’s sexual health. You need to use a barrier method such as condoms to protect against STIs (a contraceptive such as the pill won’t work). This includes during oral sex.
As herpes is now so common, testing is not usually included as part of a regular sexual health check-up, except for in specific circumstances such as during pregnancy or severe episodes.
So it’s wise not to let your guard down, even if your partner insists they have received the all-clear from a recent check-up.
If there are herpes lesions present around the genitals, avoid sex entirely. Even condoms are not fully effective at these times, as exposed areas can still transmit the infection.
Practising safe sex can help prevent the spread of herpes. cottonbro studio/Pexels Immune health
If you are infected with HSV-1 or HSV-2 it’s more likely symptoms will appear when you’re stressed, tired or overwhelmed. During these times, our immune system may not be as functional, and dormant viruses such as herpes can start to develop quickly in our bodies.
To reduce the risk of recurrent herpes infections, try to eat healthily, get at least seven hours of sleep each night if possible, and look out for when your body may be telling you to take a step back and relax. This self-care can go a long way towards keeping latent viruses at bay.
While the prevalence has increased significantly in recent years, we have not lost the war on genital herpes just yet. Safe sexual practices, education and awareness can help reduce its spread, and the stigma around it.
If you have personal concerns, you should discuss them with a medical professional.
Christian Moro, Associate Professor of Science & Medicine, Bond University and Charlotte Phelps, Senior Teaching Fellow in Medicine, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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80-Year-Olds Share Their Biggest Regrets
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Notwithstanding the title, some of these people are a little younger than 80, but this adds to the interest a little as we see the different regrets / learned wisdoms at different stages of later life!
If we could turn back the time…
There are dozens of life regrets / wishes / retroactive advices shared in this video; here are some highlights:
- “My regret was I had a dysfunctional family and I wish I would have learned not to take responsibility.”
- “In my 30s, when I started drinking very heavily, I wish I hadn’t done that because it escalated to drug abuse.”
- “When my parents were old ages, I was working very hard… I didn’t have time to take care of them, not even spend the time with them. That’s my biggest regret.”
- “Live life to the fullest because none of us have any assurance on how old we’re going to be when we’re going to die.”
- “If I could do it over, I would have called home more and realized what my brother was going through.”
- “Spent a lot of years being concerned about what other people thought of me.”
- “You got to be careful what you say to your children because it means a lot.”
For the rest, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Managing Your Mortality Without Regrets
- How To Avoid Carer Burnout (Without Dropping Care)
- Managing Sibling Relationships In Adult Life
- Family Estrangment & How To Fix It
Take care!
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Topping Up Testosterone?
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The Testosterone Drop
Testosterone levels decline amongst men over a certain age. Exactly when depends on the individual and also how we measure it, but the age of 45 is a commonly-given waypoint for the start of this decline.
(the actual start is usually more like 20, but it’s a very small decline then, and speeds up a couple of decades later)
This has been called “the male menopause”, or “the andropause”.
Both terms are a little misleading, but for lack of a better term, “andropause” is perhaps not terrible.
Why “the male menopause” is misleading:
To call it “the male menopause” suggests that this is when men’s menstruation stops. Which for cis men at the very least, is simply not a thing they ever had in the first place, to stop (and for trans men it’s complicated, depending on age, hormones, surgeries, etc).
Why “the andropause” is misleading:
It’s not a pause, and unlike the menopause, it’s not even a stop. It’s just a decline. It’s more of an andro-pitter-patter-puttering-petering-out.
Is there a better clinical term?
Objectively, there is “late-onset hypogonadism” but that is unlikely to be taken up for cultural reasons—people stigmatize what they see as a loss of virility.
Terms aside, what are the symptoms?
❝Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age. Diagnosis of late-onset of hypogonadism is based on presence of symptoms suggestive of testosterone deficiency – prominent among them are sexual symptoms like…❞
…and there we’d like to continue the quotation, but if we list the symptoms here, it won’t get past a lot of filters because of the words used. So instead, please feel free to click through:
Source: Andropause: Current concepts
Can it be safely ignored?
If you don’t mind the sexual symptoms, then mostly, yes!
However, there are a few symptoms we can mention here that are not so subjective in their potential for harm:
- Depression
- Loss of muscle mass
- Increased body fat
Depression kills, so this does need to be taken seriously. See also:
The Mental Health First-Aid That You’ll Hopefully Never Need
(the above is a guide to managing depression, in yourself or a loved one)
Loss of muscle mass means being less robust against knocks and falls later in life
Loss of muscle mass also means weaker bones (because the body won’t make bones stronger than it thinks they need to be, so bone will follow muscle in this regard—in either direction)
See also:
- Resistance Is Useful! (Especially As We Get Older)
- Protein vs Sarcopenia
- Fall Special (How to Proof Yourself Against Falls)
Increased body fat means increased risk of diabetes and heart disease, as a general rule of thumb, amongst other problems.
Will testosterone therapy help?
That’s something to discuss with your endocrinologist, but for most men whose testosterone levels are lower than is ideal for them, then yes, taking testosterone to bring them [back] to “normal” levels can make you happier and healthier (though it’s certainly not a cure-all).
See for example:
Testosterone Therapy Improves […] and […] in Hypogonadal Men
(Sorry, we’re not trying to be clickbaity, there are just some words we can’t use without encountering software problems)
Here’s a more comprehensive study that looked at 790 men aged 65 or older, with testosterone levels below a certain level. It looked at the things we can’t mention here, as well as physical function and general vitality:
❝The increase in testosterone levels was associated with significantly increased […] activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased […] desire and […] function.
The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003).
Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy–Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo❞
Source: Effects of Testosterone Treatment in Older Men
We strongly recommend, by the way, when a topic is of interest to you to read the paper itself, because even the extract above contains some subjectivity, for example what is “slightly better”, and what is “no significant benefit”.
That “slightly better mood and lower severity of depressive symptoms”, for example, has a P value of 0.004 in their data, which is an order of magnitude more significant than the usual baseline for significance (P<0.05).
And furthermore, that “no significant benefit with respect to vitality” is only looking at either the primary outcome aggregated goal or the secondary FACIT score whose secondary outcome had a P value of 0.06, which just missed the cut-off for significance, and neglects to mention that all the other secondary outcome metrics for men involved in the vitality trial were very significant (ranging from P=0.04 to P=0.001)
Click here to see the results table for the vitality trial
Will it turn me into a musclebound angry ragey ‘roidmonster?
Were you that kind of person before your testosterone levels declined? If not, then no.
Testosterone therapy seeks only to return your testosterone levels to where they were, and this is done through careful monitoring and adjustment. It’d take a lot more than (responsible) endocrinologist-guided hormonal therapy to turn you into Marvel’s “Wolverine”.
Is testosterone therapy safe?
A question to take to your endocrinologist because everyone’s physiology is different, but a lot of studies do support its general safety for most people who are prescribed it.
As with anything, there are risks to be aware of, though. Perhaps the most critical risk is prostate cancer, and…
❝In a large meta-analysis of 18 prospective studies that included over 3500 men, there was no association between serum androgen levels and the risk of prostate cancer development
For men with untreated prostate cancer on active surveillance, TRT remains controversial. However, several studies have shown that TRT is not associated with progression of prostate cancer as evidenced by either PSA progression or gleason grade upstaging on repeat biopsy.
Men on TRT should have frequent PSA monitoring; any major change in PSA (>1 ng/mL) within the first 3-6 months may reflect the presence of a pre-existing cancer and warrants cessation of therapy❞
Those are some select extracts, but any of this may apply to you or your loved one, we recommend to read in full about this and other risks:
Risks of testosterone replacement therapy in men
See also: Prostate Health: What You Should Know
Beyond that… If you are prone to baldness, then taking testosterone will increase that tendency. If that’s a problem for you, then it’s something to know about. There are other things you can take/use for that in turn, so maybe we’ll do a feature on those one of these days!
For now, take care!
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Reporting on psychedelics research or legislation? Proceed with caution
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More cities and states are introducing bills to decriminalize and regulate access to psychedelic drugs, which could potentially become another option to treat mental health conditions and substance use disorders. But the substances remain illegal under U.S. federal law and scientific evidence about their effectiveness is still far from conclusive.
This month alone, California lawmakers introduced a bill to allow people 21 and older to consume psychedelic mushrooms under medical supervision. In Massachusetts, lawmakers are working on a bill that would legalize psilocybin, the active ingredient of psychedelic mushrooms. And Arizona legislators have also introduced a bill that would make psychedelic mushrooms available as a mental health treatment option.
Last December, Congress passed legislation that included funding for psychedelic clinical trials for active-duty service members. And in January this year, the Department of Veterans Affairs announced that it will begin funding research on MDMA, also known as ecstasy, and psilocybin, to treat veterans with post-traumatic stress disorder and depression. This is the first time since the 1960s that the VA is funding research on such compounds, according to the department.
The rise of proposed and passed legislation in recent years necessitates more journalistic coverage. But it’s important for journalists to go beyond what the bills and lawmakers say and include research studies about psychedelics and note the limitations of those studies.
Major medical organizations, including the American Psychiatric Association, have not yet endorsed psychedelics to treat psychiatric disorders, except in clinical trials, due to inadequate scientific evidence.
The authors of a 2023 study published in the journal Therapeutic Advances in Psychopharmacology, also advise “strong caution” regarding the hype around the potential medical use of psychedelics. “There is not enough robust evidence to draw any firm conclusions about the safety and efficacy of psychedelic therapy,” they write.
Scientists are still trying to better understand how psychedelics work, what’s the best dose for treating different mental health conditions and how to reduce the risk of potential side effects such as intense emotional experiences or increased heart rate and blood pressure, the authors of a February 2024 study published in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry write.
In a 2022 study published in JAMA Psychiatry, Dr. Joshua Siegel and his colleagues at Washington University in St. Louis write that while legislative reform for psychedelic drugs is moving forward rapidly, several issues have not been addressed, including:
- A mechanism for verifying the chemical content of drugs that are obtained from outside the medical establishment.
- Licensure and training criteria for practitioners who wish to provide psychedelic treatment.
- Clinical and billing infrastructure.
- Assessing potential interactions with other drugs.
- How the drugs should be used in populations such as youths, older adults and pregnant people.
“Despite the relative rapidity with which some have embraced psychedelics as legitimate medical treatments, critical questions about the mechanism of action, dose and dose frequency, durability of response to repeated treatments, drug-drug interactions, and the role that psychotherapy plays in therapeutic efficacy remain unanswered,” Siegel and colleagues write.
What are psychedelics?
Psychedelics are among the oldest class of mind-altering substances, used by humans for thousands of years in traditional or religious rituals.
In 2021, 74 million people 12 years and older reported using hallucinogens, according to the National Survey on Drug Use and Health.
The terms “psychedelics” and “hallucinogens” are used interchangeably in public discourse, but scientifically, hallucinogens fall into three groups based on chemical structure and mechanism of action, according to NIH’s National Institute on Drug Abuse:
- Psychedelic drugs, also called “classic psychedelics” or simply “psychedelics,” mainly affect the way the brain processes serotonin, a chemical that carries messages between nerve cells in the brain and the body. These drugs can bring on vivid visions and affect a person’s sense of self, according to NIDA. Drugs in this category include:
- Psilocybin is the active ingredient in psychedelic mushrooms, also known as “magic” mushrooms or shrooms. It’s a Schedule 1 drug in the U.S. under the Controlled Substances Act, which means it has a high potential for abuse and has no accepted medical use. However, some states have decriminalized it, according to NIDA. The drug has also been given the Breakthrough Therapy designation from the FDA, a process to speed up the development and review of drugs, for the treatment of major depressive disorder.
- LSD, or lysergic acid diethylamide, is a synthetic chemical made from a fungus that infects rye. It’s a Schedule 1 drug.
- DMT, or dimethyltryptamine, found in certain plants native to the Amazon rainforest, has been used in religious practices and rituals. The plants are sometimes used to make a tea called ayahuasca. DMT can also be made in the lab as a white powder. DMT is generally smoked or consumed in brews like ayahuasca. It’s a Schedule 1 drug.
- Mescaline, a chemical compound found in a small cactus called peyote, has been used by Indigenous people in northern Mexico and the southwestern U.S. in religious rituals. Mescaline can also be produced in the lab. Mescaline and peyote are Schedule 1 drugs.
- Dissociative drugs affect how the brain processes glutamate, an abundant chemical released by nerve cells in the brain that plays an important role in learning and memory. These drugs can make people feel disconnected from their bodies and surroundings. Drugs in this category include:
- PCP, or phencyclidine, was developed in the 1950s as an injectable anesthetic but was discontinued because patients became agitated and delusional. Today it is an illegal street drug. It’s a Schedule 2 drug, which means it has a high potential for abuse, but lower compared to Schedule 1 drugs.
- Ketamine, a drug developed in the 1960s and used as an anesthetic in the Vietnam War, is approved by the FDA as an anesthetic. It has been shown to play a role in pain management and treatment of depression. It is also illegally used for its hallucinogenic effects. It is a Schedule 3 drug, which means it has a moderate to low potential for physical and psychological dependence. A chemically-similar drug called esketamine is approved by the FDA for the treatment of depression that doesn’t respond to standard treatment.
- Other hallucinogens, which affect different brain functions and can cause psychedelic and potentially dissociative effects, include:
- MDMA, or ecstasy, is a synthetic drug that’s a stimulant and hallucinogen. It is a Schedule 1 drug. It has been given the Breakthrough Therapy designation from the FDA for the treatment of PTSD.
- Salvia is an herb in the mint family that has hallucinogenic effects. It is not a federally controlled drug, but it is controlled in some states, according to the DEA.
- Ibogaine is derived from the root bark of a West African shrub and is a stimulant and hallucinogen. It is a Schedule 1 drug.
Research on psychedelics
There was a wave of studies on psychedelics, particularly LSD, in the 1950s and 1960s, but they came to a halt when the U.S. declared a “War on Drugs” in 1971 and tightened pharmaceutical regulations. There was little research activity until the early 1990s when studies on drugs such as MDMA and DMT began to emerge.
In 2006, researchers at Johns Hopkins University published a seminal double-blind study in which two-thirds of participants — who had never taken psychedelics previously — said their psychedelic sessions were among the most meaningful experiences of their lives.
“These studies, among others, renewed scientific interest in psychedelics and, accordingly, research into their effects has continued to grow since,” Jacob S. Aday and colleagues write in a 2019 study published in Drug Science, Policy and Law.
In their paper, Aday and colleagues argue that 2018 may be remembered as the true turning point in psychedelic research due to “advances within science, increased public interest, and regulatory changes,” such as psilocybin receiving the “breakthrough therapy” status from the FDA.
Today, there are numerous ongoing clinical trials on the therapeutic potential of psychedelics for different conditions, including substance use disorders and mental health conditions such as depression, anxiety and post-traumatic stress disorder.
Given the growing number of studies on psychedelics, the Food and Drug Administration issued a draft guidance in June 2023 for clinical trials with psychedelic drugs, aiming to help researchers design studies that will yield more reliable results for drug development.
The systematic reviews highlighted below show that there’s a lack of robust study designs in many psychedelic clinical trials. Some have small sample sizes. Some include participants who have used psychedelics before, so when they participate in a randomized controlled clinical trial, they know whether they are receiving psychedelic treatment or a placebo. Or, some include participants who may have certain expectations due to positive coverage in the lay media, hence creating bias in the results.
If you’re covering a study about psychedelics…
It’s important for journalists to pay close attention to study design and speak with an expert who is not involved in the study.
In a February 2024 blog post from Harvard Law School’s Petrie-Flom Center, Leiden University professors Eiko I. Fried and Michiel van Elk share several challenges in psychedelic research:
- “Conclusions are dramatically overstated in many studies. This ranges from conclusions in the results sections, abstracts, and even titles of papers not consistent with the reported results.”
- “There is emerging evidence that adverse events resulting from psychedelic substances are both common and underreported.”
- Some studies don’t have control groups, which can create problems for interpreting results, “because treatments like psychedelics need to be compared against a placebo or other treatment to conclude that they work beyond the placebo effect or already existing, readily available treatments.”
- “Participants in psychedelic studies usually know if they are in the treatment or control group, which artificially increases the apparent efficacies of psychedelics in clinical studies.”
- Small sample sizes can affect the statistical power and generalizability of the findings. “Small samples also mean that results are not representative. For example, participants with severe or comorbid mental health problems are commonly excluded from psychedelic studies, and therefore results may look better in these studies than in real-world psychiatric settings.”
- Many studies do not include long-term follow-ups of participants. “Studying how these people are feeling a few days or weeks after they receive treatment is not sufficient to establish that they are indeed cured from depression.”
Fried and van Elk also have a useful checklist for assessing the quality and scientific rigor of psychedelic research in their 2023 study “History Repeating: Guidelines to Address Common Problems in Psychedelic Science,” published in the journal Therapeutic Advances in Psychopharmacology.
Journalists should also remind their audiences that the drugs are still illegal under federal law and can pose a danger to health.
In California, the number of emergency room visits involving the use of hallucinogens increased by 54% between 2016 and 2022, according to a January 2024 study published in Addiction. Meanwhile, the law enforcement seizure of psychedelic mushrooms has risen dramatically, increasing nearly four-fold between 2017 and 2022, according to a February 2024 study published in the journal Drug and Alcohol Dependence.
Below, we have curated and summarized five recent studies, mostly systematic reviews and meta-analyses, which examine various aspects of psychedelic drugs, including legislative reform; long-term effects; efficacy and safety for the treatment of anxiety, depression and PTSD; and participation of older adults in clinical trials. The research summaries are followed by recommended reading.
Research roundup
Psychedelic Drug Legislative Reform and Legalization in the US
Joshua S. Siegel, James E. Daily, Demetrius A. Perry and Ginger E. Nicol. JAMA Psychiatry, December 2022.The study: Most psychedelics are Schedule I drugs federally, but state legislative reforms are changing the prospects of the drugs’ availability for treatment and their illegal status. For a better understanding of the legislative reform landscape around Schedule I psychedelic drugs, researchers collected all bills and ballot initiatives related to psychedelic drugs that were introduced into state legislatures between 2019 and September 2022. They used publicly available sources, including BillTrack50, Ballotpedia and LexisNexis.
The findings: In total, 25 states considered 74 bills, although the bills varied widely in their framework. A majority proposed decriminalization but only a few would require medical oversight and some would not even require training or licensure, the authors write. Ten of those bills became law in seven states — Colorado, Connecticut, Hawaii, New Jersey, Oregon, Texas and Washington. As of August 1, 2022, 32 bills were dead and 32 remained active.
The majority of the bills — 67 of them — referred to psilocybin; 27 included both psilocybin and MDMA; 43 proposed decriminalization of psychedelic drugs.
To predict the future legalization of psychedelics, the authors also created two models based on existing medical and recreational marijuana reform. Using 2020 as the year of the first psychedelic decriminalization in Oregon, their models predict that 26 states will legalize psychedelics between 2033 and 2037.
In the authors’ words: “Despite the relative rapidity with which some have embraced psychedelics as legitimate medical treatments, critical questions about the mechanism of action, dosing and dose frequency, durability of response to repeated treatments, drug-drug interactions, and the role psychotherapy plays in therapeutic efficacy remain unanswered. This last point is critical, as a significant safety concern associated with drugs like psilocybin, MDMA, or LSD is the suggestibility and vulnerability of the patient while under the influence of the drug. Thus, training and clinical oversight is necessary to ensure safety and also therapeutic efficacy for this divergent class of treatments.”
Who Are You After Psychedelics? A Systematic Review and a Meta-Analysis of the Magnitude of Long-Term Effects of Serotonergic Psychedelics on Cognition/Creativity, Emotional Processing and Personality
Ivana Solaja, et al. Neuroscience & Behavioral Reviews, March 2024.The study: Many anecdotal reports and observational studies have reported that psychedelics, even at microdoses, which are roughly one-tenth of a typical recreational dose, may enhance certain aspects of cognition and/or creativity, including coming up with new, useful ideas. Cognition is a “range of intellectual functions and processes involved in our ability to perceive, process, comprehend, store and react to information,” the authors explain. There are established relationships between impaired cognitive functioning and mental health disorders.
Due to limitations such as a lack of rigorous study designs, various populations in the studies and lack of documented dosage, it’s difficult to draw any conclusions about changes that last at least one week as a result of consuming psychedelics.
The authors screened 821 studies and based on the criteria they had set, found 10 to be eligible for the review and meta-analysis. The drugs in the studies include psilocybin, ayahuasca and LSD.
The findings: Overall, there was little evidence that these psychedelics have lasting effects on creativity. Also, there was not sufficient evidence to determine if this group of psychedelics enhances cognition and creativity in healthy populations or improves cognitive deficits in the study populations.
Pooled data from three studies showed lasting improvement in emotional processing — perceiving, expressing and managing emotions.
The studies offered little evidence suggesting lasting effects of psychedelics on personality traits.
In the authors’ words: “Results from this study showed very limited evidence for any lasting beneficial effects across these three psychological constructs. However, preliminary meta-analytic evidence suggested that these drugs may have the potential to cause lasting improvement in emotional recognition time. Future studies investigating these constructs should employ larger sample sizes, better control conditions, standardized and validated measures and longer-term follow-ups.”
The Impact of Psychedelics on Patients with Alcohol Use Disorder: A Systematic Review with Meta-Analysis
Dakota Sicignano, et al. Current Medical Research and Opinion, December 2023.The study: Researchers are exploring the psychedelics’ potential for the treatment of alcohol use disorder, which affected nearly 30 million Americans in 2022. The authors of this study searched PubMed from 1960 to September 2023 for studies on the use of psychedelics to treat alcohol use disorder. Out of 174 English-language studies, they selected six studies that met the criteria for their analysis.
The findings: LSD and psilocybin are promising therapies for alcohol use disorder, the authors report. However, five of the six trials were conducted in the 1960s and 1970s and may not reflect the current treatment views. Also, four of the six studies included patients who had used psychedelics before participating in the study, increasing the risk of bias.
In the authors’ words: “Despite the existence of several clinical trials showing relatively consistent benefits of psychedelic therapy in treating alcohol use disorder, there are important limitations in the dataset that must be appreciated and that preclude a conclusive determination of its value for patient care at this time.”
Older Adults in Psychedelic-Assisted Therapy Trials: A Systematic Review
Lisa Bouchet, et al. Journal of Psychopharmacology, January 2024.The study: People 65 years and older have been underrepresented in clinical trials involving psychedelics, including the use of psilocybin for the treatment of depression and anxiety. About 15% of adults older than 60 suffer from mental health issues, the authors note. They wanted to quantify the prevalence of older adults enrolled in psychedelic clinical trials and explore safety data in this population. They searched for English-language studies in peer-reviewed journals from January 1950 to September 2023. Of 4,376 studies, the authors selected 36. The studies involved psilocybin, MDMA, LSD, ayahuasca, and DPT (dipropyltryptamine), which is a less-studied synthetic hallucinogen.
The findings: Of the 1,400 patients participating in the selected studies, only 19 were 65 and older. Eighteen received psychedelics for distress related to cancer or other life-threatening illnesses. In a trial of MDMA-assisted therapy for PTSD, only one older adult was included. Adverse reactions to the drugs among older patients, including heart and gastrointestinal issues were resolved within two days and didn’t have a long-lasting impact.
In the authors’ words: “Although existing data in older adults is limited, it does provide preliminary evidence for the safety and tolerability of [psychedelic-assisted therapy] in older patients, and as such, should be more rigorously studied in future clinical trials.”
Efficacy and Safety of Four Psychedelic-Assisted Therapies for Adults with Symptoms of Depression, Anxiety, and Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis
Anees Bahji, Isis Lunsky, Gilmar Gutierrez and Gustavo Vazquez. Journal of Psychoactive Drugs, November 2023.The study: LSD, psilocybin, ayahuasca and MDMA have been approved for clinical trials on psychedelic-assisted therapy of mental health conditions in Canada and the U.S. However, major medical associations, including the American Psychiatric Association, have argued that there is insufficient scientific evidence to endorse these drugs for treating mental health disorders. To better understand the current evidence, researchers reviewed 18 blinded, randomized controlled trials, spanning 2008 through 2023. Most studies were conducted in the U.S. or Switzerland.
The findings: The studies overall suggest preliminary evidence that psychedelic drugs are mostly well-tolerated. Psilocybin and MDMA therapies may offer relief from depression and PTSD symptoms for at least a year. Most studies also used therapy and psychological support along with psychedelics.
In the authors’ words: “Despite the promising evidence presented by our study and previous reviews in the field, the evidence base remains limited and underpowered. Long-term efficacy and safety data are lacking,” the authors write. “Future steps should encourage and highlight the need for more robust larger scale randomized controlled trials with longer follow-up periods, and efforts to address regulatory and legal barriers through the collaborations between researchers, healthcare professionals, regulatory bodies, and policymakers.”
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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