Giving a Lift to Depression

There may be a time in the not-too-distant future when Canadian workers treated for depression will, in the words of noted 1960s psychologist Timothy Leary, “turn on, tune in, drop out.” Research from recent years seems to point to psychedelic drugs such as psilocybin — the mind-altering ingredient found in magic mushrooms — as holding promise in treating depression.

Two recent studies from the Imperial College London (ICL) in the United Kingdom found that magic mushrooms could be used to treat depression by helping patients relive happy moments of their lives.

The first study, published in January of 2012 in the Proceedings of the National Academy of Science, used magnetic resonance imaging to chart the brains of 30 healthy volunteers while psilocybin was injected into their blood. The scans showed less activity in the part of the brain that is hyperactive in people with depression. Blood flow to the hypothalamus, which increases during cluster headaches, is also reduced, an ICL statement writes.

The second study, published online in the same month in the British Journal of Psychiatry, found that volunteers who were administered psilocybin experienced enhanced recollections of personal memories than those given a placebo. “Our findings support the idea that psilocybin facilitates access to personal memories and emotions,” Dr. Robin Carhart-Harris, a neuroscientist with the department of medicine at ICL and lead author of both studies, says in the statement. 

While findings suggest psilocybin can improve emotional well-being and reduce depression, Dr. Carhart-Harris says the effects are small and the potential to use psychedelic drugs as a treatment for depression requires further investigation.

HOLDING PROMISE

The studies “suggest there is something going on in mental processes that could be used in the treatment of depression,” says Rick Doblin, executive director of the Santa Cruz, California-based Multidisciplinary Association for Psychedelic Studies (MAPS), a non-profit organization that helped fund the ICL studies.

“Psilocybin is just a tool that opens up a lot of emotional content,” says Doblin, adding that the hallucinogenic agent — in concert with proper psychotherapeutic treatment — has the potential to alleviate depression.

While preliminary research suggests that psychedelic substances, when used in a supportive therapeutic setting, could have more benefits than risks, Doblin cautions this may run counter to the criminal justice system. In Canada, magic mushrooms are illegal to possess, obtain or produce without a prescription or licence and are listed as Schedule III under the Controlled Drugs and Substances Act. Possession of magic mushrooms is a criminal offence punishable by imprisonment for up to three years and a fine of up to $1,000.

For comparison, Schedule I lists some of the most dangerous drugs like heroin and cocaine; Schedule II includes marijuana and other forms of cannabis.

HARD HIT

While the potential of magic mushrooms in treating depression is still being studied, antidepressants currently prescribed to mental health patients have side-effects that interfere with functioning at work. A 2009 report, Antidepressant Skills at Work by the Centre for Applied Research in Mental Health and Addiction (CARMHA) in Vancouver, reported that employees returning to work after a leave of absence due to depression found their medication’s side effects made it more difficult to re-adjust to work.

The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors — the most popular types being Prozac, Zoloft and Paxil — and serotonin-norepinephrine reuptake inhibitors, like Effexor and Cymbalta. These medications have side-effects that can affect job performance, including headaches, insomnia, dizziness, fatigue, sedation and drowsiness, the report adds.

“Antidepressants are extremely powerful medications and they profoundly alter brain chemistry,” warns Glynis Sherwood, a Vancouver-based counselling therapist who also works with clients under the Employee Assistance Program (EAP). “In the long term, some antidepressants may cause some of the same brain-disabling symptoms as anti-psychotic medications,” she points out.

While antidepressants can help those with mental afflictions get over the hump of their crises, the medication seems to lose its effectiveness after a period of time, she notes.

People with depression may lack energy and feel exhausted by everyday activities, which could pose a problem for those working long hours or alternating shifts. “In jobs that are safety-sensitive (such as an airline pilot or a health care worker), lack of alertness due to depression can be very risky,” the CARMHA report notes.

Assessment is the first thing that needs to be done when dealing with depression, Sherwood advises. This would involve looking at whether or not the mental health issue stems from bullying or harassment in the workplace, if it is a recent development or a longstanding one (which could suggest historical abuse or trauma), and if substance abuse — common in those with depression — is part of the picture.

She also stresses the importance of drawing on various therapeutic approaches, citing counselling, relaxation training and lifestyle changes such as proper diet, exercise and restful sleep as examples. “If people just take pills, it’s really hard for them to believe in themselves and to think they’ll be able to deal with situations because they’re relying on an external source to make them feel better,” Sherwood says.

When prescribed properly, however, “most medications are extremely effective” for the treatment of depression, says Paula Allen, vice-president of health solutions at Morneau Shepell, a human resources firm in Toronto. “It’s really symptom matching that is the most important.”

BIG PICTURE

Studies point to a clear need for an enhanced treatment for major depressive disorder, which afflicts 11 per cent of Canadians at some time in their lives, and approximately four per cent during any given year, notes information from the Canadian Network for Mood and Anxiety Treatments (CANMAT), a network of health professionals across Canada. 

The Canadian Mental Health Commission in Ottawa estimates that 49 per cent of all Canadians who battle with depression never seek help, and 70 per cent of all depressed Canadians are in the workplace, notes information from Peel Public Health in Brampton, Ontario.

A 2008 report by Homewood Human Solutions, a Toronto-based provider of workplace wellness programs, found that about two-thirds of employees with mental health conditions do not get any treatment, but of the third who do, it is most often from primary care doctors who are not trained to treat mental health concerns. “The sad truth is simply that most businesses do not provide a level of attention and investment in mental health conditions that corresponds to their level of prevalence and cost burden,” the report states.

Mental health conditions that are inadequately treated result in higher direct job-related and disability claim costs, as well as indirect costs from employee absence and lower productivity. Scott Patten, a professor in the Departments of Community Health Sciences and Psychiatry at the University of Calgary,
found that depression profoundly affects the ability to function at work, both through absenteeism and presenteeism. Depressed employees are also more likely to become unemployed or miss time at work than those who are physically ill, notes Patten’s research for CANMAT’s guidelines for managing depression, published in 2009.

“Mental health issues, with depression being the most significant one, [are] the major cause of productivity issues in the workplace,” says Allen, pointing out that mental health problems among employees are often not caught in time. “People go on short-term disability and, very often, don’t get the right kind of care while they are off work.” 

Statistics from Health Canada show that about 40 per cent of disability claims and sick leave are due to mental health issues, with depression and anxiety being the most prevalent.

While many employers offer general mental health benefits through EAPs, “employer-sponsored programs that specifically target depression remain uncommon,” states the report, Systematic review of intervention practices for depression in the workplace, published in February of 2012 by the Institute for Work & Health in Toronto.

“Despite the clear necessity for these programs, there are barriers and information gaps that may prevent employers from making further investments to reduce the impact of depression in the workplace,” the report adds.

OFF BALANCE

Depression in the workplace is just not being treated seriously enough, charges Jim Wright, a national representative at United Food and Commercial Workers Canada in Toronto. “The fact of the matter is that employers don’t recognize it as something that’s important to them,” he says.  

Rather than channelling mental health patients into counselling and community support programs to help integrate them back into the workplace, Wright contends that most doctors look at simply medicating what may not be a chemical imbalance. “Prozac may not be what I need. I may simply need to sit down with someone and have a chat as to what’s going on in my life,” Wright says. 

“A lot of it is based on incidents that happen in people’s lives,” Doblin suggests.

Researchers from the ICL will start a pilot study by the end of the year to determine whether or not psilocybin can alleviate symptoms of depression, Doblin reveals. Meanwhile, MAPS will be funding a Health Canada-approved study that involves treating veterans and police officers suffering from post-traumatic stress disorder with MDMA (3,4-methylenedioxy-N-methylamphetamine), widely known as ecstasy. 

“The attitudes are already changing in a really profound way among psychiatrists, psychotherapists and other health care providers that there may indeed be some beneficial uses for psychedelics,” Doblin says. “The idea that these are drugs that only have risks and there’s no context that the use can be beneficial are slowly, but pretty certainly, diminishing.” 

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Sidebar:

Fungal Power

Psilocybin occurs naturally in certain species of mushrooms. Magic mushrooms — typically sold as dried whole mushrooms or as a brown powdered material — are most commonly chewed, but can also be made into a form of tea.

Depending on how they are consumed, effects usually last three to six hours. Other influencing factors include a person’s age, weight, mood, the type and volume of food consumed and existing medical or psychiatric conditions. Short-term effects associated with use of psilocybin could make it difficult to stay focused and alert. They include:

• anxiety, hallucinations and loss of touch with reality;
• light-headedness;
• dilated pupils, causing blurred vision;
• nausea and vomiting;
• numbness, particularly in the face;
• sweating and increased body temperature, followed by chills and shivering;
• muscle weakness and twitching; and
• increased blood pressure and heart rate.

Although long-term effects have not been studied, overdose from magic mushrooms alone has not been directly associated with death. There is also no evidence to indicate that addiction develops with continued use.

Source: Health Canada