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  • Grace Blest-Hopley

Do psychedelics offer a chance for healing after head trauma?

Following the near eradication of psychedelic research in the 1970s a second age has dawned, bringing undeniable evidence of their therapeutic effect. Researchers have now used these substances in scientific trials, from cell lines to clinical work with patients, uncovering huge potential. Trials in human populations show psychedelics to be effective in the treatment of some of the world’s most prevalent (and difficult to treat) conditions such as depression, anxiety and substance use disorder; and now even post-traumatic stress disorder (PTSD). But what other conditions could these drugs help to treat? Once we begin to fully explore their mechanisms of action in the body, what other disorders might benefit from the re-emergence of these medicines?

One potential candidate is head trauma. I interviewed one of the most vocal advocates of psychedelics being used in the treatment of head trauma – the former professional ice hockey player Daniel Carcillo – during a recent panel with PsyTech. His moving story is one of a retired athlete who had achieved so much during both his career and personal life, who found himself in total despair and contemplating suicide. Not only was he suffering physically as a result of the numerous concussions he sustained during his career, but most poignantly he was suffering emotionally. Over 18 months Daniel completed several sessions using psychedelics, after which he found himself not only ‘back to normal’ in terms of his physical and mental health, but with a new purpose in life. One of the most remarkable parts of this story and one that has led to questions about the role psychedelics played in his recovery, is the return to an acceptable ‘normal’ in both his brain wave functioning and blood markers. Daniel is not the only sports person to have spoken out about their healing journey using these substances, following periods of struggle after a career that exposed them to head injuries. Could all these stories be coincidence or placebo, or are these high-profile cases starting to shine a light on the healing powers of psychedelics for head trauma?

It’s not a secret the crisis numerous sporting bodies face in light of more and more athletes coming forward with life changing disabilities, as a result of head traumas sustained during their careers. Military veterans are also at an occupationally high risk of head trauma. This doesn’t always come in the form of physical impacts to the head, although these are common given the highly physical aspects of the job, particularly in combat. Exposure to repeated explosive forces (e.g. artillery, mortar rounds, fired rockets, door breaches, IEDs, etc.) exert a physical impact on the brain, as pressure waves cause traumas to air and fluid filled tissues of the body; this is alongside inertial force from rapid acceleration and deceleration of the body. Due to the commonality and frequency that military personnel are exposed to such forces, many may not even be aware they are being affected by these sorts of damaging concussive forces. Both military and sports institutions are waking up to the need for not just better prevention methods but also treatments for their personnel. Finding a way to combat the symptoms and rehabilitate people after head trauma would clearly be of huge value, not only to veterans and athletes, but also the wider society, given that traumatic head injuries are so commonplace and a global health concern.

Traumatic head injuries are brought about when an external force affects the brain, sometimes leading to periods of unconsciousness, memory loss and confusion. Symptoms however can be long lived, particularly when someone has been involved in multiple incidences of head trauma. These symptoms can interfere with someone’s everyday life including problems with memory, cognition, sleep, dizziness, coordination and headaches. Further to this, we now understand that head trauma symptoms can also be psychological, such as depression, anxiety, PTSD, irritability, loss of pleasure and chronic pain. Possibly most devastatingly is the links of head trauma to the development of neurodegenerative disorders such as dementia, Parkinson’s Disease and chronic traumatic encephalopathy.

The prevalence of PTSD is well documented in the veteran community, along with it’s devastating effects both personally and societally. This is only made worse by the limited effective medication and treatments available and the low level of responsiveness to these particularly in the veteran community. PTSD is regarded as a psychological phenomenon in terms of its biology and development, and perhaps it’s association with head injuries may shed light on its development in some instances. Veterans who have returned from recent conflicts have a high rate of co-morbidity between head injuries, post-concussive symptoms and the development of PTSD. Perhaps this is due to areas that are commonly affected by head traumas, including areas such as the hippocampus and amygdala – critical for memory consolidation, emotion and fear conditioning – which are areas also affected in PTSD.

The biology behind the damage that can come from head traumas and concussions is complex and quite often obviously incident specific. The primary effects of trauma itself can cause brain cells to become strained or deformed causing chemicals to come out of the cells, starting a series of events and reactions that ultimately can result in death of the cell, if not just the connection where the ‘leakage’ occurs. This process takes place in the days to weeks after the event, however the neuro-chemical deficits brought about by its happening may alter that part of the brain's functioning beyond this time frame. Inflammation is a common effect of head trauma. This is an immediate reaction that in some cases becomes chronic. The prolonged inflammatory state can then lead to increased and maintained activation of immune and regulatory cells (such as astrocytes and microglia) in the brain that will eventually lead to degradation of brain cells that can continue for years after the initial injury. Although the initial inflammation serves to manage the damage caused by the head trauma, excessive and prolonged inflammation can actually exacerbate the damage, hinder the repair and reduce the recovery of brain function. Coupled with the primary effects of head trauma, the inflammatory state leads to death of connections and potential brain cells, but also to secondary changes that actually reduce the production of new ones. These effects can change the expression of genes that make chemicals whose roles promote cell growth and the development of new connections - fundamental in the way our brains think, remember and adapt. This may very well link head traumas to the development of the commonly reported memory and cognitive difficulties, as well as psychological disorders such as depression, but also more complex trauma related syndromes. A reduction in the brain's plasticity - from reduced growth and connection making following head trauma - is also seen in the development of some psychological disorders, which appear to be related to rigidity in the brain.

There is now emerging evidence that psychedelics have some anti-inflammatory effects as well as immune modulating effects, though the way that they may exert these properties on the brain is still not fully understood. One way might involve the serotonin receptors, via which psychedelics most famously have their effects, as some of these receptors have a role in inflammation and immune regulation. Other receptors that psychedelics have been shown to interact with may also be involved, such as Sig-1; who’s eventual downstream action can alter how inflammation genes are expressed. The full spectrum of receptors in the brain that psychedelics can act upon and the effects they might having on other types of cells in the brain - like those that are involved in regulating the brains environment (such as astrocytes and microglia) - are areas science is just beginning to discover. The most obvious benefit from what we currently understand about psychedelics and how they might help following head trauma, is their unlocking and promotion of the abilities to make new connections in the brain. The chain reaction set off by psychedelics action in the brain, lead to the production of chemicals that support neural connections, with potentially lasting effects. This chain reaction in places increases expression of genes for chemicals such as BDNF (brain-derived neurotropic factor), that in turn promotes neuron growth and therefore increased plasticity of the brain. BDNF is a fundamental factor for the repair, maintenance and survival of neurons. Some initial studies conducted in labs have even seen psychedelics promoting growth of whole new brain cells. During the period where the psychedelics are active within the brain, under their acute influence, it appears brain functioning can break through existing and often limiting networks of activation to allow ‘new ways of thinking’ - limiting networks are often a result of rigidity of the brain, found in some psychological disorders. Parts of the brain that don’t usually ‘talk’, appear to activate and make connections that disrupt the stagnancy of previous restricted patterns of activation.

There is a further consideration for the advantage of psychedelic use for particularly the rehabilitation and reintegration of veterans and sport personnel. Post service, be that in the military or as an athlete, where much of one’s life has been attributed to the pursuit of success within their career, retirement can bring about a loss of direction or purpose. Through the experience of taking psychedelics, due to the enhanced functional connections in the brain, comes an opportunity to alter the ‘brain map’. A map that holds the narrative of one’s self, life and purpose. This opportunity for introspection has been found to be enormously beneficial for helping people to improve their openness, personal understanding and ultimately perceived quality of life.

The anecdotal evidence is certainly compelling and the rationale for the science, although not yet fully understood, makes sense for the idea of psychedelics being used for treatment following head traumas. The need for further study and understanding is clear to see. Although the pioneers leading the charge on today’s psychedelic research have managed to breach the regulatory walls, legislatory challenges still lie ahead. What we need now are observational studies and clinical trials in those that have had head traumas, and preclinical studies using both animals and cells that would be able to further untangle the exacting mechanisms by which these medicines are working. A trial using a psychedelic, psilocybin, in combination with a cannabinoid CBD has been started, initially with animals and then humans at the University of Miami. This will be one of the first studies of its kind to investigate psychedelics for head trauma. However, the combination of the drugs, depending on the study design, may make untangling their individual effects difficult; particularly as CBD is known to have anti-inflammatory effects, although the receptors via which it has effects similar to psychedelics are not fully understood. The result of this study may provide us with a suitable drug for treatment of head trauma, although a patent on such a drug could hinder studies elsewhere, gatekeeping discovery of the science behind psychedelics use for head trauma. The Heroic Hearts Project and Heroic Hearts UK are set to offer psychedelic retreats to veterans who have suffered head traumas. An observational study conducted by Imperial College London alongside these retreats may help to further evidence their use for this purpose and form the bases of evidence for more structured studies in the future.

Return to the study of psychedelics may initially seem concerning to a public who have been provided with an anti-all drug narrative for several decades. However, the safety and tolerability of psychedelics has now been proven in numerous observational and clinical studies. They bear an extremely low toxicity level and when used in a safe and responsible setting have very few, if any, adverse effects. When one considers this in comparison to the outcomes of some following head trauma, in many cases masked as mental health problems that in numerous cases have led to people taking their own lives, can we really deny the potential for these drugs to be used for medicinal good? The onward march of psychedelic research will undoubtedly uncover the usefulness of these substances for a variety of conditions. From what we currently know and have seen it seems a fair assumption that they could play a valuable role in the treatment of head trauma. That would relieve suffering and in some cases save lives. Hopefully we will now start to see an increase in studies to improve the depth and breadth of evidence to support and better understand the use of psychedelics for the treatment of head trauma.

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