Urgent Need for Research Into Psychedelic Tx for Older Adults

Older age is associated with many health conditions that could potentially benefit from psychedelic-assisted therapy, yet very few older adults have been included in clinical trials of psychedelics, new research shows.

“Geriatric psychiatrists and others caring for older adults are interested in how much is known about psychedelic use in older adults,” study investigator C. Bree Johnston, MD, MPH, University of Arizona College of Medicine – Tucson, told Medscape Medical News.

“A major concern is how safe psychedelic assisted therapy is for patients with heart disease, hypertension, neurological disorders, and multi-morbidity,” Johnston said.

The study is published online in The American Journal of Geriatric Psychiatry on September 6.

‘Groundswell’ of Research

The past few years have brought a “groundswell” of interest and promising research into the potential therapeutic benefit of psychedelic-assisted therapy for a variety of conditions affecting adults, the researchers note.

They include psilocybin-assisted therapy for the distress associated with a terminal diagnosis, depression, and addiction, and MDMA-assisted therapy for posttraumatic stress disorder (PTSD).

However, in most studies, psychedelic therapy has been in relatively young healthy adults, testing the question of how generalizable the study results are for the patients that most geropsychiatrists will be treating, the investigators note.

They reviewed “the most important” research studies on psilocybin- and MDMA-assisted therapies published over the past two decades that are likely to be relevant for geriatric psychiatrists and other professionals caring for older adults.

The researchers point out that psychedelics and related compounds have shown efficacy for the treatment of a number of conditions that are common among older adults, including mood disorders, distress associated with a serious medical illness, PTSD, substance use problems, and prolonged concern.

Psychedelics also have properties that may provide for cognitive impairment and dementia and promote personal growth among healthy older adults.

Research has shown that psychedelics can be safely administered to healthy adults in controlled conditions.

However, both psilocybin and MDMA can increase blood pressure and heart rate, which could be a concern if used in older adults with cardiovascular disease, the investigators note.

“Healthy older adults are likely to face similar risks when undergoing psychedelic-assisted therapy as healthy younger adults,” said Johnston.

“In carefully selected adults, those risks appear to be minor when psychedelics are administered in controlled conditions under the guidance of a skilled therapist,” he added.

Given the potential of psychedelic compounds to benefit older adults, the authors call for more research to establish the safety and efficacy among older adults, particularly those with multiple comorbidities.

Pressing Knowledge Gaps

The exclusion of older adults from clinical trials of novel treatments is “one of contemporary psychiatry’s more pressing problems — one that extends beyond psychedelics,” Ipsit V. Vahia, MD, aassociate chief of the Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts , who wasn’t involved in the review, told Medscape Medical News.

“Currently, there is little evidence that clinicians can lean on while considering the use of psychedelics in older adults,” Vahia said.

This paper highlights “the most pressing gaps in the evidence that bear addressing in order to develop more substantial best practices around the use of these drugs,” he added.

For example, little is known about appropriate dosing, pharmacokinetics, and pharmacodynamics of psychedelics in older adults, Vahia said.

“Their risks, severe cardiovascular risks, are barely studied, and almost nothing is known about how these drugs may impact those in their 80s or older, or those with serious medical comorbidities who use multiple medications,” Vahia told Medscape Medical News.

“The majority of the existing literature has excluded older adults, and the extremely limited evidence that does exist has been collected in relatively healthy, and relatively young (aged below 75) persons,” he noted.

“Before considering whether psychedelics as a class can be considered viable treatment options for a broader group of older adults, more research is needed, particularly to establish safety,” Vahia said.

This research had no specific funding. Johnston and Vahia have no relevant conflicts of interest.

Am J Geriatr Psychiatry. Published online September 6, 2022. Abstract

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