Psychedelics stand at a pivotal crossroad in mental health, offering the prospect of novel therapeutic avenues to address multiple mental conditions, from treatment-resistant depression to post-traumatic stress disorder (PTSD). However, their mind-altering properties present unique ethical and clinical challenges. In a newly published article in Nature Medicine, leading psychiatrists, psychologists and psychotherapists highlight the importance of protecting patients during these vulnerable states of altered consciousness and the imperative for regulatory frameworks and collaborative efforts to fully realise the potential benefits of this emerging treatment paradigm.

The exploration of alternative therapeutics for hard-to-treat mental health disorders has brought into focus an array of psychedelics such as psilocybin, present in ‘magic mushrooms’, and LSD, substances once associated more with counterculture than clinical practice. Alongside ‘atypical’ psychedelics like ketamine and MDMA, these substances are increasingly being recognised for their potential therapeutic attributes. For example, synthetic psilocybin has shown promising results in alleviating symptoms of depression and anxiety associated with cancer diagnosis, while its efficacy is being investigated in relation to conditions such as obsessive-compulsive disorder, eating disorders, and substance use disorders.

Moreover, while the subjective experiences they elicit may differ, both typical and atypical psychedelics are generally deemed safe with limited potential for abuse. However, a seamless transition from clinical trials to regular clinical practice is by no means guaranteed. As Albino Oliveira-Maia, senior author of the article and head of the Champalimaud Foundation’s Neuropsychiatry Unit, notes, “up until now, psychedelic therapies have largely been confined to the realm of research and clinical studies. But this looks set to change. We’re already witnessing off-label use of ketamine, once solely viewed as an anaesthetic, in treating depression and substance use disorders, despite the lack of clear guidelines, formal approval from regulatory agencies, and recommendations regarding psychological support”.

Unlike most drug treatments, psychedelics are typically coupled with psychotherapy to safeguard patients and potentially enhance clinical effectiveness through shaping the drug-induced subjective experiences. The authors emphasise the necessity of assessing the clinical effectiveness of the accompanying therapy. “If psychotherapy during the psychedelic experience offers substantial additional benefits to the patient, defining and standardising optimal therapeutic procedures for these dosing sessions becomes essential”, says Oliveira-Maia. “Our goal is also to ensure that the promise of psychedelics does not come at the expense of patient safety”. Psychedelics can provoke heightened suggestibility or feelings of intimacy, which may increase vulnerability to potential abuse and boundary transgressions in the therapist-patient relationship.

An alleged example of such a transgression occurred in a Canadian clinical trial of MDMA-assisted therapy for PTSD, where a participant and her unlicensed therapist were involved in an out-of-court settlement for a sexual assault claim. Such incidents underscore the necessity for certified and professionally trained practitioners, regulatory oversight, and enhanced informed consent procedures to address possible use of touch and patient susceptibility during altered states of mind.

“This will demand a collective effort”, elucidates co-author Ana Matos Pires, Director of the Mental Health Department at Unidade Local de Saúde do Baixo Alentejo and Member of the Board of Psychiatrists at the Portuguese Medical Association. “Not only will it involve the physicians who prescribe the treatment and the psychologists who administer it, but also a range of other stakeholders at national and international levels, from regulatory bodies like the US Food and Drug Administration and European Medicines Agency, to policy makers, ethics boards, pharmacists, nurses, and of course, the patients themselves”.

In Portugal, researchers working with psychedelics are already engaging with professional societies of psychiatrists and clinical psychologists, as well as ethical authorities, to preemptively address the regulatory challenges that may surface if these psychedelic treatments become mainstream. “We see our proactive approach serving as a blueprint for other countries preparing for the potential incorporation of psychedelic treatments into clinical practice”, asserts Matos Pires. “Health literacy is also critical in this area. It’s crucial that we clearly inform the public about this kind of treatment. Psychedelic therapies are not a panacea but another tool with which to treat mental illness”.

Many aspects remain to be clarified, from determining appropriate dosages and antipsychotics to counter adverse effects, to identifying the ideal settings for treatment, whether within traditional hospital environments or alternative therapeutic spaces. Time, though, is of the essence. Recently, Australia declared its intent to authorise the therapeutic use of MDMA and psilocybin starting July 2023, while the FDA could approve the use of MDMA for treating PTSD as early as 2024.

“We agree on the potential benefits of psychedelics”, says co-author Luís Madeira, President-elect of the Portuguese Society of Psychiatry and Mental Health, and Counsellor  of the National Council of Ethics for the Life Sciences. “Nevertheless, it’s vital to acknowledge the associated challenges and avoid rushing the process. Given that trials typically pair psychedelics with therapy, further research will be needed to better understand the individual effects of both the drug and the therapy. It’s plausible that one may prove more efficacious than the other”.

One notable challenge Madeira brings up is the difficulty of conducting unbiased double-blind studies, as the distinct psychoactive effects make it obvious to both participant and researcher who has received the treatment or placebo. Additionally, the question of accessibility in the public health system arises, given that each psychedelic experience can last 8 hours and usually involves two trained therapists. “A potential solution”, explains Madeira, “might be group therapy, allowing therapists to treat multiple patients simultaneously, thereby reducing costs and making the treatment more feasible within public health systems”.

The article’s first author Carolina Seybert, Clinical Psychologist at the Champalimaud Clinical Centre, stresses the need for an agile process. “These protocols need to be flexible and dynamic as our understanding of these therapies evolves. In a rapidly changing field like this, in which our knowledge base is constantly updating, it’s key that our guidelines and regulations are not just robust, but also adaptable. We need a uniform framework in place that can be modified as new information comes in. If we leave this process to the self-regulation of individuals, the patient’s experience may vary substantially from one case to the next”. In a sense, our exploration of psychedelics in mental health mirrors the very nature of the treatment itself, a venture into uncharted territory and new possibilities. The authors’ article provides a timely compass and a lucid appreciation of the ethical and regulatory realities ahead.

In recent years, the way people respond to light has been something of a hot topic. From the growing numbers of people dealing with Seasonal Affective Disorder (SAD) to the rise of blue light glasses, we’re learning more and more about how lighting can affect our moods, life patterns and behaviours.

Often, people don’t realise the impact that lighting can have upon their sleep and wellbeing. The simplest of changes could help you enjoy a new lease of life. Here, the lighting and smart home system experts at Wandsworth Electrical take a look at how you can use lighting in your home to feel better, sleep deeper and unwind in style.

Key findings

• Seasonal Affective Disorder (SAD) usually occurs during winter, when days are darker and there’s less light. Light therapy, using a lightbox, can help combat this.
• Blue light limits the amount of melatonin your body produces, making it more difficult for you to sleep at night.
• Certain colours of light can affect your mood in different ways – yellow can relieve feelings of irritation and green can reduce feelings of pleasure.
• Studies suggest that lighting can even affect your appetite, the speed at which you eat, and your overall decision-making.

Lighting and mental health

Your home’s lighting can be used to combat Seasonal Affective Disorder (SAD). Sometimes known as winter depression, SAD predominantly occurs during the winter months, since the bad weather and short daylight hours are thought to negatively affect your mood.

According to the NHS website, some people who suffer from SAD find light therapy helpful. This involves sitting in front of a specialised light box for 30-60 minutes a day. The lightbox simulates the sunlight that’s missing during the winter months, encouraging your brain to produce serotonin.

Sweet dreams

If your body is exposed to bright light before bed, it can negatively affect your sleep. Your circadian rhythm (a.k.a. your body clock) responds primarily to lighting. Your body responds to light as a sign that it needs to be awake, and darkness as a signal to fall asleep. This doesn’t just mean the sun, however. Sitting in a brightly lit room just before going to bed will make it harder for you to go sleep.

The backlight on your phone screen and other devices can also prevent you from sleeping and is one of the main reasons most smartphones have a night mode. Blue light, which is present in white light, reduces your body’s ability to produce melatonin, thereby making it more difficult for you to get to sleep.

Colour Me Excited

The colour of your lighting can also have a huge impact on your mental health – and your mood. Studies show that certain lighting colours can affect your mood in different ways; yellow light can help relieve feelings of irritation, whilst green light can reduce feelings of pleasure and negatively impact your mood.

Warm colours like yellow and red can trick your brain, triggering some of the same responses as if you were actually sat in a warm room. Meanwhile, colder colours like blues and greens can have the opposite effect, and can make you feel colder. Warming light can make all the difference in winter!

Feeling hungry?

Research in the International Journal of Environmental Research and Public Health showed that lighting is not only important for visual performance and safety, but also plays a vital role in regulating human physiological functions.

In fact, lighting can have an effect on everything, from your appetite to the speed that you eat at Research shows that dining in bright interiors will make you eat faster, whilst dim lighting will make you eat slower. Even your perception of flavour can be altered by the lighting you choose in your home.

Clearly, lighting has a noticeable effect on people’s moods. But how can you implement these changes at home?

Dimmer switches

Installing dimmer switches in your home gives you more flexibility to tailor your lighting to your mood – it’s called mood lighting for a reason! Dimmer lighting allows your eyes to relax, and can help your entire body feel more comfortable. Some studies even suggest dimmer lighting calms our body down, improving our decision-making skills.

Daylight harvesting

Daylight harvesting, also known as constant light levels, can be used to help offset some of the effects of SAD. Daylight harvesting uses a Passive Infrared (PIR) sensor to detect the level of light you’ve set and maintain it constantly all day, adjusting in line with how much natural light comes into the room.

If you’re working from home, you can set your light levels to a specific brightness at the start of the day. The PIR sensor will then take over, dimming your light up or down depending on the time of day. Eventually, you’ll end up with 100% artificial light inside and darkness outside. This way, you can maintain the perfect light level, whilst cutting your energy costs.

Timing your lights

It’s easy to lose track of time, particularly if you’re having a busy day! If you’re working late or even just unwinding at home, you might forget to dim the lights to prep your body for bed. Try having your lighting on a timer to make sure you don’t strain your eyes – if you’ve got a smart home, you can set your lighting to change at certain times to ease you into the morning, or wind down at night.

Switch the big light off

If you’re looking to go for some softer lighting, investing in some smaller, more restrained lighting could be the way to go. Freestanding lights, table lamps or fairy lights are a great way to reduce brightness in your home. Plus, LED bulbs are much better for the planet than traditional filament bulbs, so you can cut down on your electricity bill, too.

Colour carefully

Customising the colour of your lighting is another great way to ensure that your body and mind benefit from your lighting choices. Whether you’re opting for a smart-controlled main light bulb or remote LEDs in your ambient lighting, you can tailor your light to your mood and the time of day, to ensure you’re not getting too much blue light and can properly relax.

Robert Aiken, Technical Director at Wandsworth Electrical, comments: “In many ways, your lighting choices are just as important as your interior design, and the two should go hand-in-hand to maximise the potential of your space. However, it’s not just aesthetics that make lighting a vital consideration – people should understand the consequences of being exposed to bright light or coloured light, and how these can affect their body.”

New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London has used an assessment of gene expression involved in the immune response to show that there could be more patients with MDD with activated immune systems than research has previously estimated.   

By identifying the molecular mechanisms involved in this association, the research could pave the way to better identify those patients with an immune component to their depression which would potentially help to provide more personalised approaches to treatment and management of MDD.

The research, published in Translational Psychiatry and funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC) and a Wellcome Trust strategy award, builds on previous findings that there is an activated immune response in many people with MDD.

However, most of the research in this area has focussed on the levels of inflammation related proteins like C-reactive protein (CRP). Studies using CRP have found that about 21 to 27 % of people with depression have an activated immune response¹ but CRP levels do not capture the complete picture of the immune response.  This new study set out to observe broader immune related characteristics that are not captured by CRP levels.

168 participants were sourced from the Biomarkers in Depression Study (BIODEP). 128 of them had a confirmed diagnosis of MDD and they were then divided into three subgroups according to their levels of CRP in the blood.

Researchers analysed the expression of 16 genes whose activation is involved in the immune response. Gene expression is the initial stage of the process by which the information present in our genes influences our features and behaviour. The initial analysis found increased expression of immune-related genes in people with MDD compared to the those without a diagnosis of depression. When comparing MDD patients who did and didn’t have elevated levels of CRP in their blood, there were no differences in the expression of these 16 genes, suggesting this pattern of expression was independent of CRP levels and potentially underlying a different mechanism.

Importantly, researchers then conducted a secondary analysis on all those participants (both with and without a diagnosis of MDD) who had CRP values of less than 1, meaning that they are not considered to have any inflammation. The researchers found that participants with MDD and low levels of CRP still had significantly higher expression of immune genes compared to those without a depression diagnosis.

Professor Carmine Pariante, Professor of Biological Psychiatry at King’s IoPPN and the study’s senior author said, “Previous research into this field has had a significant focus on C-reactive protein (CRP) levels within people with MDD which is a known marker for inflammation but just part of the immune response. Our study has successfully broadened this focus and shown that there is an immune response in the genes of those with MDD that is independent of CRP levels and, crucially, even in those where inflammation is not captured by measuring CRP. This means that increased immune activation is present in many more depressed patients than originally thought.”

“These important findings will allow us to identify the molecular pathways involved in depression and also help to more accurately identify those who have different types of immune responses which could pave the way for more personalised approaches to treatment.”

Dr Luca Sforzini, the study’s first author from King’s IoPPN said, “This evidence contributes to strengthen our knowledge on immune-related depression. Notably, people with depression and immune alterations are less likely to respond to standard antidepressant medications and may benefit from specific interventions targeting the immune system. I am hopeful these findings will aid current and future research in better characterizing individuals with depression based on their immunobiological profiles, offering more effective clinical strategies to a large number of people who are not benefitting from current antidepressants.”

The evidence of an immune related predisposition in people with depression irrespective of their levels of inflammation as routinely measured can extend our concept of immune related depression.

15 May marks the start of Mental Health Awareness Week. With the country facing a mental health crisis accelerated by rising costs-of-living, it’s vital to understand the difficulties your mates could be facing – and how to deal with them.

While women are more likely to experience mental health conditions, the consequences can be deadlier for men – suicide is the biggest cause of death for men under 45. And, black men are much more likely to be diagnosed with mental health problems. So what can we do?

Supporting your mates’ mental health can be as easy as keeping an eye on them; supporting your own mental health can be a bit harder, but opening your mouth to chat about your problems will help take that weight off. Here, men’s streetwear brand King Apparel discusses what can be done to support men’s mental health in 2023.

Key findings:

• People from poorer backgrounds are 2x more likely to suffer from depression as a result of the cost-of-living crisis.
• Data from Mind shows that black men in the UK are far more likely to be diagnosed with mental health problems, and are also far more likely to be sectioned under the Mental Health Act.
• Suicide is the biggest killer of men under 45, and socio-economic status plays a role too – poorer men are more likely to die by suicide.
• The pressure to be traditionally “masculine”, feelings of embarrassment and the stigma of men experiencing mental health issues are the main factors stopping men seeking help.
• Confiding in loved ones, whether it be friends, family or partners, can help men to feel more comfortable opening up and seeking help.
• If men feel uncomfortable speaking to their GP, they can self-refer to mental health services anonymously.
• Many NHS services can be delivered digitally and remotely, reducing the pressure of speaking to someone face-to-face and verbally.

Speaking up, speaking out

One of the contributors to the state of men’s mental health is that we’re less likely to seek help than our female counterparts. The pressure of being masculine encourages men to keep a “stiff upper lip”, even though it’s proven that this can make these problems worse. 29% of men who haven’t sought help for their mental health feel “too embarrassed”; a further 20% cited the “negative stigma” around it.

Such pressures are exacerbated amongst Britain’s working class – people from poorer socio-economic backgrounds are much more likely to experience the risk factors for poor mental health. Young black men are often most exposed to these factors, which can include poor housing, living in unsafe neighbourhoods, and a lack of access to employment and education opportunities.

Frank, open representations of real-life mental health issues amongst black men are beginning to help cultivate a more positive culture, but there is still much more to be done. Famous faces from the spectrum of music, TV, sport and film are beginning to speak out about mental health – Tyrone Mings spoke of struggling with his mental health during the rearranged Euro 2020 tournament, while Jesse Lingard opened up about turning to alcohol to cope during a period on the sidelines.

Meanwhile, Stormzy challenged stereotypes by speaking openly about his mental health. His candid 2017 interview was seen as a breakthrough for black men who are underserved by mental health services but overrepresented in psychiatric detentions. His comments were followed up by Dave’s seminal album, Psychodrama, which bridges important topics from mental health to identity politics.

Similarly, actor Nicholas Pinnock has been a MIND ambassador since 2013, and has since been committed to encouraging others to speak up, spreading the message that it’s OK to talk about your mental health.

Keep an eye on those around you

Whilst representation on a national scale is massively important when it comes to legitimising mental health problems in our communities, bridging these topics at home is just as important.

Roman Kemp’s 2021 documentaryon mental health, Our Silent Emergency, suggested you should ask your friends if they’re OK not once, but twice. It’s easy to respond to “are you OK?” with “yeah, fine” – but it’s only when you’re asked again that you might feel comfortable opening up.

The Capital DJ spoke to young men around the UK, who recalled devastating stories about theirs and their friends’ struggles with mental health. One group of teenagers lost a friend to suicide when he was only 15.

In a world where men are still wrongly expected to be stoic and emotionless, taking the first step in opening up can be the biggest challenge. Make sure you’re checking in on your friends regularly. Knowing that you have a listening ear is invaluable when talking about mental health for the first time.

Charities and campaigns have been releasing valuable resources to help you do this. Movember launched Movember Conversations, an online tool that can help people practise asking their loved ones about their mental health. Laid out in a chat format, the tool can help people ask about mental health for the first time or encourage closed-off friends to open up.

Meanwhile, the Men’s Health Forum launched its Man MOT campaign in Men’s Health Week 2022, encouraging us to check in on our mental and physical health and to be Men MOT Champions by encouraging our mates to open up.

Speak to your loved ones

Whether or not you’re aware of it, you’ll know someone living with a mental health condition. Speaking to the people you feel most comfortable confiding in is the first step for many. If it’s not a conversation you feel comfortable having in your circle of friends, consider talking to family members or partners.

Sometimes, all it takes is for one person to open up to understand how many others are feeling the same way. But we know it’s not as easy as just saying the words out of the blue. Use TV, music or some other media to start the conversation if that feels more comfortable.

If you’re not sure where to start, first try to identify the emotions you’re feeling. Is it sadness? Despair? Loneliness? Understanding the specific emotions you’re experiencing can help you to start the conversation. Think about what you want from it too – are you looking for advice, or just a listening ear? Considering these elements will make the conversation feel like less of a hurdle.

Seeking medical help when it feels difficult

There are a lot of factors that contribute to high suicide rates amongst men. The societal expectations of masculinity are a major factor, and so is the fact that fewer men seek help from their doctors for mental health struggles. Only a third of mental health referrals are made for men. This stems from men holding more negative views of therapy and counselling than women, relationship breakdowns and a higher tendency for men to turn to alcohol.

There are ways to seek help in a more private setting if talking to loved ones or doctors doesn’t feel like a step you can take right now. Most NHS practices in the UK allow people to refer themselves for mental health and psychological therapies online, which removes the step of having to verbally explain your struggles to your GP. This removes the perceived stigma of speaking to a doctor.

Virtual therapies

An online referral is all well and good, but what if the idea of speaking to someone in counselling feels daunting? While talking therapies are proven to dramatically improve the lives of those with mental health conditions, there are alternatives if you don’t feel ready to talk openly yet.

The NHS offers a self-serve mental health tool, known as self-guided help. This online tool allows you to understand why you feel this way and provides guidance and tutorials on how you can improve your mental health.

iCBT is another option that gives you access to a real-life therapist. You can conduct sessions virtually from the comfort of your own home, and your therapist can assign you exercises that will improve your mental health condition. They can then review your progress, and you’ll have access to their guidance through messaging. CBT is proven to help people manage the symptoms of mental health conditions; multiple studies show that over half of people who take this type of talking therapy recover or better manage their conditions. iCBT offers a way to take this effective treatment without the pressures of talking in person.

The state of men’s mental health in the UK is worrying, and without proper attention and support, it’s only going to get worse. There’s still a stigma attached to men experiencing, and seeking help for, mental health conditions, and that must be tackled. Prominent celebrities raising awareness of their own issues is essential to breaking down this barrier, but there are things you can do to help yourself and your friends.

David Graham at King Apparel comments: “In order to properly improve the state of men’s mental health in the UK, we must tackle the problem on two fronts: in the public eye, to spread awareness amongst young men, and in our communities, to encourage our mates to speak up more openly. Encouraging dialogue in black communities is so important, given that black men are much more likely to suffer from mental health issues, and cultural perceptions may increase the stigma around talking to family members. Let’s make 2023 the year we finally improve the state of men’s mental health.”