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Psychedelics paired with therapy could treat chronic mental health conditions

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By VITTORIA D’ALESSIO

Mind-bending drugs and psychedelics are generally stigmatised and illegal in EU member states, due to concerns about their possible harmful effects. However, in other parts of the world, some psychedelic compounds are exalted for their healing properties and have been consumed in spiritual and cultural ceremonies for millennia.

Now scientists in Europe and the USA are starting to wake up to what shamans have been saying for years. There is a growing body of evidence to suggest some psychoactive substances have immense therapeutic potential, especially when it comes to tackling serious, hard-to-manage mental health issues such as post-traumatic stress disorder (PTSD), depression, alcoholism and eating disorders.

Mental disorders contribute enormously to the global burden of disease, with huge costs to both society and the economy. Psychedelics (which are generally considered non-addictive) may offer a tantalising form of therapy for difficult-to-treat conditions.

In response to the burgeoning interest from the scientific community, dozens of privately funded American studies, and a handful in Europe too, are attempting to unravel the neuroscience of psychedelic “trips”.

The endgame for many scientists in this area is to decriminalise psychedelics (both synthetic and natural) and establish safe protocols that will allow doctors and psychotherapists to harness the “magic” in these compounds for medical purposes. The goal is to achieve a lasting recovery in patients.

‘Researchers involved in this field picture a world where psychedelics are safely and legally available for beneficial use, and where research is given the opportunity to thoroughly evaluate their risks and benefits,’ said Dr Claudia Schwarz-Plaschg, who recently completed the three-year, Horizon-funded ReMedPsy project, where she examined (among other things) society’s evolving views on psychedelics.

Mainstream acceptance

‘Before we can make real progress in the medical use of psychedelics, we need to cultivate mainstream acceptance of these substances,’ said Dr Schwarz-Plaschg, adding, ‘In this sense, America is definitely ahead of Europe.’

While psychedelics are enjoying favourable attention from scientists, this is not the first time research institutions have expressed an interest in these substances. The 1950s and 1960s were a previous age of scientific and cultural exploration of psychedelic substances. However, when the political mood swung against all categories of “recreational” drugs, research was shut down.

Today’s revival of interest seeks to deepen our understanding of the biological mechanisms that give rise to the mind-altering effects of psychedelics, so they can be safely integrated into society.

‘These substances must be used with great care and respect,’ said Dr Schwarz-Plaschg. ‘They can be abused and they can be used to control people, so it’s vital to get both the set and setting right before they are taken.’

The “set” refers to the mindset of the person entering the experience. People need to be relaxed and free of fear, as this will influence the experience they have.

And the “setting” refers to the physical place you are in. ‘You must be comfortable and in good hands, and you must feel safe,’ she said.

Altered state

So, what is it about these substances that makes them so appealing both on the nightlife scene and in a therapeutic setting?

Psychedelics trigger an altered state of consciousness. They affect all the senses and shift a person’s thought processes, sense of time and emotions. Dr Schwarz-Plaschg says the sensation they elicit is one of ‘opening up’.

She said: ‘Take a substance like MDMA (the active ingredient in the dance party drug Ecstasy). It produces a lot of empathy and strong feelings of bonding with others. Taken in the right setting, a person will also go within, and feel a lot of love and empathy for themselves – and if they’ve been the victim of a traumatic crime, probably for the perpetrator too.’

In this state of emotional expansiveness, patients are sometimes able to revisit traumatic experiences and confront catastrophic memories in a way that would be impossible under normal circumstances.

‘They can feel the same powerful feelings they first experienced at the time of their trauma but with less fear,’ explained Dr Schwarz-Plaschg. ‘And with the help of the psychedelic and their therapist, they can reframe the memory in a new light.

Positive perspective

‘This process can help a person release feelings that have been stored in their bodies and give their traumatic experience a fresh, more positive perspective,’ said Dr Schwarz-Plaschg. ‘This perspective seems to stay with them even after the effects of the substance have worn off.’

Dr Schwarz-Plaschg is quick to point out that the work of psychedelics is explained through science, not magic. Their active molecules bind with the body’s receptors for serotonin – the ‘feel good’ neurotransmitter. Established antidepressants work along similar lines. However, psychedelics, when paired with therapy, appear to stave off mental health disorders for longer – for some, perhaps even forever.

A radical approach being proposed by scientists in this field is psychedelic-assisted psychotherapy (PAP). This is the professionally supervised use of psychedelic substances as part of a detailed psychotherapy programme.

Psychedelic therapy

‘We picture a world where psychotherapists are trained in the use of psychedelics, so these substances can be offered as part of a package,’ said Dr Schwarz-Plaschg. The programme would involve the pairing of a specific substance with a specific type of therapy. Maybe the patient would have two sessions where the therapist gives them psilocybin (found in “magic mushrooms”) and then two sessions of pure therapy.

In one 2021 trial, run by the Multidisciplinary Association for Psychedelic Studies (MAPS) – an American non-profit to raise awareness and understanding of psychedelics – MDMA-assisted therapy was given to people suffering from chronic post-traumatic stress disorder (PTSD). This condition is profoundly challenging to treat. After just three sessions, 67% no longer met the diagnostic criteria for PTSD while 88% experienced an improvement in symptoms.

‘Once we have more data on the best type of treatment mode to make people better, we are hopeful that the European Medicines Agency will give their approval,’ said Dr Schwarz-Plaschg.

The three substances at the centre of current scientific research are MDMA, psilocybin and ketamine (used as a sedative at higher concentrations and also known for its hallucinogenic effects).

Since 2019, esketamine – a ketamine-based nasal spray – has been allowed in the US and the EU to treat major depressive disorders, but only when other antidepressants have failed and only when administered from a certified clinic.

For many people with depression (but not all), esketamine is proving to be a breakthrough therapy. It acts fast and seems to significantly decrease the likelihood of a relapse into severe depression, when compared to oral antidepressants paired with a placebo nasal spray.

Optimal dose

However, as with other psychedelics, more data is needed on the mechanism by which this mind-altering treatment works. More work is also needed to establish how many doses, and at what concentration, patients should take the treatment to achieve optimal results.

The use of MDMA and psilocybin is forbidden in most of Europe (some exceptions are available, with restrictions, in the Netherlands and Austria). However, champions of psychedelics are making good progress in the USA.

Since 2021, magic mushrooms have been legal for mental health treatment in supervised settings in some parts of the USA, and a bill pending in California would go some way to legalising the use of a medley of psychedelics that includes magic mushrooms, MDMA and LSD.

Dr Schwarz-Plaschg is hopeful that MDMA-assisted psychotherapy will be available in Europe within the next two or three years.

Research in this article was funded via the EU’s Marie Skłodowska-Curie Actions (MSCA). The article was originally published in Horizon, the EU Research and Innovation Magazine.  

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Making face creams from coffee beans as cosmetics get greener

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By Tom Cassauwers

‘Plant ingredients have always been used in cosmetics,’ said Heiko Rischer, head of plant biotechnology at VTT, a Finnish research centre. ‘But in recent years, there’s been a revived interest in plant-based compounds. Consumers are interested in greener and more sustainable ingredients.’

Today, most of the key ingredients used in the €80 billion European cosmetics industry are synthetic or animal-based or taken from wild plants. Producing these ingredients sometimes includes solvents or processes that are unsustainable and are becoming less popular with consumers. Harvesting wild plants also puts natural ecosystems under pressure.

Rischer and other European scientists are investigating how to get more natural and sustainable plant-based ingredients into cosmetic products.

Ecosystem pressure

The EU-funded InnCoCells project that VTT is coordinating is creating alternative ingredient options by growing plants or plant cells for use in cosmetics in a sustainable way.

‘We grow plant cells and organs in bioreactors,’ Rischer said. ‘But other partners grow the entire plants in aeroponics and greenhouses or in the field.’

InnCoCells is researching the commercial production of innovative cosmetic ingredients from plants such as basil or aromatic ginger.

‘Our work is currently in a bio-prospecting stage,’ said Rischer. ‘We evaluate different plant species for compounds. We start from a wide range of potential plants and reduce them over time.’

The team aims to develop up to 10 ingredients to bring to the market within the next three years – although it’s still early days for a project that started in May 2021.

‘Finding our way in this jungle of plant options is a challenge,’ Rischer said.

The focus is on the bio-active compounds in cosmetics, meaning the ingredients that create a desired effect such as anti-ageing of the skin rather than ingredients like stabilisers or fragrances. An essential part of the work in InnCoCells is to have the cosmetics do what they promise in a transparent way.

‘Cosmetics need to open up the evidence, so that products actually do what they claim,’ said Rischer. ‘This would really help the consumer make choices. When we buy food, there’s a lot of information on the package helping the consumer. We need to do the same for cosmetics.’

Coffee creams

In a separate, just-ended, initiative to green the cosmetics industry, the EU-funded Prolific project transformed plant residues into ingredients for beauty products. The team extracted polyphenols from coffee silverskins, a type of compound useful in cosmetics because of its anti-ageing effects on the skin. The polyphenol extract was standardised and used in a prototype face cream.

Normally, polyphenols are already derived from plants. But the compound is extracted through a chemical procedure resulting in waste that needs to be disposed of carefully. The project applied an environmentally friendly method, called subcritical water extraction, which only uses water under very high pressure to extract the polyphenols from the coffee silverskins.

All in all, the Prolific research used a range of new processes to derive useful compounds from agricultural waste of different plant sources such as coffee beans, fungi and legumes.

‘We use a cascading approach,’ said Annalisa Tassoni, the project’s scientific coordinator and an associate professor at the University of Bologna in Italy. ‘We do a first extraction, after which we look at what remains and try to extract another compound.’

Ultimately the residual fibres were used at different stages of production. Three prototype cosmetics were made by Greek partner company COSMETIC including a face cream, toothpaste and even a container jar that was made from plant fibres.

‘We valorise all the parts of the residues,’ said Georgios Tsatsos, general director of COSMETIC. ‘This goes up to the fibres left after the extraction process.’

Plant-based compounds

Several steps need to be taken before these green compounds can reach the cosmetics market. The techniques used by Prolific in processing coffee are close to being introduced into cosmetics production, but the methods need to be scaled up so that plant-based compounds can compete with synthetic ones.

‘There’s a lot playing in favour of this process for coffee,’ said Tassoni, ‘We opened up perspectives, and confirmed that certain techniques really work.’

While it will be difficult to outcompete all of the synthetic techniques in use in the cosmetics industry, Rischer is optimistic about the outlook for more environmentally sound approaches.

‘The cosmetics market is very big and diverse,’ he said. ‘Consumers are demanding more sustainable and green cosmetics, and within our own niche, we can have an impact.’

Research in this article was funded by the EU. This material was originally published in Horizon, the EU Research and Innovation Magazine.   

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In fight against male cancer, caring for mental health is a growing priority

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By Anthony King

At a hotel in the Scottish city of Aberdeen about 20 years ago, urologist James N’Dow and other doctors met a group of men who had suffered prostate cancer to ask for feedback on their care before and after surgery. The clinicians were stunned by the critical, albeit constructive, responses.

‘Frankly, they felt abandoned,’ said Professor N’Dow, who works at the University of Aberdeen. ‘When we discharged them after surgery, we thought their general practitioners were looking after them and their GPs thought we were.’

Minding the mind

Dealing with the emotional and mental toll of prostate cancer has grown in importance along with detecting and curing the disease itself. Prostate cancer is the second-leading cancer among men in Europe and is sometimes mistakenly viewed as a disease only of old age. It caused an estimated 335 500 cases, or 12.5% of cancers, in the EU in 2020.

Prof N’Dow heads an Innovative Medicines Initiative project – PIONEER – on prostate cancer that seeks to improve diagnosis and treatment. A parallel EU-funded initiative called FAITH is developing an electronic application for cancer survivors that could help spot if the “black dog” of depression is stalking them.

‘Depression is a big thing in post-cancer survivors,’ said Gary McManus, who leads FAITH and works at the Walton Institute for Information and Communication Systems Science in Waterford, Ireland.

Four in 10 men who have been treated for prostate cancer say they are anxious or depressed to some degree, with troubles worsening the more advanced the cancer, according to a 2020 study by Europa Uomo, a European advocacy movement for sufferers of the disease. Prostate cancer can increase the risk of suicide.

Stopping the spread

When prostate cancer is caught early enough, a man can be cured. If it spreads beyond the prostate, the cost of treatment is high and delivers minimal benefit. Usually, the disease will spread – metastasize – to the bones and lymph nodes.

‘It is not curable at that stage,’ said Prof N’Dow. ‘We are still picking up too many men with metastatic disease – and this is a failure of the system.’

Without treatment, the average period of survival from prostate cancer that has spread beyond the gland is about 21 months. With some newer therapies, some metastatic prostate cancer patients can survive five years or more.

Even when the cancer is aggressive, if it is restricted to the prostate gland a patient can be cured by surgery or radiation therapy – or a combination. Almost 95% of these patients are still alive up to 15 years after their diagnosis. Treatment can, however, affect a man’s urinary or erectile function.

Prof N’Dow hails recent EU recommendations to screen prostate cancer in men up to the age of 70 using a blood test and magnetic resonance imaging (MRI) scans based on an individual’s risk. Certain men over 50 and those of African descent or with a family history of prostate cancer are at heightened risk from this cancer and should be targeted for early detection.

Tracking the blues

Amid the efforts to improve detection and cures, FAITH’s planned app highlights the heightened focus on the psychological well-being of cancer patients.

Although it is being tested on people who have overcome lung and breast cancer, the app could be made to work for survivors of the disease in other parts of the body including the prostate.

In its study two years ago on anxiety or depression among men who have been treated for prostate cancer, Europa Uomo said 0.5% felt either one to an “extreme” degree and almost 4% to a “severe” extent. Nearly 11% and 28% fell into “moderate” and “slight” categories, respectively.   

A tracker of sorts, the app is being developed by European technologists and cancer doctors working together. The tests are taking place at three hospitals in Ireland, Spain and Portugal.

At home, a wearable watch records movement and sleep patterns that get fed into a phone app. Patients must occasionally answer questions from the app, for example about dietary choices, while a voice module checks for any changes in a person’s speech that may indicate depression.

In all, 27 measurements are being tracked in a bid to uncover which ones could flag a downward trajectory in a patient’s mental health. Performance will be compared against clinical questionnaires that doctors already use to monitor patients.

‘Once the patient is signed out of the hospital, they’re often on their own,’ said McManus. ‘If the hospital gives this app to a patient, doctors can remotely monitor how the patient is getting on.’

The phone app will not send sensitive patient data to the Internet. Instead, an algorithm is updated on the phone and fed back to the development team, which helps improve the app’s performance.

‘We’ll build our algorithm and try to pick out these downstream trajectories,’ said McManus. ‘Then we are basically training the app.’ Eventually, if the app picks up worrying signals, ‘an alarm is raised in the hospital and the patient is contacted,’ he said.

Empowering patients

The mental-health aspect of cancer diagnosis and care needs to be improved across Europe, according to Prof N’Dow, who said that this is a central goal of the European Association of Urology, where he is adjunct secretary general responsible for education.

‘The impact psychologically of the diagnosis or consequences of treatment is huge,’ he said. ‘This is something we understood in PIONEER.’

The project has sought to ensure that treatment comparisons take into account the impact on patient quality of life such as sexual, bowel or urinary function. Also crucial has been to identify those outcomes that matter most to patients.

That is why PIONEER has included patients themselves in discussions aimed at determining key unanswered research questions about prostate cancer.

‘Patients understand what they need,’ Prof N’Dow said. ‘Our job is to improve the lives of the most vulnerable and get them back to the life they knew before it was rudely interrupted by disease. The psychological well-being of the patient and their families should be recognized as central to that.’

Research in this article was funded via the EU. This material was originally published in Horizon, the EU Research and Innovation Magazine.   

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Central Asian Countries Show Commitment to a Cross-regional Approach to Pandemic Prevention

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Government officials representing health, environment, and agriculture sectors from all of Central Asian countries participated in a regional ministerial meeting Protecting Livestock and Preventing Pandemics that took place in Almaty today. The participants reaffirmed commitment to cooperating on One Health–a cross-sectoral approach that aims to help the region prevent future pandemics. The participants signed a communiqué giving a formal start to the development of the Central Asia One Health Framework for Action and a call for joint resource mobilization in support of the initiative.

Managing global health risks requires full cooperation between the livestock, environmental and public health sectors, at the national, regional, and global levels. One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment are closely linked and inter-dependent.

“The case for collaboration on One Health in Central Asia could not be clearer,” said Tatiana Proskuryakova, World Bank Regional Director for Central Asia. “The region shares many common challenges but also strengths and opportunities that can help the region realize One Health. What we are witnessing now is Central Asia setting an example for other regions and countries on how to work together for future generations’ health and wellbeing”.

The event in Almaty builds on the discussions held during a meeting in Tashkent in July 2022 when participants agreed on the need to prepare the Central Asia One Health Framework for Action that could provide a blueprint for the countries in the region to move forward with concrete actions, as well as would include a roadmap for investments at national and regional levels.

More specifically, the Regional One Health Framework for Action aims to contribute to addressing three high-level goals shared among Central Asian countries: pandemic prevention and preparedness, resilience of food systems, and improving regional trade and the competitiveness of agriculture. In addition, the Framework for Action will identify focus areas and mechanisms for regional collaboration, and include a One Health dashboard to monitor progress, while facilitating policy responses to emerging issues.

“Investing in One Health is an investment in humanity’s future. The proposed investment framework helps governments and development partners to avoid the cycle of panic-and-neglect and direct financial resources. This integrated, risk-based approach requires compliance with international health standards and promotes country ownership, while recognizing its global public goods nature. The vast majority of investments in One Health will also result in significant co-benefits, including improving food safety, preserving biodiversity and reducing GHG emissions” said Martien van Nieuwkoop, the World Bank’s Global Director for Agriculture and Food. “The World Bank is collaborating with several countries in Central Asia on this approach, and we are encouraged by the region’s resolve to work together to invest in One-Health as an important building block for pandemic prevention, preparedness and response”.

The development of the Framework for Action will support regional dialogue between networks of decision makers and technical staff, including epidemiologists, veterinarians, and environmental specialists from the three operational sectors. This will be especially useful in cases of transborder disease outbreaks, as it would enable sharing of information, quick integration of new knowledge, and regional action.

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