The age of psychedelics
Abstract
The 21st century has seen a dramatic flow and ebb in the fortunes of clinical psychopharmacology particularly with regard to antidepressants. For about 20 years, perhaps from about 1985 onwards, the tide flowed in with many ‘new’ drugs being made available to clinicians. In mood and psychotic disorders, these were essentially incremental advances from old drugs such as amitriptyline and clozapine albeit often treatments with very real extra clinical benefits such as improved toxicity. Some of these, such as the SSRIs (selective serotonin re-uptake inhibitors), were even celebrated as ‘wonder drugs’ in popular culture. Inevitably, the tide turned. Many large pharmaceutical companies reoriented their strategic directions away from psychopharmacology causing much consternation from researchers in the field despite a flowering of experimental approaches which significantly enhanced our capacity for research (Dawson et al., 2011). The tide also turned in popular culture probably due to, now discredited, secondary analyses suggesting that SSRIs were not significantly better than placebo. Although, it has now been recognised that antidepressants ‘do work after all’ (Young and Moulton, 2020), it remains a concern that this further re-evaluation has not changed popular opinion which may be even influencing policy decisions and may likely reflect stigma and biases (Nutt et al., 2014). Controversy also continues with regard to antidepressants and withdrawal. Much of the recent debate…
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