In a new review of clinical trials published in The American Journal of Geriatric Psychiatry, researchers suggest psychedelics are safe for older adults when used in controlled therapeutic contexts, but that this safety profile has not been established for older adults with health issues such as cardiovascular disease.
This caution is notable as 60% of older adults manage at least two chronic health conditions and 75% of adults over the age of 60 have been diagnosed with hypertension, according to estimates from the Centers for Disease Control. These health challenges reflect common issues that may contraindicate psychedelic use among the elderly.
In their paper, titled “The Safety and Efficacy of Psychedelic-Assisted Therapies for Older Adults: Knowns and Unknowns,” the authors also suggest that older adults are prone to develop psychological distress from their illnesses, including cancer anxiety and bereavement-related grief. They note that this distress might be effectively treated with psychedelic-assisted therapies.
Reviewing clinical trials over roughly the last 30 years that examine psilocybin and MDMA-assisted therapies, the authors found almost no reports of serious adverse reactions in study participants, including in older adults. They note, however, that “most study participants administered psychedelics have been relatively healthy and very few were over the age of 60.”
For instance, among the phase I, II, and III clinical trials for MDMA-assisted therapy that the researchers reviewed, the average participant was 41 years old.
The paper notes that past research has found that some psychedelics, including MDMA and psilocybin, increase blood pressure and might cause people’s hearts to beat irregularly. The authors note that there was one severe case of heart problems in a clinical trial for MDMA-assisted therapy.
“The only drug-related serious adverse event in these trials was a transient increase in pre-existing ventricular ectopy that required overnight monitoring,” wrote the authors.
While clinical trial subjects did experience the expected spike in blood pressure, sometimes to a concerning level, the review authors found there were no reports of heart attacks or strokes.
“We have certainly seen a few participants become rather hypertensive when their blood pressure really goes up during the acute effects of the medicine,” says Brian Anderson, assistant clinical professor of psychiatry at the University of California, San Francisco and senior author of the review. “But that has not been associated with any sort of neurologic damage. No detectable strokes have happened in these participants.”
Unknown Impacts on Older Adults
Although the studies of psychedelic-assisted therapies reviewed by the authors highlighted improvements to participants’ conditions such as PTSD, depression, and distress associated with a life-threatening illness, they note that the low average age means that the generalizability of psychedelic therapy’s effects on older populations – especially those who are affected by chronic illnesses – is still unknown.
“The studies that have been done have been on highly, highly screened people,” says C. Bree Johnston, director of palliative care at Skagit Regional Health and professor of medicine at the University of Arizona, who led the review. “So, people who are generally healthier than people in the average population.”
Johnston notes that while our knowledge about the effects of psychedelic-assisted therapies is drawn mostly from these relatively healthy young adults, the conditions that were studied, such as depression stemming from a terminal illness, are particularly relevant to the elderly community. This may extend to related conditions that have not been studied: prolonged grief from the death of a loved one is estimated to affect 7-10% of older adults.
The researchers caution, however, that their review of clinical research was designed to be exploratory rather than to be conclusive. They did not systematically review the individual results of older adults in these studies.
Concerns About Cardiovascular Events
Johnston says that while she suspects that psychedelics are “extremely safe” compared to other psychiatric drugs when used in guided settings for older adults, there are concerns about their potential impact on cardiac health.
Anderson adds that there are anecdotes, outside of medical settings, of people having significant cardiovascular events associated with psychedelic use. One study looked at several years of hospitalizations in an emergency department and found over one hundred cases of serious reactions, such as shallow breathing and electrical disturbances in the heart, related to the consumption of psychedelics. Another report highlights the case of a heart attack while on psilocybin.
“There are a few reports like this that would just make me concerned that, once in a while, as more people ingest these substances, particularly people who are older and have potentially other issues, that we could see, specifically, cardiovascular problems, like having a severe heart attack related to taking a substance like this,” says Anderson.
Older adults who are considering taking any psychedelic, such as people ingesting these compounds in Oregon where psilocybin mushroom services are regulated under state law and will be available soon, should consider taking smaller doses, says Anderson. He believes that this would diminish their risk of an adverse health event.
Anderson observes that he sometimes hears “older folks talking about how they want to go get psilocybin therapy out in the community, sometimes in ways that are not legal at the state or federal level, because they read that patients with cancer did this at a prominent university on the east coast.” He says that this review demonstrates that even if psychedelics appear to be safe for older adults, there is a “disconnect between what the numbers actually show and the level of interest out there” for older adults.
“That is something that really stands out to me, that I had to sit with in doing this review with my colleagues,” Anderson adds.
More Research Is Needed
Researchers note that the potential benefits of psychedelic-assisted therapy for older adults merit additional investigations. An expert commentary on the review paper points out that improvements seen in recipients of psychedelic-assisted therapies may extend to their caregivers. This was observed in previous research showing lower rates of depression in caregivers when their elderly patients developed more effective coping mechanisms for their disabilities.
With the population of adults over the age of 60 in the worldwide population expected to double from 12% in 2015 to 22% by 2050, the expert commentary notes that caregiver burnout is also expected to increase.
“This was a very refreshing paper to come across,” says Tyler Toueg, a doctoral student at the University of California, Berkeley. In the context of psychedelic effects, he says older adults are under-studied. Toueg believes that trials specifically following the effects of psychedelic-assisted therapies with older adults are warranted.
Toueg also notes that generalizing the promise of psychedelic-assisted therapies to older adults could be limited by biological factors that have not yet been discovered.
“There are certain changes in the brain associated with aging, such as a decline in the number of serotonin receptors in the brain,” says Toueg. “We might expect that the 5-HT2A receptors that are crucial for the effects of psychedelics to be among these receptors to decline.”
“It could be the case that maybe if you give an older subject the same dose as a young [person], maybe they don’t have as intense an experience because they don’t have as many of these receptors. But we just don’t know.”
As for why there is a dearth of studies on older adults,Toueg notes researchers’ concerns about safety.
“We’re basically, as a field, trying to minimize that possibility of having an adverse event in a psychedelic state, keeping safety as the most important thing in the studies that we do,” notes Toueg. “My guess is that the studies that have been done so far haven’t wanted to dive into this uncharted territory, because we don’t really know what’s going to happen.”
“No one wants to be the researcher that shows psychedelics are unsafe,” he adds.
Psychedelic-Assisted Therapies For Palliative Care
While questions about the impact of psychedelics on older adults points the way for more research, Johnston says she remains optimistic about the promise of these therapies. She cites her work as a palliative care doctor as her reason for conducting the review of current findings. Like many of her colleagues who were attracted to this research after encountering Michael Pollan’s widely-read article about psychedelic therapy in The New Yorker, Johnston said she immediately thought of her patients with terminal illness.
“I thought, oh my gosh, if psilocybin helps people that much, why don’t we have that available? Because I so often just feel helpless,” says Johnston.
Johnston adds that psychedelic-assisted therapies could focus on more than treating health conditions, and also aid the experience of aging itself.
“There’s so much agism in our culture,” she says. “And old age can be a time of great happiness and growth and meaning. Many cultures value older people as wise elders, and I would really like to see our culture start moving more in that direction.”
Yet Johnston notes that “old age is a time of transition that many people struggle with.” As an older adult herself, she says she is also “struggling with who I am on those weeks when I’m not, you know, the director of palliative care.”
In regards to aging well in our final years, Johnston adds that, “for many people, it’s a time to really sit down and re-examine what’s important in life. And, again, I think that psychedelic-assisted therapy could be a tool in that.”