A group of Estonian psychiatrists and civic activists are calling for the legal therapeutic use of psychedelic substances, which they believe could be pivotal in addressing the country’s ongoing mental health crisis. While psychedelic research is legal in Estonia, experts stress the importance of evaluating the balance between potential risks and benefits before widespread use can be considered.
Psychedelic substances such as LSD, MDMA, and psilocybin often evoke associations with illicit drug use, from the counterculture movements of the 1960s to modern rave culture. However, experts argue that these compounds, known for inducing altered states of consciousness, could hold therapeutic potential for various mental health conditions. Such substances affect perception, thinking, mood, and cognition, effects which are now being explored for clinical benefit.
A Historical Overview of Psychedelic Research
The scientific exploration of psychedelics dates back to the 1950s and 1960s, a period when researchers first began investigating their potential for mental health treatments. However, the momentum of psychedelic research was abruptly halted by U.S. President Richard Nixon’s administration, which associated psychedelics with countercultural movements and anti-Vietnam War sentiments. This era also marked the start of the broader war on drugs.
Research into psychedelics has seen a resurgence since the late 1990s. For example, MDMA has now reached phase three of clinical trials for the treatment of post-traumatic stress disorder (PTSD), where its effectiveness is compared against existing treatments or placebos. Similarly, the U.S. Food and Drug Administration (FDA) has advanced LSD as a potential treatment for generalized anxiety disorder and psilocybin for depression, both substances showing promising results.
Progress in Estonian Psychedelic Therapy Initiatives
In Estonia, the Foundation for the Development and Innovation of Psychedelic Therapy (TAIP) recently held a seminar in Tallinn, highlighting the growing interest in psychedelic-assisted therapy. The foundation aims to promote a science-based approach to integrating psychedelics in mental health care, either as primary treatments or as adjuncts to traditional psychotherapy.
Viljar Veede, a psychiatrist and chair of TAIP’s supervisory board, emphasized the need to increase awareness among healthcare professionals and the public. “There is a lack of understanding about the potential of psychedelics within both agencies and the medical community,” said Veede, noting that TAIP is part of a pan-European network supporting the field.
The Need for New Treatment Approaches
Anne Kleinberg, chair of the Estonian Psychiatric Association, highlighted the inadequacies in the current mental health system. “Existing treatments, such as antidepressants, only work for a portion of patients and are often ineffective or slow to show results,” she explained. While antidepressants take weeks to alleviate symptoms, psychedelics may offer more immediate relief, particularly for patients suffering from severe depression and anxiety disorders.
Kleinberg and Veede also pointed to the lack of effective treatments for certain conditions, such as alcohol addiction, especially when combined with mental health issues like PTSD. Psychedelic-assisted therapy has shown promise in helping patients with chronic, treatment-resistant depression and anxiety, as well as substance abuse issues.
However, not all patients are suitable candidates for psychedelic therapies. Conditions such as psychotic disorders, bipolar disorder, and severe personality disorders would make psychedelics unsuitable. The therapeutic potential of these substances must be carefully evaluated on a case-by-case basis.
Revisiting Psychedelics for Therapeutic Use
Kleinberg believes that the time has come to reconsider the therapeutic use of psychedelics, which were once part of mainstream medicine before being sidelined. “The science has advanced significantly, and we now have the tools to safely explore their potential,” she said. While some Estonian physicians remain cautious about psychedelics, many are attending international conferences to gain a deeper understanding of their possible benefits.
The key, according to Kleinberg, is fostering a science-based dialogue within the medical community and among the public. She pointed to the years of resistance to ADHD medications as an example of how medical professionals can be slow to embrace new treatment options.
Ketamine: A Precedent for Psychedelic Treatment in Estonia
Although psychedelics are largely prohibited in Estonia, ketamine has been available for psychiatric use for several years. Originally used as an anesthetic, ketamine has been shown to have fast-acting antidepressant effects. In Estonia, ketamine is used to treat severe depression, especially in cases where conventional antidepressants fail to provide relief.
Veede explained that ketamine, as the first fast-acting antidepressant of its kind, has paved the way for future psychedelic therapies. Clinical studies have shown that ketamine can provide rapid relief, sometimes within hours, offering hope for patients in crisis.
Ketamine treatments in Estonia can be administered in two ways: as a low-dose medication without psychological support, or in conjunction with therapy, where the drug induces a mild psychedelic experience to facilitate the healing process.
Defining Effective Psychedelic Therapy
A clear distinction must be made between the use of psychedelics as a therapeutic tool and simple drug administration. In some U.S. studies, the psychological support component was minimized, but Veede emphasized the importance of therapy alongside drug use for effective outcomes. “The therapy itself is a crucial part of the healing process, as it helps guide patients through their experience and integrate it into their recovery,” he said.
While much of the research on psychedelics is conducted in the U.S., Europe is catching up, with Switzerland standing out for its more advanced approach to legal psychedelic therapy. Swiss regulations allow for the therapeutic use of substances like LSD, MDMA, and psilocybin under certain conditions. Veede believes Estonia could learn from Switzerland’s model, offering these therapies through special permits for patients who have exhausted other options.
The Future of Psychedelic Therapy in Estonia
In addition to ketamine, Estonia has allowed psychedelic research under special permits issued by the Estonian Medicines Agency. The agency evaluates each study on a case-by-case basis, assessing the potential therapeutic effects and the risks involved.
TAIP is planning a clinical trial and will also focus on providing training for therapists in this emerging field. The foundation aims to ensure that Estonia has a future workforce capable of supporting psychedelic therapies.
“The key takeaway is that, when used in a controlled medical setting, psychedelics are safe and effective,” Veede stated. “Their potential benefits are significant, and they do not cause addiction.”
While the scientific community continues to explore the therapeutic potential of psychedelics, it is clear that the discussion in Estonia is just beginning. As more data becomes available, the hope is that these substances will become an accepted part of the country’s mental health treatment landscape.
