Brain reboot? Psychiatric care may see radical shift

Even if you’re unfamiliar with serotonin, a chemical messenger in the brain, you’ve likely heard of drugs such as Prozac, Paxil and Zoloft that are designed to affect its function. Called SSRIs (Selective Serotonin Reuptake Inhibitors), these drugs, which increase the amount of serotonin in the brain, are commonly prescribed as a treatment for depression and other mental health conditions.

Now, researchers from Imperial College London are suggesting that a better understanding of how serotonin works could lead to a radical shift in psychiatric care.

Vero Beach psychiatrist Liana Urfer says the research is “exciting, reasonable and backed up by science.” She adds that the study’s lead author, Dr. Carhart-Harris, is well-known in the psychiatric community as an innovator who, through his research and experiments, challenges traditional thinking.

It has long been known that serotonin helps brain cells communicate with each other, playing an important role in stabilizing mood and regulating stress. This communication is through “receptors”; SSRIs work by interacting with these receptors and boosting levels of serotonin in the brain.

One of these serotonin receptors – called 1A – is thought to be particularly important. Evidence suggests that SSRIs increase activity at this receptor, which in turn reduces activity in the brain’s “stress circuits,” helping ease symptoms of depression. But writing in the Journal of Psychopharmacology, the UK researchers say that this approach ignores the therapeutic importance of activating another serotonin receptor, called 2A.

A growing body of evidence shows that in certain conditions – such as treatment-resistant depression, obsessive compulsive disorder (OCD), and addiction – some brain circuitry could become entrenched, and therefore resistant to change. Carhart-Harris and his team suggest that activating the 2A receptor with medication could potentially allow the brain to enter into a more flexible state, making the person more receptive to psychotherapy.

Carhart-Harris says, “Several of our patients described feeling ‘reset’ after the treatment and often used computer analogies. For example, one said he felt like his brain had been ‘defragged’ like a computer hard drive, and another said he felt ‘rebooted.’” He adds, “In psychiatry, as in science, things are rarely black and white, and part of the approach we’re promoting is to have a more sophisticated model of mental healthcare that isn’t just a drug or psychotherapy, it’s both. I believe this is the future.”

Vero’s Dr. Urfer agrees that the combination of medication and psychotherapy (which is designed to help people change negative behaviors and thought patterns) is often the best approach for treating depression and other mental health conditions. She says, “Because SSRIs target the 1A receptor, they are good at providing relief from symptoms, which allows the person to live more comfortably. Adding treatments that target the 2A receptor could make the person more engaged, more willing to push themselves. This could make psychotherapy more effective, taking treatment to the next level.”

Currently, there is one approved treatment that activates the 2A receptor: electroconvulsive therapy (ECT), a procedure in which a brief application of electric stimulus is used to produce a generalized seizure. According to the Mayo Clinic, ECT can provide rapid, significant improvements in symptoms of several mental health conditions, including severe depression, severe mania, schizophrenia, and the agitation and aggression sometimes associated with dementia.

Clinical trials using Psilocybin to target the 2A receptor also are underway. Psilocybin is a naturally occurring psychedelic compound found in certain types of mushrooms. (Often called “magic” mushrooms, they have been used for centuries in various cultures for healing and religious purposes.)

Dr. Urfer believes an even more significant development involves MDMA, the main ingredient in the recreational drug Ecstasy. MDMA, which also activates the 2A receptor, has been granted a “Breakthrough Therapy Designation” by the FDA for treatment of post-traumatic stress disorder (PTSD).

This designation indicates that the FDA believes that MDMA may have a “meaningful advantage” over available PTSD medications, and signals the FDA’s intent to help accelerate the approval process.


Dr. Urfer’s practice is located at 641 17th Ave in Vero Beach; the office phone is 772-978-9793.

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