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Videira NB, Nair V, Paquet V, Calhoun D. The changing outlook of psychedelic drugs: The importance of risk assessment and occupational exposure limits. J Appl Toxicol 2024; 44:216-234. [PMID: 37646119 DOI: 10.1002/jat.4533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
Serotonergic psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, dimethyltryptamine (DMT), and 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT), are currently being investigated for the treatment of psychiatric disorders such as depression and anxiety. Clinical trials with psilocybin and LSD have shown improvement in emotional and psychological scores. Although these drugs are reported to be safe in a controlled environment (such as clinical trials), exposure to low doses of these drugs can result in psychedelic effects, and therefore, occupational safety is an important consideration to prevent adverse effects in the workplace from low daily exposure. This article will discuss the factors involved in the derivation of occupational exposure limits (OELs) and risk assessment of these psychedelic drugs. To support the OEL derivations of psychedelic drugs, information regarding their mechanism of action, adverse effect profiles, pharmacokinetics, clinical effects, and nonclinical toxicity were considered. Additionally, psilocybin and LSD, which are the most extensively researched psychedelic substances, are employed as illustrative examples in case studies. The OELs derived for psilocybin and for LSD are 0.05 and 0.002 μg/m3 , respectively, which indicates that these are highly hazardous compounds, and it is important to take into account suitable safety measures and risk-management strategies in order to minimize workplace exposure.
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Affiliation(s)
| | | | - Valérie Paquet
- formerly Affygility Solutions, Broomfield, Colorado, USA
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2
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Holas P, Kamińska J. Mindfulness meditation and psychedelics: potential synergies and commonalities. Pharmacol Rep 2023; 75:1398-1409. [PMID: 37926796 PMCID: PMC10661803 DOI: 10.1007/s43440-023-00551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
There has been increasing scientific and clinical interest in studying psychedelic and meditation-based interventions in recent years, both in the context of improving mental health and as tools for understanding the mind. Several authors suggest neurophysiological and phenomenological parallels and overlaps between psychedelic and meditative states and suggest synergistic effects of both methods. Both psychedelic-assisted therapy and meditation training in the form of mindfulness-based interventions have been experimentally validated with moderate to large effects as alternative treatments for a variety of mental health problems, including depression, addictions, and anxiety disorders. Both demonstrated significant post-acute and long-term decreases in clinical symptoms and enhancements in well-being in healthy participants, in addition. Postulated shared salutogenic mechanisms, include, among others the ability to alter self-consciousness, present-moment awareness and antidepressant action via corresponding neuromodulatory effects. These shared mechanisms between mindfulness training and psychedelic intervention have led to scientists theorizing, and recently demonstrating, positive synergistic effects when both are used in combination. Research findings suggest that these two approaches can complement each other, enhancing the positive effects of both interventions. However, more theoretical accounts and methodologically sound research are needed before they can be extended into clinical practice. The current review aims to discuss the theoretical rationale of combining psychedelics with mindfulness training, including the predictive coding framework as well as research findings regarding synergies and commonalities between mindfulness training and psychedelic intervention. In addition, suggestions how to combine the two modalities are provided.
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Affiliation(s)
- Paweł Holas
- Faculty of Psychology, University of Warsaw, Warsaw, Poland.
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3
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Hilal F, Jeanblanc J, Naassila M. [Interest and mechanisms of action of ketamine in alcohol addiction- A review of clinical and preclinical studies]. Biol Aujourdhui 2023; 217:161-182. [PMID: 38018944 DOI: 10.1051/jbio/2023028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Indexed: 11/30/2023]
Abstract
Alcohol Use Disorder (AUD) is a psychiatric condition characterized by chronic and excessive drinking despite negative consequences on overall health and social or occupational functioning. There are currently limited treatment options available for AUD, and the effects size and the response rates to these treatments are often low to moderate. The World Health Organization has identified the development of medications to treat AUD as one of its 24 priorities. This past decade was marked by a renewed interest in psychedelic use in psychiatry. At the centre of this renaissance, ketamine, an atypical psychedelic already used in the treatment of major depression, is an NMDA receptor antagonist that exists as a racemic compound made of two enantiomers, S-ketamine, and R-ketamine. Each form can be metabolized into different metabolites, some of which having antidepressant properties. In this article, we review both clinical and preclinical studies on ketamine and its metabolites in the treatment of AUD. Preclinical as well as clinical studies have revealed that ketamine is effective in reducing withdrawal symptoms and alcohol craving. Convergent data showed that antidepressant properties of ketamine largely contribute to the decreased likelihood of alcohol relapse, especially in patients undergoing ketamine-assisted psychotherapies. Its effectiveness is believed to be linked with its ability to regulate the glutamatergic pathway, enhance neuroplasticity, rewire brain resting state network functional connectivity and decrease depressive-like states. However, it remains to further investigate (i) why strong differences exist between male and female responses in preclinical studies and (ii) the respective roles of each of the metabolites in the ketamine effects in both genders. Interestingly, current studies are also focusing on ketamine addiction and the comorbidity between alcohol addiction and depression occurring more frequently in females.
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Affiliation(s)
- Fahd Hilal
- Groupe de recherche sur l'alcool et les pharmacodépendances, INSERM U1247, CURS, Amiens, France
| | - Jérôme Jeanblanc
- Groupe de recherche sur l'alcool et les pharmacodépendances, INSERM U1247, CURS, Amiens, France
| | - Mickaël Naassila
- Groupe de recherche sur l'alcool et les pharmacodépendances, INSERM U1247, CURS, Amiens, France
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Buchborn T, Kettner HS, Kärtner L, Meinhardt MW. The ego in psychedelic drug action - ego defenses, ego boundaries, and the therapeutic role of regression. Front Neurosci 2023; 17:1232459. [PMID: 37869510 PMCID: PMC10587586 DOI: 10.3389/fnins.2023.1232459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/18/2023] [Indexed: 10/24/2023] Open
Abstract
The ego is one of the most central psychological constructs in psychedelic research and a key factor in psychotherapy, including psychedelic-assisted forms of psychotherapy. Despite its centrality, the ego-construct remains ambiguous in the psychedelic literature. Therefore, we here review the theoretical background of the ego-construct with focus on its psychodynamic conceptualization. We discuss major functions of the ego including ego boundaries, defenses, and synthesis, and evaluate the role of the ego in psychedelic drug action. According to the psycholytic paradigm, psychedelics are capable of inducing regressed states of the ego that are less protected by the ego's usual defensive apparatus. In such states, core early life conflicts may emerge that have led to maladaptive ego patterns. We use the psychodynamic term character in this paper as a potential site of change and rearrangement; character being the chronic and habitual patterns the ego utilizes to adapt to the everyday challenges of life, including a preferred set of defenses. We argue that in order for psychedelic-assisted therapy to successfully induce lasting changes to the ego's habitual patterns, it must psycholytically permeate the characterological core of the habits. The primary working principle of psycholytic therapy therefore is not the state of transient ego regression alone, but rather the regressively favored emotional integration of those early life events that have shaped the foundation, development, and/or rigidification of a person's character - including his or her defense apparatus. Aiming for increased flexibility of habitual ego patterns, the psycholytic approach is generally compatible with other forms of psychedelic-assisted therapy, such as third wave cognitive behavioral approaches.
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Affiliation(s)
- Tobias Buchborn
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Hannes S. Kettner
- Centre for Psychedelic Research, Department of Medicine, Imperial College London, London, United Kingdom
- Psychedelics Division, Neuroscape, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Laura Kärtner
- Centre for Psychedelic Research, Department of Medicine, Imperial College London, London, United Kingdom
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Marcus W. Meinhardt
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
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5
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Ley L, Holze F, Arikci D, Becker AM, Straumann I, Klaiber A, Coviello F, Dierbach S, Thomann J, Duthaler U, Luethi D, Varghese N, Eckert A, Liechti ME. Comparative acute effects of mescaline, lysergic acid diethylamide, and psilocybin in a randomized, double-blind, placebo-controlled cross-over study in healthy participants. Neuropsychopharmacology 2023; 48:1659-1667. [PMID: 37231080 PMCID: PMC10517157 DOI: 10.1038/s41386-023-01607-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
Mescaline, lysergic acid diethylamide (LSD), and psilocybin are classic serotonergic psychedelics. A valid, direct comparison of the effects of these substances is lacking. The main goal of the present study was to investigate potential pharmacological, physiological and phenomenological differences at psychoactive-equivalent doses of mescaline, LSD, and psilocybin. The present study used a randomized, double-blind, placebo-controlled, cross-over design to compare the acute subjective effects, autonomic effects, and pharmacokinetics of typically used, moderate to high doses of mescaline (300 and 500 mg), LSD (100 µg), and psilocybin (20 mg) in 32 healthy participants. A mescaline dose of 300 mg was used in the first 16 participants and 500 mg was used in the subsequent 16 participants. Acute subjective effects of 500 mg mescaline, LSD, and psilocybin were comparable across various psychometric scales. Autonomic effects of 500 mg mescaline, LSD, and psilocybin were moderate, with psilocybin causing a higher increase in diastolic blood pressure compared with LSD, and LSD showing a trend toward an increase in heart rate compared with psilocybin. The tolerability of mescaline, LSD, and psilocybin was comparable, with mescaline at both doses inducing slightly more subacute adverse effects (12-24 h) than LSD and psilocybin. Clear distinctions were seen in the duration of action between the three substances. Mescaline had the longest effect duration (mean: 11.1 h), followed by LSD (mean: 8.2 h), and psilocybin (mean: 4.9 h). Plasma elimination half-lives of mescaline and LSD were similar (approximately 3.5 h). The longer effect duration of mescaline compared with LSD was due to the longer time to reach maximal plasma concentrations and related peak effects. Mescaline and LSD, but not psilocybin, enhanced circulating oxytocin. None of the substances altered plasma brain-derived neurotrophic factor concentrations. In conclusion, the present study found no evidence of qualitative differences in altered states of consciousness that were induced by equally strong doses of mescaline, LSD, and psilocybin. The results indicate that any differences in the pharmacological profiles of mescaline, LSD, and psilocybin do not translate into relevant differences in the subjective experience. ClinicalTrials.gov identifier: NCT04227756.
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Affiliation(s)
- Laura Ley
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Friederike Holze
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Denis Arikci
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Anna M Becker
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Isabelle Straumann
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Aaron Klaiber
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Fabio Coviello
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Sophie Dierbach
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Jan Thomann
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Urs Duthaler
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Dino Luethi
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Nimmy Varghese
- Psychiatric University Hospital, University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Anne Eckert
- Psychiatric University Hospital, University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Matthias E Liechti
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
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6
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Doss MK, de Wit H, Gallo DA. The Acute Effects of Psychoactive Drugs on Emotional Episodic Memory Encoding, Consolidation, and Retrieval. Neurosci Biobehav Rev 2023; 150:105188. [PMID: 37085021 DOI: 10.1016/j.neubiorev.2023.105188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
Psychoactive drugs modulate learning and emotional processes in ways that could impact their recreational and medical use. Recent work has revealed how drugs impact different stages of processing emotional episodic memories, specifically encoding (forming memories), consolidation (stabilizing memories), and retrieval (accessing memories). Drugs administered before encoding may preferentially impair (e.g., GABAA sedatives including alcohol and benzodiazepines, Δ9-tetrahydrocannabinol or THC, ketamine), enhance (e.g., dextroamphetamine and dextromethamphetamine), or both impair and enhance (i.e., ±3,4-methylenedioxymethylamphetamine or MDMA) emotionally negative and positive compared to neutral memories. GABAA sedatives administered immediately post-encoding (during consolidation) can preferentially enhance emotional memories, though this selectivity may decline or even reverse (i.e., preferential enhancement of neutral memories) as the delay between encoding and retrieval increases. Finally, retrieving memories under the effects of THC, dextroamphetamine, MDMA, and perhaps GABAA sedatives distorts memory, with potentially greater selectively for emotional (especially positive) memories. We review these effects, propose neural mechanisms, discuss methodological considerations for future work, and speculate how drug effects on emotional episodic memory may contribute to drug use and abuse.
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Affiliation(s)
- Manoj K Doss
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic & Consciousness Research.
| | - Harriet de Wit
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
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7
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VanderZwaag J, Halvorson T, Dolhan K, Šimončičová E, Ben-Azu B, Tremblay MÈ. The Missing Piece? A Case for Microglia's Prominent Role in the Therapeutic Action of Anesthetics, Ketamine, and Psychedelics. Neurochem Res 2023; 48:1129-1166. [PMID: 36327017 DOI: 10.1007/s11064-022-03772-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
There is much excitement surrounding recent research of promising, mechanistically novel psychotherapeutics - psychedelic, anesthetic, and dissociative agents - as they have demonstrated surprising efficacy in treating central nervous system (CNS) disorders, such as mood disorders and addiction. However, the mechanisms by which these drugs provide such profound psychological benefits are still to be fully elucidated. Microglia, the CNS's resident innate immune cells, are emerging as a cellular target for psychiatric disorders because of their critical role in regulating neuroplasticity and the inflammatory environment of the brain. The following paper is a review of recent literature surrounding these neuropharmacological therapies and their demonstrated or hypothesized interactions with microglia. Through investigating the mechanism of action of psychedelics, such as psilocybin and lysergic acid diethylamide, ketamine, and propofol, we demonstrate a largely under-investigated role for microglia in much of the emerging research surrounding these pharmacological agents. Among others, we detail sigma-1 receptors, serotonergic and γ-aminobutyric acid signalling, and tryptophan metabolism as pathways through which these agents modulate microglial phagocytic activity and inflammatory mediator release, inducing their therapeutic effects. The current review includes a discussion on future directions in the field of microglial pharmacology and covers bidirectional implications of microglia and these novel pharmacological agents in aging and age-related disease, glial cell heterogeneity, and state-of-the-art methodologies in microglial research.
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Affiliation(s)
- Jared VanderZwaag
- Neuroscience Graduate Program, University of Victoria, Victoria, BC, Canada
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Torin Halvorson
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Kira Dolhan
- Department of Psychology, University of Victoria, Vancouver, BC, Canada
- Department of Biology, University of Victoria, Vancouver, BC, Canada
| | - Eva Šimončičová
- Neuroscience Graduate Program, University of Victoria, Victoria, BC, Canada
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Benneth Ben-Azu
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Marie-Ève Tremblay
- Neuroscience Graduate Program, University of Victoria, Victoria, BC, Canada.
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
- Département de médecine moléculaire, Université Laval, Québec City, QC, Canada.
- Axe Neurosciences, Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada.
- Neurology and Neurosurgery Department, McGill University, Montreal, QC, Canada.
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada.
- Centre for Advanced Materials and Related Technology (CAMTEC), University of Victoria, Victoria, BC, Canada.
- Institute for Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada.
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von Rotz R, Schindowski EM, Jungwirth J, Schuldt A, Rieser NM, Zahoranszky K, Seifritz E, Nowak A, Nowak P, Jäncke L, Preller KH, Vollenweider FX. Single-dose psilocybin-assisted therapy in major depressive disorder: A placebo-controlled, double-blind, randomised clinical trial. EClinicalMedicine 2023; 56:101809. [PMID: 36636296 PMCID: PMC9830149 DOI: 10.1016/j.eclinm.2022.101809] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Psilocybin has been suggested as a novel, rapid-acting treatment for depression. Two consecutive doses have been shown to markedly decrease symptom severity in an open-label setting or when compared to a waiting list group. To date, to our knowledge, no other trial compared a single, moderate dose of psilocybin to a placebo condition. METHODS In this double-blind, randomised clinical trial, 52 participants diagnosed with major depressive disorder and no unstable somatic conditions were allocated to receive either a single, moderate dose (0.215 mg/kg body weight) of psilocybin or placebo in conjunction with psychological support. MADRS and BDI scores were assessed to estimate depression severity, while changes from baseline to 14 days after the intervention were defined as primary endpoints. The trial took place between April 11th, 2019 and October 12th, 2021 at the psychiatric university hospital in Zürich, Switzerland and was registered with clinicaltrials.gov (NCT03715127). FINDINGS The psilocybin condition showed an absolute decrease in symptom severity of -13.0 points compared to baseline and were significantly larger than those in the placebo condition (95% CI -15.0 to -1.3; Cohens' d = 0.97; P = 0.0011; MADRS) and -13.2 points (95% CI; -13.4 to -1.3; Cohens' d = 0.67; P = 0.019; BDI) 14 days after the intervention. 14/26 (54%) participants met the MADRS remission criteria in the psilocybin condition. INTERPRETATION These results suggest that a single, moderate dose of psilocybin significantly reduces depressive symptoms compared to a placebo condition for at least two weeks. No serious adverse events were recorded. Larger, multi-centric trials with longer follow-up periods are needed to inform further optimisation of this novel treatment paradigm. FUNDING The study was funded by the Swiss National Science Foundation, Crowdfunding, the Swiss Neuromatrix Foundation, and the Heffter Research Institute.
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Affiliation(s)
- Robin von Rotz
- Neurophenomenology of Consciousness Lab, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
- Corresponding author.
| | - Eva M. Schindowski
- Neurophenomenology of Consciousness Lab, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Johannes Jungwirth
- Neurophenomenology of Consciousness Lab, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Anna Schuldt
- Neurophenomenology of Consciousness Lab, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Nathalie M. Rieser
- Neurophenomenology of Consciousness Lab, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Katharina Zahoranszky
- Neurophenomenology of Consciousness Lab, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Albina Nowak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Peter Nowak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Lutz Jäncke
- Division Neuropsychology, Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Katrin H. Preller
- Neurophenomenology of Consciousness Lab, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Franz X. Vollenweider
- Neurophenomenology of Consciousness Lab, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
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Scholkmann F, Vollenweider FX. Psychedelics and fNIRS neuroimaging: exploring new opportunities. NEUROPHOTONICS 2023; 10:013506. [PMID: 36474478 PMCID: PMC9717437 DOI: 10.1117/1.nph.10.1.013506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
In this Outlook paper, we explain to the optical neuroimaging community as well as the psychedelic research community the great potential of using optical neuroimaging with functional near-infrared spectroscopy (fNIRS) to further explore the changes in brain activity induced by psychedelics. We explain why we believe now is the time to exploit the momentum of the current resurgence of research on the effects of psychedelics and the momentum of the increasing progress and popularity of the fNIRS technique to establish fNIRS in psychedelic research. With this article, we hope to contribute to this development.
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Affiliation(s)
- Felix Scholkmann
- University Hospital Zurich, University of Zurich, Biomedical Optics Research Laboratory, Department of Neonatology, Zurich, Switzerland
- University of Bern, Institute of Complementary and Integrative Medicine, Bern, Switzerland
| | - Franz X. Vollenweider
- University Hospital of Psychiatry, University of Zurich, Neuropsychopharmacology and Brain Imaging, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
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10
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Urban MM, Stingl MR, Meinhardt MW. Mini-review: The neurobiology of treating substance use disorders with classical psychedelics. Front Neurosci 2023; 17:1156319. [PMID: 37139521 PMCID: PMC10149865 DOI: 10.3389/fnins.2023.1156319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 05/05/2023] Open
Abstract
The potential of psychedelics to persistently treat substance use disorders is known since the 1960s. However, the biological mechanisms responsible for their therapeutic effects have not yet been fully elucidated. While it is known that serotonergic hallucinogens induce changes in gene expression and neuroplasticity, particularly in prefrontal regions, theories on how specifically this counteracts the alterations that occur in neuronal circuitry throughout the course of addiction are largely unknown. This narrative mini-review endeavors to synthesize well-established knowledge from addiction research with findings and theories regarding the neurobiological effects of psychedelics to give an overview of the potential mechanisms that underlie the treatment of substance use disorders with classical hallucinogenic compounds and point out gaps in the current understanding.
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Affiliation(s)
- Marvin M. Urban
- Interdisciplinary Center for Neurosciences, University of Heidelberg, Heidelberg, Germany
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
- *Correspondence: Marvin M. Urban,
| | - Moritz R. Stingl
- Interdisciplinary Center for Neurosciences, University of Heidelberg, Heidelberg, Germany
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | - Marcus W. Meinhardt
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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11
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Muacevic A, Adler JR. Potential Therapeutic Effects of Psilocybin: A Systematic Review. Cureus 2022; 14:e30214. [PMID: 36381758 PMCID: PMC9650681 DOI: 10.7759/cureus.30214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
Abstract
Psilocybin is a plant alkaloid that is derived from precursors of tryptamine and is present in many different types of mushrooms. It has been utilized by indigenous peoples of Central and South America for centuries in a ceremonial setting to promote spiritual experiences. Indigenous societies have long employed psilocybin and other 5-HT 2A agonist classic psychedelics in their rites. They were a focus in psychiatry in the middle of the 20th century as both experimental medicines and tools for studying brain function. Due to the fact that traditional psychedelics were being used for purposes other than medical research and in connection with the burgeoning counterculture by the late 1960s and early 1970s, these scientific investigations fell out of favor. However, thanks to a number of encouraging studies that validated the earlier research, interest in traditional psychedelics has surged among scientists in the 21st century. In this review, we examine therapeutic studies on psilocybin, the traditional psychedelic that has received the lion's share of recent attention. According to three controlled studies, psilocybin may reduce symptoms of depression and anxiety in the context of cancer-related psychological discomfort for at least six months after a single acute treatment for mood and anxiety disorders. Three months after two acute doses, individuals in a small, open-label study with treatment-resistant depression reported fewer depressive and anxiety symptoms. Small, open-label pilot studies on addiction have demonstrated encouraging success rates for alcohol and cigarette addiction. The review also briefly discusses the synthesis, mechanism of action, effects, molecular pharmacology, adverse effects, and contraindications of psilocybin.
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Bogenschutz MP, Ross S, Bhatt S, Baron T, Forcehimes AA, Laska E, Mennenga SE, O’Donnell K, Owens LT, Podrebarac S, Rotrosen J, Tonigan JS, Worth L. Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:953-962. [PMID: 36001306 PMCID: PMC9403854 DOI: 10.1001/jamapsychiatry.2022.2096] [Citation(s) in RCA: 164] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Although classic psychedelic medications have shown promise in the treatment of alcohol use disorder (AUD), the efficacy of psilocybin remains unknown. OBJECTIVE To evaluate whether 2 administrations of high-dose psilocybin improve the percentage of heavy drinking days in patients with AUD undergoing psychotherapy relative to outcomes observed with active placebo medication and psychotherapy. DESIGN, SETTING, AND PARTICIPANTS In this double-blind randomized clinical trial, participants were offered 12 weeks of manualized psychotherapy and were randomly assigned to receive psilocybin vs diphenhydramine during 2 day-long medication sessions at weeks 4 and 8. Outcomes were assessed over the 32-week double-blind period following the first dose of study medication. The study was conducted at 2 academic centers in the US. Participants were recruited from the community between March 12, 2014, and March 19, 2020. Adults aged 25 to 65 years with a DSM-IV diagnosis of alcohol dependence and at least 4 heavy drinking days during the 30 days prior to screening were included. Exclusion criteria included major psychiatric and drug use disorders, hallucinogen use, medical conditions that contraindicated the study medications, use of exclusionary medications, and current treatment for AUD. INTERVENTIONS Study medications were psilocybin, 25 mg/70 kg, vs diphenhydramine, 50 mg (first session), and psilocybin, 25-40 mg/70 kg, vs diphenhydramine, 50-100 mg (second session). Psychotherapy included motivational enhancement therapy and cognitive behavioral therapy. MAIN OUTCOMES AND MEASURES The primary outcome was percentage of heavy drinking days, assessed using a timeline followback interview, contrasted between groups over the 32-week period following the first administration of study medication using multivariate repeated-measures analysis of variance. RESULTS A total of 95 participants (mean [SD] age, 46 [12] years; 42 [44.2%] female) were randomized (49 to psilocybin and 46 to diphenhydramine). One participant (1.1%) was American Indian/Alaska Native, 3 (3.2%) were Asian, 4 (4.2%) were Black, 14 (14.7%) were Hispanic, and 75 (78.9%) were non-Hispanic White. Of the 95 randomized participants, 93 received at least 1 dose of study medication and were included in the primary outcome analysis. Percentage of heavy drinking days during the 32-week double-blind period was 9.7% for the psilocybin group and 23.6% for the diphenhydramine group, a mean difference of 13.9%; (95% CI, 3.0-24.7; F1,86 = 6.43; P = .01). Mean daily alcohol consumption (number of standard drinks per day) was also lower in the psilocybin group. There were no serious adverse events among participants who received psilocybin. CONCLUSIONS AND RELEVANCE Psilocybin administered in combination with psychotherapy produced robust decreases in percentage of heavy drinking days over and above those produced by active placebo and psychotherapy. These results provide support for further study of psilocybin-assisted treatment for AUD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02061293.
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Affiliation(s)
- Michael P. Bogenschutz
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - Stephen Ross
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - Snehal Bhatt
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque
| | - Tara Baron
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | | | - Eugene Laska
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York,Department of Population Health, Division of Biostatistics, New York University Grossman School of Medicine, New York
| | - Sarah E. Mennenga
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - Kelley O’Donnell
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - Lindsey T. Owens
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York,Department of Psychology, University of Alabama at Birmingham
| | - Samantha Podrebarac
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - John Rotrosen
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - J. Scott Tonigan
- University of New Mexico Center on Alcohol, Substance Use and Addictions, Albuquerque
| | - Lindsay Worth
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque
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Microdosing with psilocybin mushrooms: a double-blind placebo-controlled study. Transl Psychiatry 2022; 12:307. [PMID: 35918311 PMCID: PMC9346139 DOI: 10.1038/s41398-022-02039-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 12/12/2022] Open
Abstract
The use of low sub-perceptual doses of psychedelics ("microdosing") has gained popularity in recent years. Although anecdotal reports claim multiple benefits associated with this practice, the lack of placebo-controlled studies severely limits our knowledge of microdosing and its effects. Moreover, research conducted in standard laboratory settings could fail to capture the motivation of individuals engaged or planning to engage in microdosing protocols, thus underestimating the likelihood of positive effects on creativity and cognitive function. We recruited 34 individuals starting to microdose with psilocybin mushrooms (Psilocybe cubensis), one of the materials most frequently used for this purpose. Following a double-blind placebo-controlled experimental design, we investigated the acute and short-term effects of 0.5 g of dried mushrooms on subjective experience, behavior, creativity (divergent and convergent thinking), perception, cognition, and brain activity. The reported acute effects were significantly more intense for the active dose compared to the placebo, but only for participants who correctly identified their experimental condition. These changes were accompanied by reduced EEG power in the theta band, together with preserved levels of Lempel-Ziv broadband signal complexity. For all other measurements there was no effect of microdosing except for few small changes towards cognitive impairment. According to our findings, low doses of psilocybin mushrooms can result in noticeable subjective effects and altered EEG rhythms, but without evidence to support enhanced well-being, creativity and cognitive function. We conclude that expectation underlies at least some of the anecdotal benefits attributed to microdosing with psilocybin mushrooms.
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Basedow LA, Kuitunen‐Paul S. Motives for the use of serotonergic psychedelics: A systematic review. Drug Alcohol Rev 2022; 41:1391-1403. [DOI: 10.1111/dar.13480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Sören Kuitunen‐Paul
- Department of Clinical Psychology and Psychotherapy Technische Universität Chemnitz Chemnitz Germany
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15
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The psychological processes of classic psychedelics in the treatment of depression: a systematic review protocol. Syst Rev 2022; 11:85. [PMID: 35513876 PMCID: PMC9074259 DOI: 10.1186/s13643-022-01930-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is currently renewed interest in the use of psychedelic therapy in the treatment of psychiatric disorders, including depression. The proposed systematic review will aim to identify, evaluate and summarise the psychological processes of change underlying psychedelic therapy for depression in the current literature and consider the implications these processes may have on the psychotherapy component of treatment. METHODS Scopus, PsycINFO, PubMed and Web of Science databases will be searched using relevant terms. Studies will be included if they discuss the use of a classic psychedelic to treat depression symptomology in an adult population and report or propose psychological processes responsible for depression symptom change. Two authors will independently screen articles, complete quality assessment tools and conduct data extraction. Empirical and non-empirical research will be extracted and synthesised separately. A narrative synthesis approach will be used to report psychological processes identified in the literature. DISCUSSION This systematic review will be the first to collate available evidence on the psychological processes associated with psychedelic therapy for depression. The preliminary nature of this research field is expected to result in the review having several limitations, namely heterogeneity between studies and the inclusion of limited empirical research. We intend for this review to present the current state of the literature, identify gaps and generate candidate variables that warrant further investigation. SYSTEMATIC REVIEW PROSPERO CRD42020197202.
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Ortiz CE, Dourron HM, Sweat NW, Garcia-Romeu A, MacCarthy S, Anderson BT, Hendricks PS. Special considerations for evaluating psilocybin-facilitated psychotherapy in vulnerable populations. Neuropharmacology 2022; 214:109127. [DOI: 10.1016/j.neuropharm.2022.109127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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17
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Tagliazucchi E. Language as a Window Into the Altered State of Consciousness Elicited by Psychedelic Drugs. Front Pharmacol 2022; 13:812227. [PMID: 35392561 PMCID: PMC8980225 DOI: 10.3389/fphar.2022.812227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/01/2022] [Indexed: 11/22/2022] Open
Abstract
Psychedelics are drugs capable of eliciting profound alterations in the subjective experience of the users, sometimes with long-lasting consequences. Because of this, psychedelic research tends to focus on human subjects, given their capacity to construct detailed narratives about the contents of their consciousness experiences. In spite of its relevance, the interaction between serotonergic psychedelics and language production is comparatively understudied in the recent literature. This review is focused on two aspects of this interaction: how the acute effects of psychedelic drugs impact on speech organization regardless of its semantic content, and how to characterize the subjective effects of psychedelic drugs by analyzing the semantic content of written retrospective reports. We show that the computational characterization of language production is capable of partially predicting the therapeutic outcome of individual experiences, relate the effects elicited by psychedelics with those associated with other altered states of consciousness, draw comparisons between the psychedelic state and the symptomatology of certain psychiatric disorders, and investigate the neurochemical profile and mechanism of action of different psychedelic drugs. We conclude that researchers studying psychedelics can considerably expand the range of their potential scientific conclusions by analyzing brief interviews obtained before, during and after the acute effects. Finally, we list a series of questions and open problems that should be addressed to further consolidate this approach.
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Affiliation(s)
- Enzo Tagliazucchi
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibanez, Santiago, Chile.,Departamento de Física, Universidad de Buenos Aires and Instituto de Física de Buenos Aires (IFIBA, CONICET), Pabellón I, Ciudad Universitaria (1428), Buenos Aires, Argentina
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18
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Rossi GN, Dias ICDS, Baker G, Bouso Saiz JC, Dursun SM, Hallak JEC, Dos Santos RG. Ayahuasca, a potentially rapid acting antidepressant: focus on safety and tolerability. Expert Opin Drug Saf 2022; 21:789-801. [PMID: 35301934 DOI: 10.1080/14740338.2022.2054988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Ayahuasca is a psychedelic brew originally used by indigenous tribes from the Amazon Rainforest and in religious rituals. Pre-clinical and observational studies have demonstrated its possible potential as an antidepressant, and open and placebo-controlled clinical trials corroborated these results. For it to become an approved treatment for depression, its safety and tolerability need to be assessed and documented. AREAS COVERED We have gathered data regarding occurrence of adverse events (AEs) in all reported randomized, placebo-controlled trials with healthy and clinical populations involving ayahuasca administration (n = 108 ayahuasca administrations). We systematically categorized these results, recorded their prevalence and discussed the possible mechanisms related to their emergence. EXPERT OPINION : There were no reports of serious AEs, indicating a relative safety of ayahuasca administration in controlled settings. Most common AEs related to ayahuasca administration included nausea, vomiting, headaches and transient increases in cardiovascular measurements. Ayahuasca research is still in its infancy, especially concerning the absence of large and robust clinical trials to verify its antidepressant effects. Dose standardization, legal prohibition of the possession of its alkaloids and how traditional communities will be compensated if ayahuasca becomes an approved medicine are the biggest obstacles to overcome for its future use in the therapeutic context.
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Affiliation(s)
- Giordano Novak Rossi
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Glen Baker
- National Institute for Translational Medicine (INCT-TM) CNPq, Brazil.,Department of Psychiatry (Neurochemical Research Unit) and Neuroscience & Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - José Carlos Bouso Saiz
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Research and Services, ICEERS International Center for Ethnobotanical Education ,Barcelona, Spain.,Medical Anthopology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Spain
| | - Serdar M Dursun
- National Institute for Translational Medicine (INCT-TM) CNPq, Brazil.,Department of Psychiatry (Neurochemical Research Unit) and Neuroscience & Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jaime E C Hallak
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,National Institute for Translational Medicine (INCT-TM) CNPq, Brazil.,Department of Psychiatry (Neurochemical Research Unit) and Neuroscience & Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rafael G Dos Santos
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,National Institute for Translational Medicine (INCT-TM) CNPq, Brazil.,Research and Services, ICEERS International Center for Ethnobotanical Education ,Barcelona, Spain
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19
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Duerler P, Vollenweider FX, Preller KH. A neurobiological perspective on social influence: Serotonin and social adaptation. J Neurochem 2022; 162:60-79. [PMID: 35274296 PMCID: PMC9322456 DOI: 10.1111/jnc.15607] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 01/09/2023]
Abstract
Humans are inherently social beings. Being suggestible to each other's expectations enables pro-social skills that are crucial for social learning and adaptation. Despite its high relevance for psychiatry, the neurobiological mechanisms underlying social adaptation are still not well understood. This review therefore provides a conceptual framework covering various distinct mechanisms underlying social adaptation and explores the neuropharmacology - in particular the role of the serotonin (5-HT) system - modulating these mechanisms. This article therefore reviews empirical results on social influence processing and reconciles them with recent findings from psychedelic research on social processing to elucidate neurobiological and neuropharmacological underpinnings of social adaptation. Various computational, neurobiological, and neurochemical processes are involved in distinct mechanisms underlying social adaptation such as the multisensory process of social information integration that is crucial for the forming of self-representation and representations of social norms. This is again associated with self- and other-perception during social interactions as well as value-based decision making that guides our behaviour in daily interactions. We highlight the critical role of 5-HT in these processes and suggest that 5-HT can facilitate social learning and may represent an important target for treating psychiatric disorders characterized by impairments in social functioning. This framework also has important implications for psychedelic-assisted therapy as well as for the development of novel treatment approaches and future research directions.
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Affiliation(s)
- Patricia Duerler
- Neuropsychopharmacology and Brain Imaging, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry Zurich, Lenggstr. 31, Zurich, Switzerland
| | - Franz X Vollenweider
- Neuropsychopharmacology and Brain Imaging, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry Zurich, Lenggstr. 31, Zurich, Switzerland
| | - Katrin H Preller
- Neuropsychopharmacology and Brain Imaging, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry Zurich, Lenggstr. 31, Zurich, Switzerland
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Gründer G, Brand M, Kärtner L, Scharf D, Schmitz C, Spangemacher M, Mertens LJ. Sind Psychedelika schnell wirksame Antidepressiva? DER NERVENARZT 2022; 93:254-262. [DOI: 10.1007/s00115-021-01255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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21
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Sakurai H, Yonezawa K, Tani H, Mimura M, Bauer M, Uchida H. Novel Antidepressants in the Pipeline (Phase II and III): A Systematic Review of the US Clinical Trials Registry. PHARMACOPSYCHIATRY 2022; 55:193-202. [PMID: 35045580 PMCID: PMC9259184 DOI: 10.1055/a-1714-9097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction
There is an imminent need for faster-acting and more
effective antidepressants beyond the monoaminergic hypothesis.
Methods
We systematically searched the US Clinical Trials registry for
antidepressant compounds with completed phase II and III trials. Compounds that
demonstrated significant superiority over placebo in the primary outcome measure
in the latest phase of phase II and III trials were identified. The collateral
information was gathered via a PubMed search and press releases.
Results
Nine compounds were identified. AXS-05 (a combination of
dextromethorphan and bupropion) and ansofaxine hydrochloride showed a positive
result over placebo in a phase III study for major depressive disorder or
treatment-resistant depression. MIJ821, nitrous oxide, psilocybin, ayahuasca,
facial injection of botulinum toxin A, prasterone, and casopitant demonstrated
at least one positive result in phase II trials. Ayahuasca showed a greater
response rate than placebo at week one, indicating the rapid antidepressant
effect.
Discussion
These new compounds with novel mechanisms of action are
expected to provide a greater variety of treatment options for depression if
preliminary positive results are confirmed.
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Affiliation(s)
- Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Kengo Yonezawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Neuropsychiatry, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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22
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Basedow LA, Riemer TG, Reiche S, Kreutz R, Majić T. Neuropsychological Functioning in Users of Serotonergic Psychedelics - A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:739966. [PMID: 34603053 PMCID: PMC8481924 DOI: 10.3389/fphar.2021.739966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/01/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Serotonergic psychedelics (SPs) like LSD, psilocybin, DMT, and mescaline are a heterogeneous group of substances that share agonism at 5-HT2a receptors. Besides the ability of these substances to facilitate profoundly altered states of consciousness, persisting psychological effects have been reported after single administrations, which outlast the acute psychedelic effects. In this review and meta-analysis, we investigated if repeated SP use associates with a characteristic neuropsychological profile indicating persisting effects on neuropsychological function. Methods: We conducted a systematic review of studies investigating the neuropsychological performance in SP users, searching studies in Medline, Web of Science, embase, ClinicalTrials.gov, and EudraCT. Studies were included if they reported at least one neuropsychological measurement in users of SPs. Studies comparing SP users and non-users that reported mean scores and standard deviations were included in an exploratory meta-analysis. Results: 13 studies (N = 539) published between 1969 and 2020 were included in this systematic review. Overall, we found that only three SPs were specifically investigated: ayahuasca (6 studies, n = 343), LSD (5 studies, n = 135), and peyote (1 study, n = 61). However, heterogeneity of the methodological quality was high across studies, with matching problems representing the most important limitation. Across all SPs, no uniform pattern of neuropsychological impairment was identified. Rather, the individual SPs seemed to be associated with distinct neuropsychological profiles. For instance, one study (n = 42) found LSD users to perform worse in trials A and B of the Trail-Making task, whereas meta-analytic assessment (5 studies, n = 352) of eleven individual neuropsychological measures indicated a better performance of ayahuasca users in the Stroop incongruent task (p = 0.03) and no differences in the others (all p > 0.05). Conclusion: The majority of the included studies were not completely successful in controlling for confounders such as differences in non-psychedelic substance use between SP-users and non-users. Our analysis suggests that LSD, ayahuasca and peyote may have different neuropsychological consequences associated with their use. While LSD users showed reduced executive functioning and peyote users showed no differences across domains, there is some evidence that ayahuasca use is associated with increased executive functioning.
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Affiliation(s)
- Lukas A. Basedow
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Thomas G. Riemer
- Institute of Clinical Pharmacology and Toxicology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Reiche
- Department of Psychiatry and Psychotherapy, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Tomislav Majić
- Department of Psychiatry and Psychotherapy, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Gründer G. Psychedelics: A New Treatment Paradigm in Psychiatry? PHARMACOPSYCHIATRY 2021; 54:149-150. [PMID: 34169501 DOI: 10.1055/a-1520-5020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The renaissance of psychedelics has accelerated further over the past year. At least that's true if you follow the public press. The New York Times recently titled "The Psychedelic Revolution Is Coming. Psychiatry May Never Be the Same." on its front page 1.
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Affiliation(s)
- Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Gründer G, Jungaberle H. The Potential Role of Psychedelic Drugs in Mental Health Care of the Future. PHARMACOPSYCHIATRY 2021; 54:191-199. [PMID: 33979868 DOI: 10.1055/a-1486-7386] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Serotonergic psychedelics such as psilocybin, lysergic acid diethylamide (LSD), or dimethyltryptamine (DMT), as well as psychoactive drugs that trigger phenomenologically- related experiences like 3,4-methylenedioxymethamphetamine (MDMA) and ketamine, belong to the most promising treatment approaches in contemporary psychiatry. Psychedelic-assisted psychotherapy is not only a new treatment paradigm in psychopharmacology, but it also requires a redefinition of psychotherapeutic processes and the contextualization of psychopharmacological interventions within a new treatment infrastructure. Crucial for future practice and research in the field are (1) informed patient referral and co-treatment practices, (2) screening (e. g., choosing the right patients for these therapies), (3) the dosing preparation sessions, (4) the assisted dosing sessions as well as after-care procedures such as (5) psychological integration and (6) supporting the development of structured patient communities. Definition of future treatment delivery infrastructures and requirements for therapist training are further challenges for research and practice. Finally, the implementation of psychedelic-assisted psychotherapy in routine mental health care must be embedded into public communication about the potential and risks of these innovative therapeutic approaches. This paper provides a synopsis of challenges for practitioners, researchers, and regulators to be addressed in the approval processes of psychedelics.
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Affiliation(s)
- Gerhard Gründer
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,OVID Health Systems GmbH, Berlin, Germany
| | - Henrik Jungaberle
- OVID Health Systems GmbH, Berlin, Germany.,MIND Foundation gGmbH, Berlin, Germany
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