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Stanger MK, Soffer HO, Bryan AD, Skrzynski CJ. Comparing Cannabis Use Motivations and Dependence Across Regular Cannabis Users Who Have or Have Not Recently Used Psilocybin. Cannabis Cannabinoid Res 2024. [PMID: 38885938 DOI: 10.1089/can.2024.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
Introduction: In Colorado, both cannabis and psilocybin are legal and becoming more commonly used. However, there is almost no research detailing the public health concerns regarding negative outcomes (e.g., dependence) of cannabis and psilocybin co-use and motives that may perpetuate these negative outcomes (e.g., coping, boredom). Methods: Using data from a larger observational study on cannabis and metabolic processes, regular cannabis users (use ≥7 times/month; n = 97, 35.1% female, 89.7% WHITE) who used psilocybin in the past 3 months (n = 34) were compared with those who had not used psilocybin in the past 3 months (n = 63) on cannabis dependence as measured by the Marijuana Dependence Scale and endorsement of 12 cannabis motives from the Comprehensive Marijuana Motives Questionnaire. Correlations between motives and dependence were also examined and compared across groups. Results: Findings revealed that individuals who had recently used psilocybin had greater cannabis dependence scores than those who had not used recently [F (1, 95) = 5.53, p = 0.02], and more strongly endorsed that their cannabis use was motivated by enjoyment [F (1, 91) = 4.31, p = 0.04], boredom [F (1, 91) = 9.10, p < 0.01], and availability [F (1, 91) = 9.46, p < 0.01]. Correlations between dependence scores and coping and boredom motives were also significantly positive for both groups (all p values <0.05) whereas positive correlations with experimentation, celebration, and availability motives were only significant for recent psilocybin users (all p values <0.05). Discussion: These results suggest there are motivational differences for cannabis use among those who co-use cannabis and psilocybin, and there may be a greater risk for harm for these individuals.
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Affiliation(s)
- Madeline K Stanger
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Harmony O Soffer
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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Hatfield SP, Thornton NL, Greenstien K, Glozier N. A taxonomy of regulatory and policy matters relevant to psychedelic-assisted therapy in Australia. Aust N Z J Psychiatry 2024:48674241240597. [PMID: 38628079 DOI: 10.1177/00048674241240597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVES The Australian government recently rescheduled psilocybin and 3,4-methylenedioxymethamphetamine for limited clinical uses. This change has raised various regulatory concerns and challenges for the field of psychedelic-assisted therapy. To provide clarity, we aimed to comprehensively catalogue the matters relating to psychedelic-assisted therapy that are or could be regulated. METHODS We conducted a desktop review of the literature and current regulatory sources, semi-structured interviews with professionals who had expertise in fields relating to psychedelic-assisted therapy and a framework analysis to generate a taxonomy of relevant regulatory matters. In relation to each matter, we further identified what type of regulation (if any) currently applies to that matter, any uncertainty as to how the matter should be addressed in clinical practice in the context of current regulation and whether there are conflicting views as to how the matter could or should be further regulated. RESULTS The taxonomy is structured into six main regulatory domains, three of which have a substantial proportion of matters with uncertainty or conflicting views: Service Establishment, Practitioner, and Treatment Delivery. Key examples of such matters include the location of services and facilities required, which professionals are eligible to become psychedelic therapists, and with what qualifications and experience. Matters in the remaining three domains, Patient Evaluation, Drug Supply and Service Oversight, appear by comparison relatively settled, with regulation either well-established or thought unnecessary. CONCLUSIONS The taxonomy provides a roadmap for health services establishing and implementing a psychedelic-assisted therapy program, or for government and other policymakers when determining areas that may require further regulation.
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Affiliation(s)
- Samuel P Hatfield
- Psychological Medicine, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nicollette Lr Thornton
- Psychological Medicine, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- Australian Research Council's Centre of Excellence for Children and Families over the Life Course, Sydney, NSW, Australia
| | - Kayla Greenstien
- Australian Research Council's Centre of Excellence for Children and Families over the Life Course, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Nick Glozier
- Psychological Medicine, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- Australian Research Council's Centre of Excellence for Children and Families over the Life Course, Sydney, NSW, Australia
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Wilkes R, Roberts DM, Liknaitzky P, Brett J. The psychedelic call: analysis of Australian Poisons Information Centre calls associated with classic psychedelics. Clin Toxicol (Phila) 2024; 62:242-247. [PMID: 38753585 DOI: 10.1080/15563650.2024.2346612] [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: 11/27/2023] [Accepted: 04/18/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The global use of certain classical psychedelics has increased in recent years, but little is known about their spectrum of toxicity within Australia. We aim to describe calls to New South Wales Poisons Information Centre relating to exposures to classical psychedelics including lysergic acid diethylamide, psilocybin, N,N-dimethyltryptamine, ayahuasca, mescaline and ibogaine. METHODS This is a retrospective observational study of calls to New South Wales Poisons Information Centre between January 2014 and December 2022. We identified exposures to classical psychedelics within New South Wales Poisons Information Centre database and measured the annual number of exposures, source of call (hospital, health care worker, member of the public), co-ingested substances, clinical features and advice given. RESULTS There were 737 calls related to relevant psychedelic exposures; 352 (47.8 per cent) to lysergic acid diethylamide, 347 (47.0 per cent) to psilocybin, 28 (3.8 per cent) to N,N-dimethyltryptamine, 4 (0.5 per cent) to ayahuasca, 4 (0.5 per cent) to mescaline and 2 (0.3 per cent) to ibogaine. Cases were predominantly male (77.2 per cent) and aged between 20 and 74 years (65.6 per cent). Psychedelic calls more than doubled from 45 in 2014 to 105 in 2022 and 625 (85 per cent) of all calls were either from or referred to hospital. Co-ingestion of psychedelics with another substance occurred in 249 (33.8 per cent) of calls and the most frequent clinical features related to single substance psychedelic exposures were hallucinations (27.6 per cent), gastrointestinal symptoms (21.7 per cent) and tachycardia (18.1 per cent). Seizures occurred in 2.9 per cent of single substance psychedelic exposures. DISCUSSION Increasing incidence of psychedelic exposure calls, including those reporting significant toxicity, likely reflects increasing community use. This may in part be driven by increasing interest in psychedelic assisted psychotherapy trials subsequently increasing public awareness. CONCLUSION Relatively high poisoning severity contrasts with safety within clinical trials of psychedelic assisted psychotherapy that may relate to the uncontrolled nature of community use which is mitigated within clinical trial environments. Education about safe use may be useful.
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Affiliation(s)
- Rachael Wilkes
- Emergency Department, St. Vincent's Hospital, Sydney, Australia
| | - Darren M Roberts
- Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
- New South Wales Poison's Information Centre, Sydney Children's Hospitals Network, Westmead, Sydney, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Paul Liknaitzky
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jonathan Brett
- New South Wales Poison's Information Centre, Sydney Children's Hospitals Network, Westmead, Sydney, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
- Medicines Intelligence and Health, School of Population Health, University of New South Wales, Australia
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Watford T, Masood N. Psilocybin, an Effective Treatment for Major Depressive Disorder in Adults - A Systematic Review. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:2-12. [PMID: 38247407 PMCID: PMC10811389 DOI: 10.9758/cpn.23.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/18/2023] [Accepted: 10/16/2023] [Indexed: 01/23/2024]
Abstract
Psilocybin is a classical psychedelic which has been utilised for healing purposes for millenia. However, with its classification as a Schedule I substance, research into this compound is scarce with few FDA-approved clinical studies. Despite this, profound findings into its antidepressant effects (largely through its action on 5-HT1a receptors) in mental illnesses such as major depressive disorder have rapidly increased interest back into their potential therapeutic benefits. This systematic review provides an analysis of the studies examining the clinical use of psilocybin for major depressive disorder. In total 6 studies were selected, including 319 participants, with half being randomised controlled trials and half open label trials. In every study psychological support was included as an integral part of the treatment. It was found that every study significantly favoured the use of psilocybin in reducing depressive symptoms, with few side effects. This gives psilocybin an advantage over commonly prescribed selective serotonin reuptake inhibitors (SSRIs), which carry more risk and cause more adverse effects. This drug therefore shows promise for being used as a clinical treatment for major depressive disorder, however future research should develop a paradigm for its use, with the timing of sessions and type of psychological support specified to allow for more precise analysis of the clinical effects of the drug. Additionally, more studies into its clinical efficacy are needed for appropriate detection of any publication bias. With this, psilocybin could prove to be revolutionary in treating depression and become an alternative medication to SSRIs.
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Affiliation(s)
- Tessa Watford
- School of Life Sciences, Keele University, Staffordshire, UK
| | - Naqash Masood
- School of Life Sciences, Keele University, Staffordshire, UK
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Ching THW, Amoroso L, Bohner C, D’Amico E, Eilbott J, Entezar T, Fitzpatrick M, Fram G, Grazioplene R, Hokanson J, Jankovsky A, Kichuk SA, Martins B, Patel P, Schaer H, Shnayder S, Witherow C, Pittenger C, Kelmendi B. Safety, feasibility, tolerability, and clinical effects of repeated psilocybin dosing combined with non-directive support in the treatment of obsessive-compulsive disorder: protocol for a randomized, waitlist-controlled trial with blinded ratings. Front Psychiatry 2024; 14:1278823. [PMID: 38264632 PMCID: PMC10803438 DOI: 10.3389/fpsyt.2023.1278823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
Background To date, few randomized controlled trials of psilocybin with non-directive support exist for obsessive-compulsive disorder (OCD). Results and participant feedback from an interim analysis of an ongoing single-dose trial (NCT03356483) converged on the possibility of administering a higher fixed dose and/or more doses of psilocybin in future trials for presumably greater benefits. Objectives This trial aims to evaluate the safety, feasibility, tolerability, and clinical effects of two doses of psilocybin paired with non-directive support in the treatment of OCD. This trial also seeks to examine whether two doses of psilocybin lead to greater OCD symptom reduction than a single dose, and to elucidate psychological mechanisms underlying the effects of psilocybin on OCD. Design A randomized (1:1), waitlist-controlled design with blinded ratings will be used to examine the effects of two doses of oral psilocybin paired with non-directive support vs. waitlist control on OCD symptoms. An adaptive dose selection strategy will be implemented (i.e., first dose: 25 mg; second dose: 25 or 30 mg). Methods and analysis This single-site trial will enroll 30 adult participants with treatment-refractory OCD. Aside from safety, feasibility, and tolerability metrics, primary outcomes include OCD symptoms assessed on the Yale-Brown Obsessive-Compulsive Scale - Second Edition (Y-BOCS-II). A blinded independent rater will assess primary outcomes at baseline and the primary endpoint at the end of the second dosing week. Participants will be followed up to 12 months post-second dosing. Participants randomized to waitlist will be rescreened after 7 weeks post-randomization, and begin their delayed treatment phase thereafter if still eligible. Ethics Written informed consent will be obtained from participants. The institutional review board has approved this trial (protocol v. 1.7; HIC #2000032623). Discussion This study seeks to advance our ability to treat refractory OCD, and catalyze future research seeking to optimize the process of psilocybin treatment for OCD through understanding relevant psychological mechanisms.Clinical trial registration: ClinicalTrials.gov, identifier NCT05370911.
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Affiliation(s)
- Terence H. W. Ching
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Lucia Amoroso
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Calvin Bohner
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Elizabeth D’Amico
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jeffrey Eilbott
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Tara Entezar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Madison Fitzpatrick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Geena Fram
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Rachael Grazioplene
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jamila Hokanson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Anastasia Jankovsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Stephen A. Kichuk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Bradford Martins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Prerana Patel
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Henry Schaer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Sarah Shnayder
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chelsea Witherow
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Psychology, Yale University, New Haven, CT, United States
- Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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6
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Sharma P, Nguyen QA, Matthews SJ, Carpenter E, Mathews DB, Patten CA, Hammond CJ. Psilocybin history, action and reaction: A narrative clinical review. J Psychopharmacol 2023; 37:849-865. [PMID: 37650489 DOI: 10.1177/02698811231190858] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Hallucinogenic mushrooms have been used in religious and cultural ceremonies for centuries. Of late, psilocybin, the psychoactive compound in hallucinogenic mushrooms, has received increased public interest as a novel drug for treating mood and substance use disorders (SUDs). In addition, in recent years, some states in the United States have legalized psilocybin for medical and recreational use. Given this, clinicians need to understand the potential benefits and risks related to using psilocybin for therapeutic purposes so that they can accurately advise patients. This expert narrative review summarizes the scientific basis and clinical evidence on the safety and efficacy of psilocybin-assisted therapy for treating psychiatric disorders and SUDs. The results of this review are structured as a more extensive discussion about psilocybin's history, putative mechanisms of action, and recent legislative changes to its legal status. There is modest evidence of psilocybin-assisted therapy for treating depression and anxiety disorders. In addition, early data suggest that psilocybin-assisted therapy may effectively reduce harmful drinking in patients with alcohol use disorders. The evidence further suggests psilocybin, when administered under supervision (psilocybin-assisted therapy), the side effects experienced are mild and transient. The occurrence of severe adverse events following psilocybin administration is uncommon. Still, a recent clinical trial found that individuals in the psilocybin arm had increased suicidal ideations and non-suicidal self-injurious behaviors. Given this, further investigation into the safety and efficacy of psilocybin-assisted therapy is warranted to determine which patient subgroups are most likely to benefit and which are most likely to experience adverse outcomes related to its use.
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Affiliation(s)
- Pravesh Sharma
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Eau Claire, WI, USA
- Behavioral Health Research Program, Department of Psychology and Psychiatry Research, Mayo Clinic, Rochester, MN, USA
| | - Quang Anh Nguyen
- Behavioral Health Research Program, Department of Psychology and Psychiatry Research, Mayo Clinic, Rochester, MN, USA
| | - Sadie J Matthews
- Department of Psychology, University of Wisconsin (Eau Claire), Eau Claire, WI, USA
| | | | - Douglas B Mathews
- Department of Psychology, University of Wisconsin (Eau Claire), Eau Claire, WI, USA
| | - Christi A Patten
- Behavioral Health Research Program, Department of Psychology and Psychiatry Research, Mayo Clinic, Rochester, MN, USA
| | - Christopher J Hammond
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Peck SK, Shao S, Gruen T, Yang K, Babakanian A, Trim J, Finn DM, Kaye WH. Psilocybin therapy for females with anorexia nervosa: a phase 1, open-label feasibility study. Nat Med 2023; 29:1947-1953. [PMID: 37488291 PMCID: PMC10427429 DOI: 10.1038/s41591-023-02455-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/09/2023] [Indexed: 07/26/2023]
Abstract
Anorexia nervosa (AN) is a deadly illness with no proven treatments to reverse core symptoms and no medications approved by the US Food and Drug Administration. Novel treatments are urgently needed to improve clinical outcomes. In this open-label feasibility study, 10 adult female participants (mean body mass index 19.7 kg m-2; s.d. 3.7) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for AN or pAN (partial remission) were recruited to a study conducted at an academic clinical research institute. Participants received a single 25-mg dose of synthetic psilocybin in conjunction with psychological support. The primary aim was to assess safety, tolerability and feasibility at post-treatment by incidences and occurrences of adverse events (AEs) and clinically significant changes in electrocardiogram (ECG), laboratory tests, vital signs and suicidality. No clinically significant changes were observed in ECG, vital signs or suicidality. Two participants developed asymptomatic hypoglycemia at post-treatment, which resolved within 24 h. No other clinically significant changes were observed in laboratory values. All AEs were mild and transient in nature. Participants' qualitative perceptions suggest that the treatment was acceptable for most participants. Results suggest that psilocybin therapy is safe, tolerable and acceptable for female AN, which is a promising finding given physiological dangers and problems with treatment engagement. ClinicalTrials.gov identifier NCT04661514 .
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Affiliation(s)
- Stephanie Knatz Peck
- Department of Psychiatry, Eating Disorder Treatment & Research Center, University of California, San Diego, San Diego, CA, USA.
| | - Samantha Shao
- Department of Psychiatry, Eating Disorder Treatment & Research Center, University of California, San Diego, San Diego, CA, USA
| | - Tessa Gruen
- Department of Psychiatry, Eating Disorder Treatment & Research Center, University of California, San Diego, San Diego, CA, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kevin Yang
- Department of Psychiatry, Eating Disorder Treatment & Research Center, University of California, San Diego, San Diego, CA, USA
| | - Alexandra Babakanian
- Department of Psychiatry, Eating Disorder Treatment & Research Center, University of California, San Diego, San Diego, CA, USA
| | - Julie Trim
- Department of Psychiatry, Eating Disorder Treatment & Research Center, University of California, San Diego, San Diego, CA, USA
| | - Daphna M Finn
- Department of Psychiatry, Eating Disorder Treatment & Research Center, University of California, San Diego, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, Eating Disorder Treatment & Research Center, University of California, San Diego, San Diego, CA, USA.
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Ching THW, Grazioplene R, Bohner C, Kichuk SA, DePalmer G, D’Amico E, Eilbott J, Jankovsky A, Burke M, Hokanson J, Martins B, Witherow C, Patel P, Amoroso L, Schaer H, Pittenger C, Kelmendi B. Safety, tolerability, and clinical and neural effects of single-dose psilocybin in obsessive-compulsive disorder: protocol for a randomized, double-blind, placebo-controlled, non-crossover trial. Front Psychiatry 2023; 14:1178529. [PMID: 37181888 PMCID: PMC10166878 DOI: 10.3389/fpsyt.2023.1178529] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Background Psilocybin may help treat obsessive-compulsive disorder (OCD). To date, only one open-label study of psilocybin for OCD exists, necessitating further investigation with a randomized controlled design. The neural correlates of psilocybin's effects on OCD have also not been studied. Objectives This first-of-its-kind trial aims to evaluate the feasibility, safety, and tolerability of psilocybin in the treatment of OCD, provide preliminary evidence on the effects of psilocybin on OCD symptoms, and elucidate neural mechanisms that may mediate psilocybin's effects on OCD. Design We use a randomized (1:1), double-blind, placebo-controlled, non-crossover design to examine the clinical and neural effects of either a single dose of oral psilocybin (0.25 mg/kg) or active placebo-control agent (250 mg of niacin) on OCD symptoms. Methods and analysis We are enrolling 30 adult participants at a single site in Connecticut, USA who have failed at least one trial of standard care treatment (medication/psychotherapy) for OCD. All participants will also receive unstructured, non-directive psychological support during visits. Aside from safety, primary outcomes include OCD symptoms over the past 24 h, assessed by the Acute Yale-Brown Obsessive-Compulsive Scale and Visual Analog Scale ratings. These are collected by blinded, independent raters at baseline and the primary endpoint of 48 h post-dosing. Total follow-up is 12 weeks post-dosing. Resting state neuroimaging data will be collected at baseline and primary endpoint. Participants randomized to placebo will be offered the chance to return for an open-label dose of 0.25 mg/kg. Ethics statement All participants will be required to provide written informed consent. The trial (protocol v. 5.2) was approved by the institutional review board (HIC #2000020355) and registered with ClinicalTrials.gov (NCT03356483). Discussion This study may represent an advance in our ability to treat refractory OCD, and pave the way for future studies of neurobiological mechanisms of OCD that may respond to psilocybin.
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Affiliation(s)
- Terence H. W. Ching
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Rachael Grazioplene
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Calvin Bohner
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Stephen A. Kichuk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Giuliana DePalmer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Elizabeth D’Amico
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jeffrey Eilbott
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Anastasia Jankovsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Michelle Burke
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jamila Hokanson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Brad Martins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chelsea Witherow
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Prerana Patel
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Lucia Amoroso
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Henry Schaer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Psychology, Yale University, New Haven, CT, United States
- Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Brett J, Knock E, Korthuis PT, Liknaitzky P, Murnane KS, Nicholas CR, Patterson JC, Stauffer CS. Exploring psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder. Front Psychiatry 2023; 14:1123424. [PMID: 36998623 PMCID: PMC10043240 DOI: 10.3389/fpsyt.2023.1123424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Methamphetamine use disorder is a chronic relapsing condition associated with substantial mental, physical, and social harms and increasing rates of mortality. Contingency management and psychotherapy interventions are the mainstays of treatment but are modestly effective with high relapse rates, while pharmacological treatments have shown little to no efficacy. Psilocybin-assisted psychotherapy is emerging as a promising treatment for a range of difficult-to-treat conditions, including substance use disorders; however, no studies have yet been published looking at psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder. Here we review the rationale for psilocybin-assisted psychotherapy as a potential treatment for this indication, and describe practical considerations based on our early experience designing and implementing four separate clinical trials of psilocybin-assisted psychotherapy for methamphetamine use disorder.
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Affiliation(s)
- Jonathan Brett
- Department of Clinical Pharmacology, St. Vincent’s Hospital, Sydney, NSW, Australia
- School of Population Health, Medicines Intelligence Centre of Research Excellence, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Knock
- Alcohol and Drug Service, St. Vincent’s Hospital, Sydney, NSW, Australia
| | - P. Todd Korthuis
- Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Paul Liknaitzky
- Department of Psychiatry, School of Clinical Sciences, Monash University, Caulfield, VIC, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Caulfield, VIC, Australia
| | - Kevin S. Murnane
- Louisiana Addiction Research Center, Department of Pharmacology, Toxicology & Neuroscience, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health, Shreveport, LA, United States
| | - Christopher R. Nicholas
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, United States
| | - James C. Patterson
- Louisiana Addiction Research Center, Department of Pharmacology, Toxicology & Neuroscience, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health, Shreveport, LA, United States
| | - Christopher S. Stauffer
- Department of Mental Health, Veterans Affairs Portland Health Care System, Portland, OR, United States
- Social Neuroscience and Psychotherapy Lab, Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
- *Correspondence: Christopher S. Stauffer,
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Rothman EF, Jimenez C. Introduction to the Special Issue on Substance Use and Occupational Therapy. Subst Abuse 2023; 17:11782218231160016. [PMID: 36923067 PMCID: PMC10009032 DOI: 10.1177/11782218231160016] [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: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/13/2023]
Abstract
Readers of this journal are undoubtedly already aware that substance use disorders (SUDs) are a significant public health problem. More than 2% of the world population is living with a substance abuse disorder, and 1.4% of the global burden of disease is attributable to alcohol and illicit drug use. What readers may have had less opportunity to consider is that occupational therapists are an underutilized resource in our response to the substance use disorder crisis, and that occupational therapy researchers can provide key insights into the nature of substance use in individuals' lives and in our communities. That is the focus of this special issue.
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Affiliation(s)
- Emily F Rothman
- Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Christine Jimenez
- Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
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Strauss D, Ghosh S, Murray Z, Gryzenhout M. Psilocybin containing mushrooms: a rapidly developing biotechnology industry in the psychiatry, biomedical and nutraceutical fields. 3 Biotech 2022; 12:339. [PMID: 36340802 PMCID: PMC9633885 DOI: 10.1007/s13205-022-03355-4] [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: 04/07/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
Humans have collected and used hallucinogenic mushrooms for ethnic medicinal, recreational, and religious purposes since before recorded history. Currently, the use of these mushrooms is illegal in most countries, but where their use is legal they are applied as self medication. Psilocybin and psilocin, two psychoactive alkaloids, are naturally synthesized by hallucinogenic mushrooms. The chemical structure of these compounds are similar to the neurotransmitter serotonin. Activation of this system by psilocybin and psilocin may produce temporary changes in the brain that induce hallucinations and feelings of euphoria. Adjustment of the serotonin system in this way can moderate symptoms of related mental disorders. This review summarizes relevant and current information regarding the discovery of hallucinogenic mushrooms and their contained psychoactive compounds, the events that lead to their criminalization and decriminilization, and the state of knowledge of psilocybin, psilocin, and derivatives. Last, research on the psychoactive properties of these mushrooms is placed in perspective to possible applications for human dysfunctions.
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Affiliation(s)
- Dominique Strauss
- Department of Genetics, Natural and Agricultural Sciences, University of Free State, PO Box 339, Bloemfontein, 9301 South Africa
| | - Soumya Ghosh
- Department of Genetics, Natural and Agricultural Sciences, University of Free State, PO Box 339, Bloemfontein, 9301 South Africa
| | - Zurika Murray
- Department of Genetics, Natural and Agricultural Sciences, University of Free State, PO Box 339, Bloemfontein, 9301 South Africa
| | - Marieka Gryzenhout
- Department of Genetics, Natural and Agricultural Sciences, University of Free State, PO Box 339, Bloemfontein, 9301 South Africa
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Shahar O, Botvinnik A, Esh-Zuntz N, Brownstien M, Wolf R, Lotan A, Wolf G, Lerer B, Lifschytz T. Role of 5-HT2A, 5-HT2C, 5-HT1A and TAAR1 Receptors in the Head Twitch Response Induced by 5-Hydroxytryptophan and Psilocybin: Translational Implications. Int J Mol Sci 2022; 23:ijms232214148. [PMID: 36430623 PMCID: PMC9698447 DOI: 10.3390/ijms232214148] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
There is increasing interest in the therapeutic potential of psilocybin. In rodents, the serotonin precursor, 5-hydroxytryptophan (5-HTP) and psilocybin induce a characteristic 5-HT2A receptor (5-HT2AR)-mediated head twitch response (HTR), which is correlated with the human psychedelic trip. We examined the role of other serotonergic receptors and the trace amine -associated receptor 1 (TAAR1) in modulating 5-HTP- and psilocybin-induced HTR. Male C57BL/6J mice (11 weeks, ~30 g) were administered 5-HTP, 50-250 mg/kg i.p., 200 mg/kg i.p. after pretreatment with 5-HT/TAAR1 receptor modulators, psilocybin 0.1-25.6 mg/kg i.p. or 4.4 mg/kg i.p., immediately preceded by 5-HT/TAAR1 receptor modulators. HTR was assessed in a custom-built magnetometer. 5-HTP and psilocybin induced a dose-dependent increase in the frequency of HTR over 20 min with attenuation by the 5-HT2AR antagonist, M100907, and the 5-HT1AR agonist, 8-OH-DPAT. The 5-HT2CR antagonist, RS-102221, enhanced HTR at lower doses but reduced it at higher doses. The TAAR1 antagonist, EPPTB, reduced 5-HTP- but not psilocybin-induced HTR. We have confirmed the key role of 5-HT2AR in HTR, an inhibitory effect of 5-HT1AR, a bimodal contribution of 5-HT2CR and a role of TAAR1 in modulating HTR induced by 5-HTP. Compounds that modulate psychedelic-induced HTR have important potential in the emerging therapeutic use of these compounds.
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Pilc A, Machaczka A, Kawalec P, Smith JL, Witkin JM. Where do we go next in antidepressant drug discovery? A new generation of antidepressants: a pivotal role of AMPA receptor potentiation and mGlu2/3 receptor antagonism. Expert Opin Drug Discov 2022; 17:1131-1146. [PMID: 35934973 DOI: 10.1080/17460441.2022.2111415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Major depressive disorder remains a prevalent world-wide health problem. Currently available antidepressant medications take weeks of dosing, do not produce antidepressant response in all patients, and have undesirable ancillary effects. AREAS COVERED The present opinion piece focuses on the major inroads to the creation of new antidepressants. These include N-methyl-D-aspartate (NMDA) receptor antagonists and related compounds like ketamine, psychedelic drugs like psilocybin, and muscarinic receptor antagonists like scopolamine. The preclinical and clinical pharmacological profile of these new-age antidepressant drugs is discussed. EXPERT OPINION Preclinical and clinical data have accumulated to predict a next generation of antidepressant medicines. In contrast to the current standard of care antidepressant drugs, these compounds differ in that they demonstrate rapid activity, often after a single dose, and effects that outlive their presence in brain. These compounds also can provide efficacy for treatment-resistant depressed patients. The mechanism of action of these compounds suggests a strong glutamatergic component that involves the facilitation of AMPA receptor function. Antagonism of mGlu2/3 receptors is also relevant to the antidepressant pharmacology of this new class of drugs. Based upon the ongoing efforts to develop these new-age antidepressants, new drug approvals are predicted in the near future.
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Affiliation(s)
- Andrzej Pilc
- Department of Neurobiology, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland.,Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Agata Machaczka
- Department of Neurobiology, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | - Paweł Kawalec
- Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Jodi L Smith
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN, USA
| | - Jeffrey M Witkin
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN, USA
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