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Jungwirth J, Bavato F, Quednow BB. [Psychedelic and dissociative agents in psychiatry: challenges in the treatment]. DER NERVENARZT 2024; 95:803-810. [PMID: 39196383 PMCID: PMC11374839 DOI: 10.1007/s00115-024-01727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 08/29/2024]
Abstract
With the discovery of the antidepressive effects of ketamine and the increasing withdrawal of the pharmaceutical industry from the development of new psychotropic drugs, the psychiatric research into the clinical application of hallucinogens in psychiatry has literally blossomed in the last two decades. Promising results for various treatment approaches with psychedelic agents, such lysergic acid diethylamide (LSD) and psilocybin, and dissociative agents, such as ketamine and esketamine, have raised great hopes among researchers, clinicians and patients in recent years, so that there was already talk of a new era in psychiatry. As one of the first of these substances, in December 2019 intranasal esketamine was approved in the USA and the EU for the treatment of treatment-resistant depression and Switzerland followed in 2020. Recently, psilocybin was approved in Australia, Canada and Switzerland for compassionate use in exceptional cases for the treatment of depression, while large approval studies with various psychedelic agents are currently ongoing worldwide. The medical application of psychedelic agents and ketamine/esketamine is considered to be safe; however, as with all new forms of treatment it is of crucial importance that, in addition to the hopes, the specific challenges of these new treatment approaches must also be carefully considered and assessed. Excessive expectations and an insufficient risk-benefit estimation are detrimental to the patients and the reputation of the treating physician. Although a possible paradigm shift in the care of mental health is already being discussed, this review article consciously concentrates on the possible risks of treatment and the methodological weaknesses of the studies carried out so far.
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Affiliation(s)
- Johannes Jungwirth
- AG Neurophänomenologie des Bewusstseins, Erwachsenenpsychiatrie und Psychotherapie, Psychiatrische Universitätsklinik Zürich, Universität Zürich, Zürich, Schweiz
| | - Francesco Bavato
- AG Experimentelle Pharmakopsychologie und psychologische Suchtforschung, Erwachsenenpsychiatrie und Psychotherapie, Psychiatrische Universitätsklinik Zürich, Universität Zürich, Zürich, Schweiz
| | - Boris B Quednow
- AG Experimentelle Pharmakopsychologie und psychologische Suchtforschung, Erwachsenenpsychiatrie und Psychotherapie, Psychiatrische Universitätsklinik Zürich, Universität Zürich, Zürich, Schweiz.
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2
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Chen MH, Cheng SL, Kao YC, Tseng PT, Hsu CW, Yu CL, Yang FC, Thompson T, Hsu TW, Liang CS. The association between diverse psychological protocols and the efficacy of psilocybin-assisted therapy for clinical depressive symptoms: a Bayesian meta-analysis. Front Psychiatry 2024; 15:1439347. [PMID: 39193583 PMCID: PMC11347349 DOI: 10.3389/fpsyt.2024.1439347] [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: 05/27/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024] Open
Abstract
Objective Psilocybin-assisted therapy has shown promising efficacy on clinical depressive symptoms. However, diverse psychological support or psychotherapy was performed with psilocybin treatment. This study aimed to explore the association of psychological protocols with the efficacy of psilocybin-assisted therapy for depressive symptoms. Method Five major databases were systemic searched for clinical trials addressing psilocybin-assisted therapy for patients with clinical depressive symptoms. A Bayesian random-effects meta-analysis and meta-regression were performed. The effect size was mean difference (with 95% credible interval) measured by 17-Item Hamilton Depression Rating Scale. Results There were 10 eligible studies including 515 adult patients with clinically diagnosed depression. The psychological protocols could be categorized into four types: (i) manualized directive psychotherapy(k=1); (ii) manualized nondirective psychological support(k=3), (iii) non-manualized nondirective psychological support(k=5); and (iv) non-manualized supportive psychotherapy(k=1). The pooled standard mean difference of psilocybin-assisted therapy was 10.08 (5.03-14.70). Conclusion Compared with manualized nondirective psychological support, the other three psychological approaches did not differ significantly. The improvement of depressive symptoms was not associated with the psychological protocols in adult patients receiving psilocybin-assisted therapy. Systemic review registration Open Science Framework: identifier (osf.io/3YUDV).
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Affiliation(s)
- Mu-Hong Chen
- Department of Psychiatry, Taipei Veteran General Hospital, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Li Cheng
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
| | - Ping-Tao Tseng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chia-Ling Yu
- Department of Pharmacy, Chang Gung Memorial Hospital Linkou, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom
| | - Tien-Wei Hsu
- Department of Psychiatry, E-DA Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Psychiatry, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
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Palitsky R, Kaplan DM, Perna J, Bosshardt Z, Maples-Keller JL, Levin-Aspenson HF, Zarrabi AJ, Peacock C, Mletzko T, Rothbaum BO, Raison CL, Grant GH, Dunlop BW. A framework for assessment of adverse events occurring in psychedelic-assisted therapies. J Psychopharmacol 2024; 38:690-700. [PMID: 39082259 DOI: 10.1177/02698811241265756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
OBJECTIVE Despite considerable research examining the efficacy of psychedelic-assisted therapies (PATs) for treating psychiatric disorders, assessment of adverse events (AEs) in PAT research has lagged. Current AE reporting standards in PAT trials are poorly calibrated to features of PAT that distinguish it from other treatments, leaving many potential AEs unassessed. METHODS A multidisciplinary working group of experts involved in PAT pooled formally and informally documented AEs observed through research experience and published literature. This information was integrated with (a) current standards and practices for AE reporting in pharmacotherapy and psychotherapy trials and (b) published findings documenting post-acute dosing impacts of psychedelics on subjective states, meaning, and psychosocial health variables, to produce a set of AE constructs important to evaluate in PAT as well as recommended methods and time frames for their assessment and monitoring. Correspondence between identified potential AEs and current standards for AE assessment was examined, including the extent of coverage of identified AE constructs by 25 existing measures used in relevant research. RESULTS Fifty-four potential AE terms warranting systematized assessment in PAT were identified, defined, and categorized. Existing measures demonstrated substantial gaps in their coverage of identified AE constructs. Recommendations were developed for how to assess PAT AEs (including patient, clinician, and informant reports), and when to assess over preparation, dosing session, integration, and follow-up. Application of this framework is demonstrated in a preliminary assessment protocol (available in the supplement). CONCLUSIONS This assessment framework addresses the need to capture post-acute dosing AEs in PAT, accounting for its pharmacotherapy and psychotherapy components, as well as documented impacts of psychedelics on worldviews and spirituality.
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Affiliation(s)
- Roman Palitsky
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Emory Spiritual Health, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | - Deanna M Kaplan
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA, USA
- Emory Spiritual Health, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - John Perna
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Zachary Bosshardt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ali John Zarrabi
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA, USA
- Emory Spiritual Health, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Caroline Peacock
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA, USA
- Emory Spiritual Health, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Tanja Mletzko
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Barbara O Rothbaum
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles L Raison
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA, USA
- Emory Spiritual Health, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | - George H Grant
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA, USA
- Emory Spiritual Health, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | - Boadie W Dunlop
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Aday JS, Horton D, Fernandes-Osterhold G, O'Donovan A, Bradley ER, Rosen RC, Woolley JD. Psychedelic-assisted psychotherapy: where is the psychotherapy research? Psychopharmacology (Berl) 2024; 241:1517-1526. [PMID: 38782821 DOI: 10.1007/s00213-024-06620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
RATIONALE Psychedelic-assisted psychotherapy (PAP) has emerged as a potential treatment for a variety of mental health conditions, including substance use disorders and depression. Current models of PAP emphasize the importance of psychotherapeutic support before, during, and after ingestion of a psychedelic to maximize safety and clinical benefit. Despite this ubiquitous assumption, there has been surprisingly little empirical investigation of the "psychotherapy" in PAP, leaving critical questions about the necessary and sufficient components of PAP unanswered. OBJECTIVES As clinical trials for psychedelic compounds continue the transition from safety- and feasibility-testing to evaluating efficacy, the role of the accompanying psychotherapy must be better understood to enhance scientific understanding of the mechanisms underlying therapeutic change, optimize clinical outcomes, and inform cost-effectiveness. RESULTS The present paper first reviews the current status of psychotherapy in the PAP literature, starting with recent debates regarding "psychotherapy" versus "psychological support" and then overviewing published clinical trial psychotherapy models and putative models informed by theory. We then delineate lessons that PAP researchers can leverage from traditional psychotherapy research regarding standardizing treatments (e.g., publish treatment manuals, establish eligibility criteria for providers), identifying mechanisms of change (e.g., measure established mechanisms in psychotherapy), and optimizing clinical trial designs (e.g., consider dismantling studies, comparative efficacy trials, and cross-lagged panel designs). Throughout this review, the need for increased research into the psychotherapeutic components of treatment in PAP is underscored. CONCLUSIONS PAP is a distinct, integrative, and transdisciplinary intervention. Future research designs should consider transdisciplinary research methodologies to identify best practices and inform federal guidelines for PAP administration.
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Affiliation(s)
- Jacob S Aday
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
| | - David Horton
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, Madison, WI, USA
| | | | - Aoife O'Donovan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Ellen R Bradley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Raymond C Rosen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Joshua D Woolley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
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Kishon R, Modlin NL, Cycowicz YM, Mourtada H, Wilson T, Williamson V, Cleare A, Rucker J. A rapid narrative review of the clinical evolution of psychedelic treatment in clinical trials. NPJ MENTAL HEALTH RESEARCH 2024; 3:33. [PMID: 38956330 PMCID: PMC11220096 DOI: 10.1038/s44184-024-00068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/16/2024] [Indexed: 07/04/2024]
Abstract
Pre-prohibition psychedelic research with complex psychiatric patients generated a wealth of treatment methodologies and practices, providing invaluable clinical insights pertaining to the medical administration of psychedelics in various mental health diagnoses. Building upon these early studies, which lack the rigor and research tools available today, contemporary psychedelic research has focused on investigating the safety and efficacy of psychedelics in randomized controlled trials via psychometric measures and symptom assessments. Both then and now, the treatment context and the role of clinicians in psychedelic treatment has been recognized as an essential feature for positive patient outcomes. To broaden the knowledge base of modern psychedelic research and support the training of clinicians conducting medically supervised psychedelic research studies, this paper provides a review of pre-prohibition clinical research narratives pertaining to the phenomenology of psychedelic treatment and the role of the non-pharmacological treatment factors in the patient experience. Lastly, this paper explores a range of clinician perspectives and psychological interventions employed in pre-prohibition psychedelic research to inform future research directions and best practice guidelines.
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Affiliation(s)
- Ronit Kishon
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK.
| | - Yael M Cycowicz
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Hania Mourtada
- New York State Psychiatric Institute, New York, NY, USA
- Department of Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Tayler Wilson
- New York State Psychiatric Institute, New York, NY, USA
| | - Victoria Williamson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
| | - Anthony Cleare
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - James Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
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6
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Wolff M, Evens R, Mertens LJ, Schmidt C, Beck J, Rutrecht H, Cherniak AD, Gründer G, Jungaberle H. Measuring psychotherapeutic processes in the context of psychedelic experiences: Validation of the General Change Mechanisms Questionnaire (GCMQ). J Psychopharmacol 2024; 38:432-457. [PMID: 38742761 PMCID: PMC11102652 DOI: 10.1177/02698811241249698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Therapeutic and salutogenic effects of psychedelic drugs have been attributed to psychotherapeutic or psychotherapy-like processes that can unfold during the acute psychedelic experience and beyond. Currently, there are no psychometric instruments available to comprehensively assess psychotherapeutic processes (as conceptualized by empirical psychotherapy research) in the context of psychedelic experiences. AIMS We report the initial validation of the General Change Mechanisms Questionnaire (GCMQ), a self-report instrument designed to measure five empirically established general change mechanisms (GCMs) of psychotherapy-(1) resource activation, (2) therapeutic relationship, (3) problem actuation, (4) clarification, and (5) mastery-in the context of psychedelic experiences. METHODS An online survey in a sample of 1153 English-speaking and 714 German-speaking psychedelic users was conducted to evaluate simultaneously developed English- and German-language versions of the GCMQ. RESULTS The theory-based factor structure was confirmed. The five GCMQ scales showed good internal consistency. Evidence for convergent validity with external measures was obtained. Significant associations with different settings and with therapeutic, hedonic, and escapist use motives confirmed the hypothesized context dependence of GCM-related psychedelic experiences. Indicating potential therapeutic effects, the association between cumulative stressful life events and well-being was significantly moderated by resource activation, clarification, and mastery. Factor mixture modeling revealed five distinct profiles of GCM-related psychedelic experiences. CONCLUSION Initial testing indicates that the GCMQ is a valid and reliable instrument that can be used in future clinical and nonclinical psychedelic research. The five identified profiles of GCM-related experiences may be relevant to clinical uses of psychedelics and psychedelic harm reduction.
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Affiliation(s)
- Max Wolff
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- MIND Foundation, Berlin, Germany
| | - Ricarda Evens
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lea J Mertens
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Jessica Beck
- MIND Foundation, Berlin, Germany
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | | | - Aaron D Cherniak
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychology, Reichman University, Herzliya, Israel
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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7
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Mestre-Bach G, Potenza MN. Current Understanding of Compulsive Sexual Behavior Disorder and Co-occurring Conditions: What Clinicians Should Know about Pharmacological Options. CNS Drugs 2024; 38:255-265. [PMID: 38485889 DOI: 10.1007/s40263-024-01075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 04/02/2024]
Abstract
Compulsive sexual behavior disorder (CSBD) has recently been recognized as a psychiatric disorder. Pharmacological treatments for CSBD have received little study and thus have limited empirical support. The main objective of the present work is to review existing literature on the efficacy of different drugs on the symptomatology of CSBD, including the subtype of problematic pornography use (PPU). The main pharmacological approaches to treating CSBD have included opioid antagonists (naltrexone and nalmefene), selective serotonin reuptake inhibitors (paroxetine, citalopram, fluoxetine, and sertraline), mood stabilizers (topiramate), tricyclic antidepressants (clomipramine), serotonin antagonist and reuptake inhibitors (nefazodone), and N-acetylcysteine. Since people with CSBD may experience different co-occurring disorders, these should be considered when choosing the best pharmacological treatment. Pharmacological therapy for CSBD/PPU has been suggested as an adjunct to psychological therapies, which, for the moment, have the most empirical evidence. However, to evaluate the efficacy of most of the drugs presented in this narrative review, data to date have only been available from case studies. Thus, empirical support is scant and generalizability of results is limited, highlighting the need for more research in this area.
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Affiliation(s)
- Gemma Mestre-Bach
- Instituto de Investigación, Transferencia e Innovación, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, One Church Street, Rm 726, New Haven, CT, 06510, USA.
- Connecticut Mental Health Center, New Haven, CT, USA.
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA.
- Wu Tsai Institute, Yale University, New Haven, CT, USA.
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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Avram M, Herwig U, Borgwardt S, Majić T. [Towards a Better understanding of Persisting Perceptual Disturbances following the use of Classic Psychedelics.]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:118-120. [PMID: 38636490 DOI: 10.1055/a-2264-6472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Klassische Psychedelika wie Psilocybin, Lysergsäurediethylamid (LSD), Ayahuasca oder
5-Methoxy-Dimethyltryptamin (5-MeO-DMT) stehen wieder vermehrt im Fokus des
psychiatrisch-psychotherapeutischen und neurowissenschaftlichen Interesses. Dies ist
vor allem auf aktuelle klinische Studien zurückzuführen, die einen möglichen
therapeutischen Nutzen von Psychedelika in der Behandlung verschiedener psychischer
Störungen nahelegen, wie bei therapieresistenten Depressionen,
Abhängigkeitserkrankungen, Angststörungen und existentiellen Ängsten bei
lebensbedrohlichen körperlichen Erkrankungen 1
2
3
4. Trotz der beobachteten
vielversprechenden Effekte ist es wichtig zu betonen, dass Psychedelika auch
potenzielle Risiken bergen, die sie von vielen anderen psychoaktiven Substanzen
unterscheiden. Diese liegen in der besonderen Phänomenologie der Wirkungen dieser
Substanzen auf das zentrale Nervensystem und die menschliche Psyche begründet, in
der zeitlichen Dynamik ihrer psychologischen Effekte, und in ihrem biologischen
Wirkprofil.
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Affiliation(s)
- Mihai Avram
- Translational Psychiatry, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Lübeck
| | - Uwe Herwig
- Zentrum für Psychiatrie Reichenau, Akademisches Lehrkrankenhaus Universität Konstanz, Reichenau
| | - Stefan Borgwardt
- Translational Psychiatry, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Lübeck
| | - Tomislav Majić
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin
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Rosenblat JD, Meshkat S, Doyle Z, Kaczmarek E, Brudner RM, Kratiuk K, Mansur RB, Schulz-Quach C, Sethi R, Abate A, Ali S, Bawks J, Blainey MG, Brietzke E, Cronin V, Danilewitz J, Dhawan S, Di Fonzo A, Di Fonzo M, Drzadzewski P, Dunlop W, Fiszter H, Gomes FA, Grewal S, Leon-Carlyle M, McCallum M, Mofidi N, Offman H, Riva-Cambrin J, Schmidt J, Smolkin M, Quinn JM, Zumrova A, Marlborough M, McIntyre RS. Psilocybin-assisted psychotherapy for treatment resistant depression: A randomized clinical trial evaluating repeated doses of psilocybin. MED 2024; 5:190-200.e5. [PMID: 38359838 DOI: 10.1016/j.medj.2024.01.005] [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: 12/01/2023] [Revised: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Psilocybin-assisted psychotherapy (PAP) has been associated with antidepressant effects. Trials to date have typically excluded participants with complex presentations. Our aim was to determine the feasibility of PAP in a complex population, including high levels of treatment resistance in major depressive and bipolar disorder and patients with baseline suicidality and significant comorbidity. We also evaluated flexible repeated doses over a 6-month period. METHODS Adults with treatment-resistant depression as part of major depressive or bipolar II disorder without psychosis or a substance use disorder were eligible to participate. Subjects were randomized to immediate treatment or waitlist control, with all eventually receiving PAP. Participants had one, two, or three psilocybin sessions with a fixed dose of 25 mg. Each dose was accompanied by preparation and integration psychotherapy sessions. Acceptability, safety, tolerability, and efficacy were evaluated (this study was registered at ClinicalTrials.gov: NCT05029466). FINDINGS Participants were randomized to immediate treatment (n = 16) or delayed treatment (n = 14). 29/30 were retained to the week-2 primary endpoint. Adverse events were transient, with no serious adverse events. Greater reductions in depression severity as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) were observed in the immediate treatment arm compared to the waitlist period arm with a large hedge's g effect size of 1.07 (p < 0.01). Repeated doses were associated with further reductions in MADRS scores compared to baseline. CONCLUSIONS PAP was feasible in complex patients with preliminary antidepressant efficacy and adequate safety and tolerability. Repeated doses were associated with greater reductions in depression severity. FUNDING This work was funded by Brain and Cognition Discovery Foundation (BCDF), Usona, and Braxia Scientific.
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Affiliation(s)
- Joshua D Rosenblat
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada.
| | - Shakila Meshkat
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Zoe Doyle
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Erica Kaczmarek
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Ryan M Brudner
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Kevin Kratiuk
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | | | | | | | | | - Shaun Ali
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Jordan Bawks
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Marc G Blainey
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Elisa Brietzke
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; Queens University, Kingston, Ontario, Canada
| | - Victoria Cronin
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Jessica Danilewitz
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Shalini Dhawan
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Anthony Di Fonzo
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Melissa Di Fonzo
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Pawel Drzadzewski
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - William Dunlop
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Hajnalka Fiszter
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Fabiano A Gomes
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - Smrita Grewal
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Marisa Leon-Carlyle
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Marilyn McCallum
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Niki Mofidi
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Hilary Offman
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Jeremy Riva-Cambrin
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Joel Schmidt
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - Mark Smolkin
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Joan M Quinn
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Andrea Zumrova
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Michelle Marlborough
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Roger S McIntyre
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation (BCDF), Toronto, ON, Canada
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10
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Gründer G, Brand M, Mertens LJ, Jungaberle H, Kärtner L, Scharf DJ, Spangemacher M, Wolff M. Treatment with psychedelics is psychotherapy: beyond reductionism. Lancet Psychiatry 2024; 11:231-236. [PMID: 38101439 DOI: 10.1016/s2215-0366(23)00363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/17/2023]
Abstract
Treatment of psychiatric disorders with psychedelic substances represents one of the most promising current treatment approaches in psychiatry. Since its inception in the 1950s, therapy with psychedelics has been conceptualised as psychedelic-assisted psychotherapy-ie, a form of psychotherapy that uses the profound biological effects of this class of substances as a catalyst for changing thinking, emotions, and behaviour. In this view, the psychotherapy component of the treatment is considered as being of the utmost importance for both the safety and efficacy of the therapy. This conceptualisation has been challenged by the idea that the latest clinical studies suggest that the potential therapeutic effects of psychedelics must be attributed solely to the substance itself, with no role for psychotherapy. Here, accompaniment by therapists is understood as mere psychological support, to maintain the safety of the substance administration. In this Personal View, we contrast these two views and argue that the characterisation of treatment with psychedelics as a biological intervention (with psychological support as a purely safety-related component) represents an outdated and reductionistic dualism that has dominated psychiatric treatment and research for far too long. This discussion has important implications for the study and the regulation of these compounds.
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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; OVID Health Systems, Berlin, Germany.
| | - Manuela Brand
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lea J Mertens
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Henrik Jungaberle
- MIND Foundation, Berlin, Germany; OVID Health Systems, Berlin, Germany
| | - Laura Kärtner
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dennis J Scharf
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Moritz Spangemacher
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Max Wolff
- MIND Foundation, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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11
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Hashimoto K. Are "mystical experiences" essential for antidepressant actions of ketamine and the classic psychedelics? Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01770-7. [PMID: 38411629 DOI: 10.1007/s00406-024-01770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024]
Abstract
The growing interest in the rapid and sustained antidepressant effects of the dissociative anesthetic ketamine and classic psychedelics, such as psilocybin, is remarkable. However, both ketamine and psychedelics are known to induce acute mystical experiences; ketamine can cause dissociative symptoms such as out-of-body experience, while psychedelics typically bring about hallucinogenic experiences, like a profound sense of unity with the universe or nature. The role of these mystical experiences in enhancing the antidepressant outcomes for patients with depression is currently an area of ongoing investigation and debate. Clinical studies have shown that the dissociative symptoms following the administration of ketamine or (S)-ketamine (esketamine) are not directly linked to their antidepressant properties. In contrast, the antidepressant potential of (R)-ketamine (arketamine), thought to lack dissociative side effects, has yet to be conclusively proven in large-scale clinical trials. Moreover, although the activation of the serotonin 5-HT2A receptor is crucial for the hallucinogenic effects of psychedelics in humans, its precise role in their antidepressant action is still under discussion. This article explores the importance of mystical experiences in enhancing the antidepressant efficacy of both ketamine and classic psychedelics.
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Affiliation(s)
- Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chiba, 260-8670, Japan.
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12
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Bhatt KV, Weissman CR. The effect of psilocybin on empathy and prosocial behavior: a proposed mechanism for enduring antidepressant effects. NPJ MENTAL HEALTH RESEARCH 2024; 3:7. [PMID: 38609500 PMCID: PMC10955966 DOI: 10.1038/s44184-023-00053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/20/2023] [Indexed: 04/14/2024]
Abstract
Psilocybin is a serotonergic psychedelic shown to have enduring antidepressant effects. Currently, the mechanism for its enduring effects is not well understood. Empathy and prosocial behavior may be important for understanding the therapeutic benefit of psilocybin. In this article we review the effect of psilocybin on empathy and prosocial behavior. Moreover, we propose that psilocybin may induce a positive feedback loop involving empathy and prosocial behavior which helps explain the observed, enduring antidepressant effects.
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Affiliation(s)
- Kush V Bhatt
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Cory R Weissman
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
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13
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Weintraub MJ, Miklowitz DJ. How should psychotherapy proceed when adjoined with psychedelics? World Psychiatry 2024; 23:157-158. [PMID: 38214635 PMCID: PMC10786002 DOI: 10.1002/wps.21170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Affiliation(s)
- Marc J Weintraub
- Department of Psychiatry and Biobehavioral Sciences, University of California, and Semel Institute for Neuroscience and Behavior, Los Angeles, CA, USA
| | - David J Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, University of California, and Semel Institute for Neuroscience and Behavior, Los Angeles, CA, USA
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14
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Rodgers A, Bahceci D, Davey CG, Chatterton ML, Glozier N, Hopwood M, Loo C. Ensuring the affordable becomes accessible-lessons from ketamine, a new treatment for severe depression. Aust N Z J Psychiatry 2024; 58:109-116. [PMID: 37830221 DOI: 10.1177/00048674231203898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
In this paper, the case study of ketamine as a new treatment for severe depression is used to outline the challenges of repurposing established medicines and we suggest potential solutions. The antidepressant effects of generic racemic ketamine were identified over 20 years ago, but there were insufficient incentives for commercial entities to pursue its registration, or support for non-commercial entities to fill this gap. As a result, the evaluation of generic ketamine was delayed, piecemeal, uncoordinated, and insufficient to gain approval. Meanwhile, substantial commercial investment enabled the widespread registration of a patented, intranasal s-enantiomeric ketamine formulation (Spravato®) for depression. However, Spravato is priced at $600-$900/dose compared to ~$5/dose for generic ketamine, and the ~AUD$100 million annual government investment requested in Australia (to cover drug costs alone) has been rejected twice, leaving this treatment largely inaccessible for Australian patients 2 years after Therapeutic Goods Administration approval. Moreover, emerging evidence indicates that generic racemic ketamine is at least as effective as Spravato, but no comparative trials were required for regulatory approval and have not been conducted. Without action, this story will repeat regularly in the next decade with a new wave of psychedelic-assisted psychotherapy treatments, for which the original off-patent molecules could be available at low-cost and reduce the overall cost of treatment. Several systemic reforms are required to ensure that affordable, effective options become accessible; these include commercial incentives, public and public-private funding schemes, reduced regulatory barriers and more coordinated international public funding schemes to support translational research.
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Affiliation(s)
- Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Dilara Bahceci
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Mary Lou Chatterton
- Health Economics Group, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Colleen Loo
- School of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Randwick, NSW, Australia
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15
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Vanderijst L, Hever F, Buot A, Dauré C, Benoit J, Hanak C, Veeser J, Morgiève M, Campanella S, Kornreich C, Mallet L, Leys C, Noël X. Psilocybin-assisted therapy for severe alcohol use disorder: protocol for a double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial. BMC Psychiatry 2024; 24:77. [PMID: 38279085 PMCID: PMC10821548 DOI: 10.1186/s12888-024-05502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND A significant number of individuals with alcohol use disorder remain unresponsive to currently available treatments, which calls for the development of new alternatives. In parallel, psilocybin-assisted therapy for alcohol use disorder has recently yielded promising preliminary results. Building on extant findings, the proposed study is set to evaluate the feasibility and preliminary clinical efficacy of psilocybin-assisted therapy when incorporated as an auxiliary intervention during inpatient rehabilitation for severe alcohol use disorder. Moreover, it intends to pinpoint the modifications in the two core neurocognitive systems underscored by dual-process models of addiction. METHODS In this double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial, 62 participants aged 21-64 years will be enrolled to undergo psilocybin-assisted therapy as part of a 4-week inpatient rehabilitation for severe alcohol use disorder. The experimental group will receive a high dose of psilocybin (30 mg), whereas the control group will receive an active placebo dose of psilocybin (5 mg), both within the context of a brief standardized psychotherapeutic intervention drawing from key elements of acceptance and commitment therapy. The primary clinical outcome is the between-group difference regarding the change in percentage of heavy drinking days from baseline to four weeks posthospital discharge, while safety and feasibility metrics will also be reported as primary outcomes. Key secondary assessments include between-group differences in terms of changes in (1) drinking behavior parameters up to six months posthospital discharge, (2) symptoms of depression, anxiety, trauma, and global functioning, (3) neuroplasticity and key neurocognitive mechanisms associated with addiction, and (4) psychological processes and alcohol-related parameters. DISCUSSION The discussion outlines issues that might arise from our design. TRIAL REGISTRATION EudraCT 2022-002369-14 and NCT06160232.
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Affiliation(s)
- Laetitia Vanderijst
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium.
- Research Center for the Promotion of Health, Prosocial Behavior and Wellbeing, Faculty of Psychology, Université libre de Bruxelles, Brussels, Belgium.
| | - Felix Hever
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Anne Buot
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, Paris, France
| | - Charles Dauré
- Université de Paris, INSERM UMRS1144, 4 avenue de l'Observatoire, 75006, Paris, France
| | - Janaïna Benoit
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Catherine Hanak
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Johannes Veeser
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Margot Morgiève
- Université Paris Cité, CNRS, Inserm, Cermes3, F-75006, Paris, France
| | - Salvatore Campanella
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
| | - Charles Kornreich
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Luc Mallet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, Paris, France
- Département Médical-Universitaire de Psychiatrie et d'Addictologie, Univ Paris-Est Créteil, DMU IMPACT, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Christophe Leys
- Research Center for the Promotion of Health, Prosocial Behavior and Wellbeing, Faculty of Psychology, Université libre de Bruxelles, Brussels, Belgium
| | - Xavier Noël
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
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16
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Modlin NL, Creed M, Sarang M, Maggio C, Rucker JJ, Williamson V. Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions. Neuropsychiatr Dis Treat 2024; 20:109-135. [PMID: 38268571 PMCID: PMC10807282 DOI: 10.2147/ndt.s432537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/10/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT. Aim To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them. Methods Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified. Results 40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics. Conclusion This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.
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Affiliation(s)
- Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Michael Creed
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Maria Sarang
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Carolina Maggio
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - James J Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Victoria Williamson
- King’s Centre for Military Health Research, King’s College London, London, SE5 9RJ, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, OX2 6 GG, UK
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17
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Alpert MD, O'Donnell KC, Paleos CA, Sola E, Stauffer CS, Wagner AC, Nicholas CR, Mithoefer MC. Psychotherapy in Psychedelic Treatment: Safe, Evidence-Based, and Necessary. Am J Psychiatry 2024; 181:76-77. [PMID: 38161307 DOI: 10.1176/appi.ajp.20230665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Michael D Alpert
- Department of Psychiatry, Beth Israel-Deaconess Medical Center, Boston (Alpert); Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Center for Psychedelic Medicine (O'Donnell); Nautilus Sanctuary, New York (Paleos); Department of Psychiatry, University of California, San Francisco, Polaris Insight Center, San Francisco (Sola); Social Neuroscience & Psychotherapy Lab, Department of Psychiatry, Oregon Health & Science University, Portland, Ore. (Stauffer); Remedy and Remedy Institute, Department of Psychology, Toronto Metropolitan University, Toronto (Wagner); Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wis. (Nicholas); MAPS Public Benefit Corporation, San Jose, Calif., Dept of Psychiatry, Medical University of South Carolina, Charleston, S.C., Department of Psychiatry, Columbia University, New York (Mithoefer)
| | - Kelley C O'Donnell
- Department of Psychiatry, Beth Israel-Deaconess Medical Center, Boston (Alpert); Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Center for Psychedelic Medicine (O'Donnell); Nautilus Sanctuary, New York (Paleos); Department of Psychiatry, University of California, San Francisco, Polaris Insight Center, San Francisco (Sola); Social Neuroscience & Psychotherapy Lab, Department of Psychiatry, Oregon Health & Science University, Portland, Ore. (Stauffer); Remedy and Remedy Institute, Department of Psychology, Toronto Metropolitan University, Toronto (Wagner); Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wis. (Nicholas); MAPS Public Benefit Corporation, San Jose, Calif., Dept of Psychiatry, Medical University of South Carolina, Charleston, S.C., Department of Psychiatry, Columbia University, New York (Mithoefer)
| | - Casey A Paleos
- Department of Psychiatry, Beth Israel-Deaconess Medical Center, Boston (Alpert); Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Center for Psychedelic Medicine (O'Donnell); Nautilus Sanctuary, New York (Paleos); Department of Psychiatry, University of California, San Francisco, Polaris Insight Center, San Francisco (Sola); Social Neuroscience & Psychotherapy Lab, Department of Psychiatry, Oregon Health & Science University, Portland, Ore. (Stauffer); Remedy and Remedy Institute, Department of Psychology, Toronto Metropolitan University, Toronto (Wagner); Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wis. (Nicholas); MAPS Public Benefit Corporation, San Jose, Calif., Dept of Psychiatry, Medical University of South Carolina, Charleston, S.C., Department of Psychiatry, Columbia University, New York (Mithoefer)
| | - Evan Sola
- Department of Psychiatry, Beth Israel-Deaconess Medical Center, Boston (Alpert); Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Center for Psychedelic Medicine (O'Donnell); Nautilus Sanctuary, New York (Paleos); Department of Psychiatry, University of California, San Francisco, Polaris Insight Center, San Francisco (Sola); Social Neuroscience & Psychotherapy Lab, Department of Psychiatry, Oregon Health & Science University, Portland, Ore. (Stauffer); Remedy and Remedy Institute, Department of Psychology, Toronto Metropolitan University, Toronto (Wagner); Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wis. (Nicholas); MAPS Public Benefit Corporation, San Jose, Calif., Dept of Psychiatry, Medical University of South Carolina, Charleston, S.C., Department of Psychiatry, Columbia University, New York (Mithoefer)
| | - Christopher S Stauffer
- Department of Psychiatry, Beth Israel-Deaconess Medical Center, Boston (Alpert); Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Center for Psychedelic Medicine (O'Donnell); Nautilus Sanctuary, New York (Paleos); Department of Psychiatry, University of California, San Francisco, Polaris Insight Center, San Francisco (Sola); Social Neuroscience & Psychotherapy Lab, Department of Psychiatry, Oregon Health & Science University, Portland, Ore. (Stauffer); Remedy and Remedy Institute, Department of Psychology, Toronto Metropolitan University, Toronto (Wagner); Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wis. (Nicholas); MAPS Public Benefit Corporation, San Jose, Calif., Dept of Psychiatry, Medical University of South Carolina, Charleston, S.C., Department of Psychiatry, Columbia University, New York (Mithoefer)
| | - Anne C Wagner
- Department of Psychiatry, Beth Israel-Deaconess Medical Center, Boston (Alpert); Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Center for Psychedelic Medicine (O'Donnell); Nautilus Sanctuary, New York (Paleos); Department of Psychiatry, University of California, San Francisco, Polaris Insight Center, San Francisco (Sola); Social Neuroscience & Psychotherapy Lab, Department of Psychiatry, Oregon Health & Science University, Portland, Ore. (Stauffer); Remedy and Remedy Institute, Department of Psychology, Toronto Metropolitan University, Toronto (Wagner); Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wis. (Nicholas); MAPS Public Benefit Corporation, San Jose, Calif., Dept of Psychiatry, Medical University of South Carolina, Charleston, S.C., Department of Psychiatry, Columbia University, New York (Mithoefer)
| | - Christopher R Nicholas
- Department of Psychiatry, Beth Israel-Deaconess Medical Center, Boston (Alpert); Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Center for Psychedelic Medicine (O'Donnell); Nautilus Sanctuary, New York (Paleos); Department of Psychiatry, University of California, San Francisco, Polaris Insight Center, San Francisco (Sola); Social Neuroscience & Psychotherapy Lab, Department of Psychiatry, Oregon Health & Science University, Portland, Ore. (Stauffer); Remedy and Remedy Institute, Department of Psychology, Toronto Metropolitan University, Toronto (Wagner); Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wis. (Nicholas); MAPS Public Benefit Corporation, San Jose, Calif., Dept of Psychiatry, Medical University of South Carolina, Charleston, S.C., Department of Psychiatry, Columbia University, New York (Mithoefer)
| | - Michael C Mithoefer
- Department of Psychiatry, Beth Israel-Deaconess Medical Center, Boston (Alpert); Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Center for Psychedelic Medicine (O'Donnell); Nautilus Sanctuary, New York (Paleos); Department of Psychiatry, University of California, San Francisco, Polaris Insight Center, San Francisco (Sola); Social Neuroscience & Psychotherapy Lab, Department of Psychiatry, Oregon Health & Science University, Portland, Ore. (Stauffer); Remedy and Remedy Institute, Department of Psychology, Toronto Metropolitan University, Toronto (Wagner); Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wis. (Nicholas); MAPS Public Benefit Corporation, San Jose, Calif., Dept of Psychiatry, Medical University of South Carolina, Charleston, S.C., Department of Psychiatry, Columbia University, New York (Mithoefer)
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18
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Bogenschutz MP. Pharmacological and Nonpharmacological Components of Psychedelic Treatments: The Whole is Not the Sum of the Parts. Am J Psychiatry 2024; 181:75. [PMID: 38161306 DOI: 10.1176/appi.ajp.20230643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
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19
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Deckel GM, Lepow LA, Guss J. "Psychedelic Assisted Therapy" Must Not Be Retired. Am J Psychiatry 2024; 181:77-78. [PMID: 38161309 DOI: 10.1176/appi.ajp.20230667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Garrett Marie Deckel
- Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York (Deckel); Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York (Lepow); New York University Grossman School of Medicine, New York (Guss)
| | - Lauren A Lepow
- Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York (Deckel); Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York (Lepow); New York University Grossman School of Medicine, New York (Guss)
| | - Jeffrey Guss
- Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York (Deckel); Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York (Lepow); New York University Grossman School of Medicine, New York (Guss)
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20
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Thal SB, Baker P, Marinis J, Wieberneit M, Sharbanee JM, Bruno R, Skeffington PM, Bright SJ. Therapeutic frameworks in integration sessions in substance-assisted psychotherapy: A systematised review. Clin Psychol Psychother 2023. [PMID: 38148518 DOI: 10.1002/cpp.2945] [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: 06/30/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed.
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Affiliation(s)
- Sascha B Thal
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Paris Baker
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Jonathon Marinis
- Orygen Youth Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michelle Wieberneit
- Law School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jason M Sharbanee
- Enable Institute, Discipline of Psychology, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Raimundo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Petra M Skeffington
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Psychedelic Research in Science and Medicine (PRISM), Balwyn North, Victoria, Australia
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21
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Jauhar S, Cowen PJ. Are neurotransmitters passé? A view from the foothills in response to Rose. Psychol Med 2023; 53:7976-7977. [PMID: 37885323 DOI: 10.1017/s0033291723002842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Sameer Jauhar
- Department of Psychological Medicine, IoPPN, King's College, London, UK
| | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Trust, Oxford, UK
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22
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Dworkin RH, McDermott MP, Nayak SM, Strain EC. Psychedelics and Psychotherapy: Is the Whole Greater than the Sum of its Parts? Clin Pharmacol Ther 2023; 114:1166-1169. [PMID: 37795632 DOI: 10.1002/cpt.3050] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Robert H Dworkin
- Departments of Anesthesiology and Perioperative Medicine, Neurology, and Psychiatry, University of Rochester School of Medicine and Dentistry, New York, Rochester, USA
| | - Michael P McDermott
- Departments of Biostatistics and Computational Biology and Neurology, University of Rochester, New York, Rochester, USA
| | - Sandeep M Nayak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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23
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Crowe M, Manuel J, Carlyle D, Lacey C. Psilocybin-assisted psychotherapy for treatment-resistant depression: Which psychotherapy? Int J Ment Health Nurs 2023; 32:1766-1772. [PMID: 37589380 DOI: 10.1111/inm.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
This perspective paper explores the choice of psychotherapy for psilocybin-assisted psychotherapy for treatment-resistant depression. There is evidence to support the use of some psychotherapies in treating 'treatment-resistant' depression, and emerging evidence for the efficacy of psilocybin. The next step which is the focus of this paper is to identify psychotherapies that are both effective and congruent with the psilocybin experience. The evidence for the efficacy of the psychotherapies is drawn from a Cochrane review and the analysis of their congruence with the psilocybin experience is drawn from a qualitative meta-synthesis of the experience of psilocybin. The paper will examine whether three one-to-one psychotherapies identified as effective in the treatment of treatment-resistant depression are compatible with the psilocybin experience. Each psychotherapy will be examined in relation to its congruence with the qualitative evidence that suggests the choice of psychotherapy needs to give priority to the subjective experience, facilitate emotional processing, support connectedness with others, acceptance of the self as emotional and support change based on the person's insights into their relationships with others and the world in which they live. We conclude that interpersonal psychotherapy and intensive short-term dynamic psychotherapy align with that experience, although others are currently being trialled.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenni Manuel
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Māori and Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Dave Carlyle
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Māori and Indigenous Health Institute, University of Otago, Christchurch, New Zealand
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24
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Garakani A, Alexander JL, Sumner CR, Pine JH, Gross LS, Raison CL, Aaronson ST, Baron DA. Psychedelics, With a Focus on Psilocybin: Issues for the Clinician. J Psychiatr Pract 2023; 29:345-353. [PMID: 37678363 DOI: 10.1097/pra.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
There has been a burgeoning interest in psychedelics among the public, state legislatures, psychiatrists and other clinical providers, and within the research community. Increasing numbers of studies evaluating psychedelics for depression, anxiety, posttraumatic stress disorder, and substance use disorders have been conducted or are underway. While discussing psychedelics in general, the focus of this paper is on psilocybin and its mechanism, how it exerts a psychedelic effect, dosing, and a review of the treatment studies of psilocybin, which were primarily for treatment-resistant depression and cancer-related anxiety. Future directions and potential limitations of studying and regulating psilocybin and other psychedelics are also discussed.
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25
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Wall MB, Harding R, Zafar R, Rabiner EA, Nutt DJ, Erritzoe D. Neuroimaging in psychedelic drug development: past, present, and future. Mol Psychiatry 2023; 28:3573-3580. [PMID: 37759038 PMCID: PMC10730398 DOI: 10.1038/s41380-023-02271-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Psychedelic therapy (PT) is an emerging paradigm with great transdiagnostic potential for treating psychiatric disorders, including depression, addiction, post-traumatic stress disorder, and potentially others. 'Classic' serotonergic psychedelics, such as psilocybin and lysergic acid diethylamide (LSD), which have a key locus of action at the 5-HT2A receptor, form the main focus of this movement, but substances including ketamine, 3,4-Methylenedioxymethamphetamine (MDMA) and ibogaine also hold promise. The modern phase of development of these treatment modalities in the early 21st century has occurred concurrently with the wider use of advanced human neuroscientific research methods; principally neuroimaging. This can potentially enable assessment of drug and therapy brain effects with greater precision and quantification than any previous novel development in psychiatric pharmacology. We outline the major trends in existing data and suggest the modern development of PT has benefitted greatly from the use of neuroimaging. Important gaps in existing knowledge are identified, namely: the relationship between acute drug effects and longer-term (clinically-relevant) effects, the precise characterisation of effects at the 5-HT2A receptor and relationships with functional/clinical effects, and the possible impact of these compounds on neuroplasticity. A road-map for future research is laid out, outlining clinical studies which will directly address these three questions, principally using combined Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) methods, plus other adjunct techniques. Multimodal (PET/MRI) studies using modern PET techniques such as the 5-HT2A-selective ligand [11 C]Cimbi-36 (and other ligands sensitive to neuroplasticity changes) alongside MRI measures of brain function would provide a 'molecular-functional-clinical bridge' in understanding. Such results would help to resolve some of these questions and provide a firmer foundation for the ongoing development of PT.
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Affiliation(s)
- Matthew B Wall
- Invicro, London, UK.
- Faculty of Medicine, Imperial College London, London, UK.
- Centre for Psychedelic research and Neuropsychopharmacology, Imperial College London, London, UK.
| | - Rebecca Harding
- Clinical Psychopharmacology Unit, Faculty of Brain Sciences, University College London, London, UK
| | - Rayyan Zafar
- Faculty of Medicine, Imperial College London, London, UK
- Centre for Psychedelic research and Neuropsychopharmacology, Imperial College London, London, UK
| | | | - David J Nutt
- Faculty of Medicine, Imperial College London, London, UK
- Centre for Psychedelic research and Neuropsychopharmacology, Imperial College London, London, UK
| | - David Erritzoe
- Faculty of Medicine, Imperial College London, London, UK
- Centre for Psychedelic research and Neuropsychopharmacology, Imperial College London, London, UK
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