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Darke S, Duflou J, Peacock A, Farrell M, Hall W, Lappin J. A retrospective study of the characteristics and toxicology of cases of lysergic acid diethylamide (LSD)- and psilocybin-related death in Australia. Addiction 2024. [PMID: 38771189 DOI: 10.1111/add.16518] [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: 01/16/2024] [Accepted: 04/11/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND AND AIMS Lysergic acid diethylamide (LSD) and psilocybin are used as recreational drugs, and there is renewed interest in their clinical use. The current study aimed to (1) determine the circumstances of death and case characteristics of LSD- and psilocybin-related death in Australia, 2000-23; and (2) determine the toxicological profile and major autopsy findings of these cases. METHODS This was a retrospective exploratory study of all cases of LSD- and psilocybin-related death in Australia, 2000-23, retrieved from the National Coronial Information System. RESULTS A total of 43 cases were identified: 33 LSD and 10 psilocybin. The median ages were 24 years [interquartile range (IQR) = 13, range = 16-53] (LSD) and 26 years (IQR = 18.5, range = 20-58) (psilocybin), and fewer than five cases were female. The most common circumstance of death among both groups was traumatic accident (LSD 36.4%, psilocybin 40.0%). There were 12 cases of self-harm, all of which involved LSD, all by physical means. In a fifth, death was attributed to multiple drug toxicity (LSD 18.2%, psilocybin 20.0%). In one case, death was attributed solely to LSD toxicity, while in a further two cases death was attributed to a cardiovascular event following LSD consumption (one LSD only, one multiple drug toxicity). In four psilocybin cases, the cause of death was undetermined. The most common clinical presentation was severe agitation (LSD 27.3%, psilocybin 20.0%). Median blood concentrations were LSD 0.8 μg/l (IQR = 1.7, range = 0.1-3), psilocin 20 μg/l (IQR = 53.5, range = 6-83). LSD was the only drug present in 25.0% of LSD cases and psilocybin in 20.0% of psilocybin cases. Pre-existing organ pathology was uncommon. CONCLUSIONS Lysergic acid diethylamide (LSD)- and psilocybin-related death in Australia from 2000 to 2023 was primarily due to traumatic injury, whether through accident or self-harm. Cases of acute toxic reactions that were attributed solely to LSD were rare.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW, Australia
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW, Australia
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, QLD, Australia
| | - Julia Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, NSW, Australia
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Atiq MA, Baker MR, Voort JLV, Vargas MV, Choi DS. Disentangling the acute subjective effects of classic psychedelics from their enduring therapeutic properties. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06599-5. [PMID: 38743110 DOI: 10.1007/s00213-024-06599-5] [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: 06/02/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Recent research with classic psychedelics suggests significant therapeutic potential, particularly for neuropsychiatric disorders. A mediating influence behind symptom resolution is thought to be the personal insight - at times, bordering on the mystical - one acquires during the acute phase of a psychedelic session. Indeed, current clinical trials have found strong correlations between the acute subjective effects (ASE) under the influence of psychedelics and their enduring therapeutic properties. However, with potential barriers to widespread clinical implementation, including the healthcare resource-intensive nature of psychedelic sessions and the exclusion of certain at-risk patient groups, there is an active search to determine whether ASE elimination can be accompanied by the retention of persisting therapeutic benefits of these class of compounds. Recognizing the aberrant underlying neural circuitry that characterizes a range of neuropsychiatric disorders, and that classic psychedelics promote neuroplastic changes that may correct abnormal circuitry, investigators are rushing to design and discover compounds with psychoplastogenic, but not hallucinogenic (i.e., ASE), therapeutic potential. These efforts have paved the discovery of 'non-psychedelic/subjective psychedelics', or compounds that lack hallucinogenic activity but with therapeutic efficacy in preclinical models. This review aims to distill the current evidence - both clinical and preclinical - surrounding the question: can the ASE of classic psychedelics be dissociated from their sustained therapeutic properties? Several plausible clinical scenarios are then proposed to offer clarity on and potentially answer this question.
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Affiliation(s)
- Mazen A Atiq
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Matthew R Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Maxemiliano V Vargas
- Institute for Psychedelics and Neurotherapeutics, University of California, Davis, Davis, CA, USA
| | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Yao Y, Guo D, Lu TS, Liu FL, Huang SH, Diao MQ, Li SX, Zhang XJ, Kosten TR, Shi J, Bao YP, Lu L, Han Y. Efficacy and safety of psychedelics for the treatment of mental disorders: A systematic review and meta-analysis. Psychiatry Res 2024; 335:115886. [PMID: 38574699 DOI: 10.1016/j.psychres.2024.115886] [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: 01/02/2024] [Revised: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
We aim to systematically review and meta-analyze the effectiveness and safety of psychedelics [psilocybin, ayahuasca (active component DMT), LSD and MDMA] in treating symptoms of various mental disorders. Web of Science, Embase, EBSCO, and PubMed were searched up to February 2024 and 126 articles were finally included. Results showed that psilocybin has the largest number of articles on treating mood disorders (N = 28), followed by ayahuasca (N = 7) and LSD (N = 6). Overall, psychedelics have therapeutic effects on mental disorders such as depression and anxiety. Specifically, psilocybin (Hedges' g = -1.49, 95% CI [-1.67, -1.30]) showed the strongest therapeutic effect among four psychedelics, followed by ayahuasca (Hedges' g = -1.34, 95% CI [-1.86, -0.82]), MDMA (Hedges' g = -0.83, 95% CI [-1.33, -0.32]), and LSD (Hedges' g = -0.65, 95% CI [-1.03, -0.27]). A small amount of evidence also supports psychedelics improving tobacco addiction, eating disorders, sleep disorders, borderline personality disorder, obsessive-compulsive disorder, and body dysmorphic disorder. The most common adverse event with psychedelics was headache. Nearly a third of the articles reported that no participants reported lasting adverse effects. Our analyses suggest that psychedelics reduce negative mood, and have potential efficacy in other mental disorders, such as substance-use disorders and PTSD.
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Affiliation(s)
- Yuan Yao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Dan Guo
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Tang-Sheng Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Fang-Lin Liu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Shi-Hao Huang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Meng-Qi Diao
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Su-Xia Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China
| | - Xiu-Jun Zhang
- School of Psychology, College of Public Health, North China University of Science and Technology, Tangshan 063210, Hebei Province, China
| | - Thomas R Kosten
- Department of Psychiatry, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China.
| | - Lin Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China; Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China; Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences (No.2018RU006).
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China.
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Pouyan N, Younesi Sisi F, Kargar A, Scheidegger M, McIntyre RS, Morrow JD. The effects of Lysergic Acid Diethylamide (LSD) on the Positive Valence Systems: A Research Domain Criteria (RDoC)-Informed Systematic Review. CNS Drugs 2023; 37:1027-1063. [PMID: 37999867 PMCID: PMC10703966 DOI: 10.1007/s40263-023-01044-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND AND OBJECTIVES The renewed interest in psychedelic research provides growing evidence of potentially unique effects on various aspects of reward processing systems. Using the Research Domain Criteria (RDoC) framework, as proposed by the National Institute of Mental Health, we aim to synthesize the existing literature concerning the impact of lysergic acid diethylamide (LSD) on the RDoC's Positive Valence Systems (PVS) domain, and to identify potential avenues for further research. METHODS Two LSD-related terms (lysergic acid diethylamide and LSD) and 13 PVS-related terms (reward, happiness, bliss, motivation, reinforcement learning, operant, conditioning, satisfaction, decision making, habit, valence, affect, mood) were used to search electronic databases such as PubMed, Scopus, PsychINFO, and Web of Science for relevant articles. A manual search of the reference list resulted in nine additional articles. After screening, articles and data were evaluated and included based on their relevance to the objective of investigating the effects of LSD on the PVS. Articles and data were excluded if they did not provide information about the PVS, were observational in nature, lacked comparators or reference groups, or were duplicates. A risk of bias assessment was performed using the National Toxicology Program's Office of Health Assessment and Translation (NTP OHAT) risk of bias (RoB) tool. Data from the included articles were collected and structured based on the RDoC bio-behavioral matrix, specifically focusing on the PVS domain and its three constituent constructs: reward responsiveness, reward learning, and reward valuation. RESULTS We reviewed 28 clinical studies with 477 participants. Lysergic acid diethylamide, assessed at self-report (23 studies), molecular (5 studies), circuit (4 studies), and paradigm (3 studies) levels, exhibited dose-dependent mood improvement (20 short-term and 3 long-term studies). The subjective and neural effects of LSD were linked to the 5-HT2A receptor (molecular). Animal studies (14 studies) suggested LSD could mildly reinforce conditioned place preference without aversion and reduce responsiveness to other rewards. Findings on reward learning were inconsistent but hinted at potential associative learning enhancements. Reward valuation measures indicated potential reductions in effort expenditure for other reinforcers. CONCLUSION Our findings are consistent with our previous work, which indicated classical psychedelics, primarily serotonin 2A receptor agonists, enhanced reward responsiveness in healthy individuals and patient populations. Lysergic acid diethylamide exhibits a unique profile in the reward learning and valuation constructs. Using the RDoC-based framework, we identified areas for future research, enhancing our understanding of the impact of LSD on reward processing. However, applying RDoC to psychedelic research faces limitations due to diverse study designs that were not initially RDoC-oriented. Limitations include subjective outcome measure selection aligned with RDoC constructs and potential bias in synthesizing varied studies. Additionally, some human studies were open-label, introducing potential bias compared to randomized, blinded studies.
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Affiliation(s)
- Niloufar Pouyan
- Michigan Psychedelic Center (M-PsyC), and Chronic Pain and Fatigue Research Center (CPFRC), University of Michigan Medical School, Ann Arbor, MI, USA.
- Neuroscience Graduate Program, and Program in Biomedical Sciences (PIBS), University of Michigan Medical School, 1135 Catherine Street, Box 5619, 2960 Taubman Health Science Library, Ann Arbor, MI, USA.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Aracell Zist Darou pharmaceutical, Tehran, Iran.
| | - Farnaz Younesi Sisi
- Yaadmaan Institute for Brain, Cognition and Memory Studies, Tehran, Iran
- Cognitive Neurology and Neuropsychiatry Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Kargar
- Cognitive Neurology and Neuropsychiatry Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Clinical Pharmacy, School of pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milan Scheidegger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jonathan D Morrow
- Neuroscience Graduate Program, and Program in Biomedical Sciences (PIBS), University of Michigan Medical School, 1135 Catherine Street, Box 5619, 2960 Taubman Health Science Library, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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5
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Riaz K, Suneel S, Hamza Bin Abdul Malik M, Kashif T, Ullah I, Waris A, Di Nicola M, Mazza M, Sani G, Martinotti G, De Berardis D. MDMA-Based Psychotherapy in Treatment-Resistant Post-Traumatic Stress Disorder (PTSD): A Brief Narrative Overview of Current Evidence. Diseases 2023; 11:159. [PMID: 37987270 PMCID: PMC10660711 DOI: 10.3390/diseases11040159] [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: 09/06/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating mental health disorder that causes significant dysfunction in individuals. Currently, there are many approved pharmacotherapy and psychotherapy treatment options for PTSD, but unfortunately, half of the patients do not respond to traditional therapies. In this article, we review clinical trials and research on 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in PTSD patients, its pharmacokinetics, and current treatment guidelines for PTSD. Our findings are based on the results of the efficacy of MDMA-assisted psychotherapy from six phase II randomized controlled trials. MDMA-assisted psychotherapy for PTSD has received the "breakthrough therapy" designation from the FDA. MDMA can reduce PTSD symptoms even in treatment-resistant cases by increasing certain neurohormones, i.e., dopamine, serotonin, norepinephrine, and oxytocin. It also modulates activities in the brain regions involved in fear and anxiety. Future research is needed to show whether the advantages outweigh the disadvantages and whether its use can be integrated into available treatment options for PTSD.
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Affiliation(s)
- Kainat Riaz
- Dow Medical College, Dow University of Health Sciences, Karachi 75700, Pakistan; (K.R.); (S.S.)
| | - Sejal Suneel
- Dow Medical College, Dow University of Health Sciences, Karachi 75700, Pakistan; (K.R.); (S.S.)
| | | | - Tooba Kashif
- Jinnah Sindh Medical University, Karachi 75510, Pakistan;
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar 25120, Pakistan; (I.U.); (A.W.)
| | - Abdul Waris
- Kabir Medical College, Gandhara University, Peshawar 25120, Pakistan; (I.U.); (A.W.)
| | - Marco Di Nicola
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.D.N.); (M.M.); (G.S.)
| | - Marianna Mazza
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.D.N.); (M.M.); (G.S.)
| | - Gabriele Sani
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.D.N.); (M.M.); (G.S.)
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging, and Clinical Sciences, University G. D’Annunzio, 66100 Chieti-Pescara, Italy;
| | - Domenico De Berardis
- Department of Psychiatry, Azienda Sanitaria Locale 4, 64100 Teramo, Italy
- School of Nursing, University of L’Aquila, 67100 L’Aquila, Italy
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, 443100 Samara, Russia
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6
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Vermeulen SF, Polak TB, Bunnik EM. Expanded access to investigational drugs in psychiatry: A systematic review. Psychiatry Res 2023; 329:115554. [PMID: 37890403 DOI: 10.1016/j.psychres.2023.115554] [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: 08/15/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
Some psychiatric patients have exhausted all approved treatment options. Numerous investigational drugs are currently being developed and tested in clinical trials. However, not all patients can participate in clinical trials. Expanded access programs may provide an opportunity for patients who cannot participate in clinical trials to use investigational drugs as a therapeutic option outside of clinical trials. It is unknown to what extent expanded access occurs in psychiatry. We conducted a systematic literature search on PubMed, Embase, and PscyInfo, with additional information from ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and FDA/EMA approvals, in order to find all expanded access programs ever conducted, globally, in the field of psychiatry. This resulted in a total of fourteen expanded access programs ever conducted in psychiatry. Given the prevalence of psychiatric disorders, the activity in clinical research in psychiatry, the regulatory framework enabling expanded access, and the impact of psychiatric disorders on patients, their families, and society, we had expected a higher utilization of expanded access. We propose that the psychiatric community, with pharmaceutical industry, should consider establishing and optimizing expanded access programs.
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Affiliation(s)
- Stefan F Vermeulen
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, the Netherlands; GGz Breburg, Tilburg, the Netherlands.
| | - Tobias B Polak
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands; Real-World Data Department, myTomorrows, Amsterdam, the Netherlands
| | - Eline M Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, the Netherlands
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7
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Hirschfeld T, Prugger J, Majić T, Schmidt TT. Dose-response relationships of LSD-induced subjective experiences in humans. Neuropsychopharmacology 2023; 48:1602-1611. [PMID: 37161078 PMCID: PMC10516880 DOI: 10.1038/s41386-023-01588-2] [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: 10/25/2022] [Revised: 03/19/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
Lysergic acid diethylamide (LSD) is a potent classic serotonergic psychedelic, which facilitates a variety of altered states of consciousness. Here we present the first meta-analysis establishing dose-response relationship estimates of the altered states of consciousness induced by LSD. Data extracted from articles identified by a systematic literature review following PRISMA guidelines were obtained from the Altered States Database. The psychometric data comprised ratings of subjective effects from standardized and validated questionnaires: the Altered States of Consciousness Rating Scale (5D-ASC, 11-ASC) and the Mystical Experience Questionnaire (MEQ30). We performed meta-regression analyses using restricted cubic splines for data from studies with LSD doses of up to 200 μg base. Most scales revealed a sigmoid-like increase of effects, with a plateauing at around 100 μg. The most strongly modulated factors referred to changes in perception and illusory imagination, followed by positively experienced ego-dissolution, while only small effects were found for Anxiety and Dread of Ego Dissolution. The considerable variability observed in most factors and scales points to the role of non-pharmacological factors in shaping subjective experiences. The established dose-response relationships may be used as general references for future experimental and clinical research on LSD to compare observed with expected subjective effects and to elucidate phenomenological differences between psychedelics.
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Affiliation(s)
- Tim Hirschfeld
- Psychedelic Substances Research Group, Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Prugger
- Psychedelic Substances Research Group, Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
- International Graduate Program Medical Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tomislav Majić
- Psychedelic Substances Research Group, Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry und Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Timo T Schmidt
- Psychedelic Substances Research Group, Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Department of Education and Psychology, Freie Universität Berlin, 14195, Berlin, Germany.
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8
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Herrmann Z, Earleywine M, De Leo J, Slabaugh S, Kenny T, Rush AJ. Scoping Review of Experiential Measures from Psychedelic Research and Clinical Trials. J Psychoactive Drugs 2023; 55:501-517. [PMID: 36127639 DOI: 10.1080/02791072.2022.2125467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/12/2022] [Accepted: 08/02/2022] [Indexed: 10/14/2022]
Abstract
Subjective responses to psychoactive drugs have served as intriguing windows into consciousness as well as useful predictors. Subjective reactions to psychedelic molecules are particularly interesting given how they covary with subsequent improvements associated with psychedelic-assisted treatments. Although links between subjective reactions and decreases in treatment-resistant clinical depression, end-of-life anxiety, and maladaptive consumption of alcohol and nicotine appear in the empirical literature, the measurement of these subjective responses has proven difficult. Several scales developed over many decades show reasonable internal consistency. Studies suggest that many have a replicable factor structure and other good psychometric properties, but samples are often small and self-selected. We review the psychometric properties of some of the most widely used scales and detail their links to improvement in response to psychedelic-assisted treatments. Generally, assessments of mystical experiences or oceanic boundlessness correlate with improvements. Challenging subjective experiences, psychological insight, and emotional breakthroughs also show considerable promise, though replication would strengthen conclusions. We suggest a collaborative approach where investigators can focus on key responses to ensure that the field will eventually have data from many participants who report their subjective reactions to psychedelic molecules in a therapeutic setting. This may aid in predicting improvement amongst targeted conditions and wellbeing.
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Affiliation(s)
- Zachary Herrmann
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- New Hampshire Hospital, Concord, NH, USA
| | | | - Joseph De Leo
- Center for Compassionate Care, Hamilton, Ontario, Canada
| | - Sarah Slabaugh
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Timothy Kenny
- Library & Knowledge Services, Maine Medical Center, Portland, ME, USA
| | - A John Rush
- Emeritus, Duke - National University of Singapore (Nus); Adjunct Professor of Psychiatry, Duke University School of Medicine, Durham, NC, USA
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9
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Martin S. Why using “consciousness” in psychotherapy? Insight, metacognition and self-consciousness. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2023.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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10
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Tulver K, Kaup KK, Laukkonen R, Aru J. Restructuring insight: An integrative review of insight in problem-solving, meditation, psychotherapy, delusions and psychedelics. Conscious Cogn 2023; 110:103494. [PMID: 36913839 DOI: 10.1016/j.concog.2023.103494] [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: 08/26/2022] [Revised: 02/03/2023] [Accepted: 02/26/2023] [Indexed: 03/13/2023]
Abstract
Occasionally, a solution or idea arrives as a sudden understanding - an insight. Insight has been considered an "extra" ingredient of creative thinking and problem-solving. Here we propose that insight is central in seemingly distinct areas of research. Drawing on literature from a variety of fields, we show that besides being commonly studied in problem-solving literature, insight is also a core component in psychotherapy and meditation, a key process underlying the emergence of delusions in schizophrenia, and a factor in the therapeutic effects of psychedelics. In each case, we discuss the event of insight and its prerequisites and consequences. We review evidence for the commonalities and differences between the fields and discuss their relevance for capturing the essence of the insight phenomenon. The goal of this integrative review is to bridge the gap between the different views and inspire interdisciplinary research efforts for understanding this central process of human cognition.
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Affiliation(s)
- Kadi Tulver
- Institute of Computer Science, University of Tartu, Estonia.
| | | | | | - Jaan Aru
- Institute of Computer Science, University of Tartu, Estonia.
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11
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Ponomarenko P, Seragnoli F, Calder A, Oehen P, Hasler G. Can psychedelics enhance group psychotherapy? A discussion on the therapeutic factors. J Psychopharmacol 2023:2698811231155117. [PMID: 36855289 DOI: 10.1177/02698811231155117] [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: 03/02/2023]
Abstract
BACKGROUND Despite the growth of psychedelic research, psychedelic-assisted group psychotherapy (PAGP) has received little attention in comparison to individual psychedelic-assisted psychotherapy models. METHODS In this article, we aim to discuss the therapeutic potential of PAGP, as well as outline existing models and the challenges of this approach. Using Irvin Yalom's 11 therapeutic factors of group therapy as a basic framework, we analyse current literature from clinical studies and neurobiological research relative to the topic of PAGP. RESULTS We argue that combining psychedelic substances and group psychotherapy may prove beneficial for increasing group connectedness and interpersonal learning, potentially enhancing prosocial behaviour with direct opportunities to practice newly acquired knowledge about previously maladaptive behavioural patterns. Challenges regarding this approach include a more rigid therapy structure and potential loss of openness from patients, which may be ameliorated by adequate therapeutic training. CONCLUSION We hope for this article to support clinical research on PAGP by presenting a therapeutic framework and outlining its mechanisms and challenges.
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Affiliation(s)
| | | | - Abigail Calder
- Department of Medicine, University of Freiburg, Villars-sur-Glâne, Switzerland
| | - Peter Oehen
- Private Practice for Psychiatry and Psychotherapy, Biberist, Switzerland
| | - Gregor Hasler
- Department of Medicine, University of Freiburg, Villars-sur-Glâne, Switzerland
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12
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Lysergic Acid Diethylamide-Assisted Therapy in Patients With Anxiety With and Without a Life-Threatening Illness: A Randomized, Double-Blind, Placebo-Controlled Phase II Study. Biol Psychiatry 2023; 93:215-223. [PMID: 36266118 DOI: 10.1016/j.biopsych.2022.08.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/05/2022] [Accepted: 08/26/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aimed to investigate the efficacy and safety of lysergic acid diethylamide (LSD)-assisted therapy in patients who experienced anxiety with or without association with a life-threatening illness. METHODS The study is an investigator-initiated 2-center trial that used a double-blind, placebo-controlled, 2-period, random-order, crossover design with 2 sessions with either oral LSD (200 μg) or placebo per period. The primary end point was anxiety symptoms 16 weeks after the last treatment session, assessed by the Spielberger State-Trait Anxiety Inventory-Global score in 42 patients. Further outcome measures included ratings for depression symptoms (Beck Depression Inventory and Hamilton Depression Rating Scale, 21-item version) and ratings for acute subjective drug effects. The outcomes for the first period (between-subjects analysis) are primarily shown due to carryover effects. RESULTS LSD treatment resulted in significant reductions of State-Trait Anxiety Inventory-Global scores up to 16 weeks after treatment (least-square mean [standard error] change from baseline difference = -16.2 [5.8], 95% CI, -27.8 to -4.5, d = -1.18, p = .007). Similar effects were observed for ratings of comorbid depression on the Hamilton Depression Rating Scale, 21-item version (-7.0 [1.9], 95% CI, -10.8 to -3.2, d = -1.1, p = .0004) and the Beck Depression Inventory (-6.1 [2.6], 95% CI, -11.4 to -0.9, d = -0.72, p = .02). Positive acute subjective drug effects and mystical-type experiences correlated with the long-term reductions in anxiety symptoms. Transient, mild, acute untoward effects of LSD treatment were reported by 8 patients (19%). One treatment-related serious adverse event (acute transient anxiety) occurred (2%). CONCLUSIONS LSD produced long-lasting and notable reductions in anxiety and comorbid depression symptoms up to 16 weeks.
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13
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The Altered States Database: Psychometric data from a systematic literature review. Sci Data 2022; 9:720. [PMID: 36418335 PMCID: PMC9684144 DOI: 10.1038/s41597-022-01822-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/01/2022] [Indexed: 11/26/2022] Open
Abstract
In this paper, we present the development of the Altered States Database (ASDB), an open-science project based on a systematic literature review. The ASDB contains psychometric questionnaire data on subjective experiences of altered states of consciousness (ASC) induced by pharmacological and non-pharmacological methods. The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific journal articles were identified through PubMed and Web of Science. We included studies that examined ASC using the following validated questionnaires: Altered States of Consciousness Rating Scale (APZ, 5D-ASC, 11-ASC), Phenomenology of Consciousness Inventory (PCI), Hallucinogen Rating Scale (HRS), or Mystical Experience Questionnaire (MEQ30). The systematic review resulted in the inclusion of a total of 165 journal articles, whereof questionnaire data was extracted and is now available on the Open Science Framework (OSF) website (https://osf.io/8mbru) and on the ASDB website (http://alteredstatesdb.org), where questionnaire data can be easily retrieved and visualized. This data allows the calculation of comparable psychometric values of ASC experiences and of dose-response relationships of substances inducing ASC. Measurement(s) | Psychometric questionnaire data | Technology Type(s) | Systematic literature review (PRISMA) | Sample Characteristic - Organism | Human |
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14
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Schipper S, Nigam K, Piechotta V, Ljuslin M, Beaussant Y, Schwarzer G, Boehlke C. Psychedelic/entactogen‐assisted therapy for treatment of anxiety, depression and existential distress in adult palliative care. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022; 2022:CD015383. [PMCID: PMC9677948 DOI: 10.1002/14651858.cd015383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of psychedelic/entactogen‐assisted therapy compared to placebo or active comparators (e.g. antidepressants) for treatment of anxiety, depression, and existential distress in adult palliative care.
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Affiliation(s)
| | | | - Kabir Nigam
- Department of PsychiatryBrigham and Women’s HospitalBostonUSA
| | - Vanessa Piechotta
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane HaematologyFaculty of Medicine and University Hospital Cologne, University of CologneCologneGermany
| | - Michael Ljuslin
- Palliative Medicine Division, Department of Rehabilitation and GeriatricsGeneva University HospitalsGenevaSwitzerland,Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA,Harvard Medical SchoolBostonUSA
| | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA
| | - Guido Schwarzer
- Institute of Medical Biometry and StatisticsFaculty of Medicine and Medical Center, University of FreiburgFreiburgGermany
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Becker AM, Klaiber A, Holze F, Istampoulouoglou I, Duthaler U, Varghese N, Eckert A, Liechti ME. Ketanserin Reverses the Acute Response to LSD in a Randomized, Double-Blind, Placebo-Controlled, Crossover Study in Healthy Participants. Int J Neuropsychopharmacol 2022; 26:97-106. [PMID: 36342343 PMCID: PMC9926053 DOI: 10.1093/ijnp/pyac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Lysergic acid diethylamide (LSD) is currently being investigated in psychedelic-assisted therapy. LSD has a long duration of acute action of 8-11 hours. It produces its acute psychedelic effects via stimulation of the serotonin 5-hydroxytryptamine-2A (HT2A) receptor. Administration of the 5-HT2A antagonist ketanserin before LSD almost fully blocks the acute subjective response to LSD. However, unclear is whether ketanserin can also reverse the effects of LSD when administered after LSD. METHODS We used a double-blind, randomized, placebo-controlled, crossover design in 24 healthy participants who underwent two 14-hour sessions and received ketanserin (40 mg p.o.) or placebo 1 hour after LSD (100 µg p.o.). Outcome measures included subjective effects, autonomic effects, acute adverse effects, plasma brain-derived neurotrophic factor levels, and pharmacokinetics up to 12 hours. RESULTS Ketanserin reversed the acute response to LSD, thereby significantly reducing the duration of subjective effects from 8.5 hours with placebo to 3.5 hours. Ketanserin also reversed LSD-induced alterations of mind, including visual and acoustic alterations and ego dissolution. Ketanserin reduced adverse cardiovascular effects and mydriasis that were associated with LSD but had no effects on elevations of brain-derived neurotrophic factor levels. Ketanserin did not alter the pharmacokinetics of LSD. CONCLUSIONS These findings are consistent with an interaction between ketanserin and LSD and the view that LSD produces its psychedelic effects only when occupying 5-HT2A receptors. Ketanserin can effectively be used as a planned or rescue option to shorten and attenuate the LSD experience in humans in research and LSD-assisted therapy. TRIAL REGISTRY ClinicalTrials.gov (NCT04558294).
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Affiliation(s)
- Anna M Becker
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Aaron Klaiber
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Friederike Holze
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Ioanna Istampoulouoglou
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Urs Duthaler
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Nimmy Varghese
- Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Anne Eckert
- Psychiatric University Hospital, University of Basel, Basel, Switzerland,Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Matthias E Liechti
- Correspondence: Matthias E. Liechti, MD, Clinical Pharmacology, University Hospital Basel, Schanzenstrasse 55, Basel, CH-4056, Switzerland ()
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Thal SB, Wieberneit M, Sharbanee JM, Skeffington PM, Baker P, Bruno R, Wenge T, Bright SJ. Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review. J Psychopharmacol 2022; 36:1191-1207. [PMID: 36263882 DOI: 10.1177/02698811221127954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical trials are currently investigating the potential of substance-assisted psychotherapy (SAPT) as treatment for several psychiatric conditions. The potential therapeutic effects of SAPT may be influenced by contextual factors including preparation prior to and integration after the substance-assisted therapy sessions. AIMS This systematized review outlines recommendations for current practice in preparatory sessions in SAPT including safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists. METHODS A systematized review of the literature was conducted based on PRISMA guidelines. MEDLINE (OVID), PsycINFO (OVID), and Cochrane Library were searched and clinical trials, treatment manuals, study protocols, case studies, qualitative studies, descriptive studies, theoretical papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved. RESULTS The final synthesis included k = 83 sources. Information about safety measures including screening of participants, set and setting, contextual-, physiological-, and psychological preparation, roles, competencies, prerequisites, and characteristics of the therapists, and the establishment of a therapeutic relationship were summarized and discussed. CONCLUSION It is concluded that there is a consensus in the literature about the importance of adequate preparation before the administration of psychoactive substances in SAPT. However, the extent and approaches for these sessions vary across different models and there is a need for timelier and more rigorous qualitative and quantitative investigations assessing different approaches and techniques for the optimal preparation of clients in SAPT.
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Affiliation(s)
- Sascha B Thal
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia.,Physical Activity and Well-Being Group, Curtin University, Perth, WA, Australia.,Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Michelle Wieberneit
- Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn, Bonn, Germany.,Law School, University of Western Australia, Perth, WA, Australia
| | - Jason M Sharbanee
- Enable Institute, Discipline of Psychology, Curtin School of Population Health, Curtin University, Perth, WA, Australia.,Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Perth, WA, Australia
| | - Petra M Skeffington
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Paris Baker
- School of Medicine (Psychology), University of Tasmania, Hobart, TAS, Australia
| | - Raimondo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, TAS, Australia
| | - Tobias Wenge
- International Society for Bonding Psychotherapy, Friedrichshafen, Germany
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Psychedelic Research in Science and Medicine, Balwyn North, VIC, Australia
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17
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Breeksema JJ, Kuin BW, Kamphuis J, van den Brink W, Vermetten E, Schoevers RA. Adverse events in clinical treatments with serotonergic psychedelics and MDMA: A mixed-methods systematic review. J Psychopharmacol 2022; 36:1100-1117. [PMID: 36017784 PMCID: PMC9548934 DOI: 10.1177/02698811221116926] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Small-scale clinical studies with psychedelic drugs have shown promising results for the treatment of several mental disorders. Before psychedelics become registered medicines, it is important to know the full range of adverse events (AEs) for making balanced treatment decisions. OBJECTIVE To systematically review the presence of AEs during and after administration of serotonergic psychedelics and 3,4-methyenedioxymethamphetamine (MDMA) in clinical studies. METHODS We systematically searched PubMed, PsycINFO, Embase, and ClinicalTrials.gov for clinical trials with psychedelics since 2000 describing the results of quantitative and qualitative studies. RESULTS We included 44 articles (34 quantitative + 10 qualitative), describing treatments with MDMA and serotonergic psychedelics (psilocybin, lysergic acid diethylamide, and ayahuasca) in 598 unique patients. In many studies, AEs were not systematically assessed. Despite this limitation, treatments seemed to be overall well tolerated. Nausea, headaches, and anxiety were commonly reported acute AEs across diagnoses and compounds. Late AEs included headaches (psilocybin, MDMA), fatigue, low mood, and anxiety (MDMA). One serious AE occurred during MDMA administration (increase in premature ventricular contractions requiring brief hospitalization); no other AEs required medical intervention. Qualitative studies suggested that psychologically challenging experiences may also be therapeutically beneficial. Except for ayahuasca, a large proportion of patients had prior experience with psychedelic drugs before entering studies. CONCLUSIONS AEs are poorly defined in the context of psychedelic treatments and are probably underreported in the literature due to study design (lack of systematic assessment of AEs) and sample selection. Acute challenging experiences may be therapeutically meaningful, but a better understanding of AEs in the context of psychedelic treatments requires systematic and detailed reporting.
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Affiliation(s)
- Joost J Breeksema
- Department of Psychiatry, University of
Groningen, University Medical Center Groningen, Groningen, The Netherlands,Department of Psychiatry, Leiden
University Medical Center, Leiden, The Netherlands,OPEN Foundation, Amsterdam, The
Netherlands,Joost J Breeksema, University Center of
Psychiatry, University Medical Center Groningen, Hanzeplein 1, Groningen 9700
RB, The Netherlands.
| | - Bouwe W Kuin
- Department of Psychiatry, University of
Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeanine Kamphuis
- Department of Psychiatry, University of
Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam
University Medical Center, Amsterdam, The Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden
University Medical Center, Leiden, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of
Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Schlag AK, Aday J, Salam I, Neill JC, Nutt DJ. Adverse effects of psychedelics: From anecdotes and misinformation to systematic science. J Psychopharmacol 2022; 36:258-272. [PMID: 35107059 PMCID: PMC8905125 DOI: 10.1177/02698811211069100] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite an increasing body of research highlighting their efficacy to treat a broad range of medical conditions, psychedelic drugs remain a controversial issue among the public and politicians, tainted by previous stigmatisation and perceptions of risk and danger. OBJECTIVE This narrative review examines the evidence for potential harms of the classic psychedelics by separating anecdotes and misinformation from systematic research. METHODS Taking a high-level perspective, we address both psychological and psychiatric risks, such as abuse liability and potential for dependence, as well as medical harms, including toxicity and overdose. We explore the evidence base for these adverse effects to elucidate which of these harms are based largely on anecdotes versus those that stand up to current scientific scrutiny. RESULTS Our review shows that medical risks are often minimal, and that many - albeit not all - of the persistent negative perceptions of psychological risks are unsupported by the currently available scientific evidence, with the majority of reported adverse effects not being observed in a regulated and/or medical context. CONCLUSIONS This highlights the importance for clinicians and therapists to keep to the highest safety and ethical standards. It is imperative not to be overzealous and to ensure balanced media reporting to avoid future controversies, so that much needed research can continue.
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Affiliation(s)
- Anne K Schlag
- Drug Science, London, UK,Department of Brain Sciences, Imperial College London, London, UK,Department of Geography, King’s College London, London, UK
| | - Jacob Aday
- Drug Science, London, UK,Department of Psychology, Central Michigan University, Mount Pleasant, MI, USA,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA
| | | | - Jo C Neill
- Drug Science, London, UK,Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - David J Nutt
- Drug Science, London, UK,Department of Brain Sciences, Imperial College London, London, UK,David J Nutt, Department of Brain Sciences, Imperial College London, Burlington Danes Building, The Hammersmith Hospital, London W12 0NN, UK.
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Abstract
Gatherings in groups are a ubiquitous phenomenon throughout human history. This is true for everyday social tasks as well as for healing and spiritual purposes. In psychotherapy, group treatment started soon after developing psychoanalytic treatment procedures. For psychedelic therapy however, individual treatment guided by one or sometimes even two therapists is the most common and widespread treatment model for clinical research and therapy thus far. Since the foundation of the Swiss Medical Society for Psycholytic Therapy (Schweizerische Ärztegesellschaft für psycholytische Therapie, SÄPT) in 1985 in Switzerland, we however had the opportunity to conduct psychedelic group treatment in specific settings, which the following article describes.
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Sakurai H, Yonezawa K, Tani H, Mimura M, Bauer M, Uchida H. Novel Antidepressants in the Pipeline (Phase II and III): A Systematic Review of the US Clinical Trials Registry. PHARMACOPSYCHIATRY 2022; 55:193-202. [PMID: 35045580 PMCID: PMC9259184 DOI: 10.1055/a-1714-9097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction
There is an imminent need for faster-acting and more
effective antidepressants beyond the monoaminergic hypothesis.
Methods
We systematically searched the US Clinical Trials registry for
antidepressant compounds with completed phase II and III trials. Compounds that
demonstrated significant superiority over placebo in the primary outcome measure
in the latest phase of phase II and III trials were identified. The collateral
information was gathered via a PubMed search and press releases.
Results
Nine compounds were identified. AXS-05 (a combination of
dextromethorphan and bupropion) and ansofaxine hydrochloride showed a positive
result over placebo in a phase III study for major depressive disorder or
treatment-resistant depression. MIJ821, nitrous oxide, psilocybin, ayahuasca,
facial injection of botulinum toxin A, prasterone, and casopitant demonstrated
at least one positive result in phase II trials. Ayahuasca showed a greater
response rate than placebo at week one, indicating the rapid antidepressant
effect.
Discussion
These new compounds with novel mechanisms of action are
expected to provide a greater variety of treatment options for depression if
preliminary positive results are confirmed.
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Affiliation(s)
- Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Kengo Yonezawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Neuropsychiatry, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Oehen P, Gasser P. Using a MDMA- and LSD-Group Therapy Model in Clinical Practice in Switzerland and Highlighting the Treatment of Trauma-Related Disorders. Front Psychiatry 2022; 13:863552. [PMID: 35546928 PMCID: PMC9082273 DOI: 10.3389/fpsyt.2022.863552] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
The Swiss Federal Act on Narcotics allows for the restricted medical use of scheduled psychotropic drugs in cases of resistance to standard treatment, and preliminary evidence of efficacy of the scheduled drug for the particular condition. Since 2014, the authors have obtained 50 licenses on a case-by-case basis and developed a psychedelic-assisted group therapy model utilizing MDMA and LSD. The majority of the patients taking part in the psychedelic group therapy suffered from chronic complex post-traumatic stress disorder (c-PTSD), dissociative, and other post-traumatic disorders. Treatment modalities, typical developments and problems encountered during and after the psychedelic experiences are described. Recurrent depression poses a frequent problem, and requires special attention. Symptoms of c-PTSD predominantly addressed by the psychedelic experiences are the regulation of emotions and impulses, negative self-perception, alterations in relationships to others, as well as meaning, recall, and processing of traumatic memories. C-PTSD needs a larger number of psychedelic experiences in contrast to PTSD resulting from single trauma. In this model MDMA was most often used in the first phase to enhance motivation to change, strengthen the therapeutic alliance, allowing it to become more resilient, stress-relieved and less ambivalent. When emotional self-regulation, negative self-perception and structural dissociation had also begun to improve and trauma exposure was better tolerated, LSD was introduced to intensify and deepen the therapeutic process. The majority of participants improved by clinical judgement, and no serious adverse events occurred. A short case vignette describes a typical process. The experiences with this model can serve to further develop the method of psychedelic-assisted psychotherapy (PAP) and to give directions for future research.
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Affiliation(s)
- Peter Oehen
- Private Practice of Psychiatry and Psychotherapy, Biberist, Switzerland
| | - Peter Gasser
- Private Practice of Psychiatry and Psychotherapy, Solothurn, Switzerland
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22
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Holze F, Caluori TV, Vizeli P, Liechti ME. Safety pharmacology of acute LSD administration in healthy subjects. Psychopharmacology (Berl) 2022; 239:1893-1905. [PMID: 34515824 PMCID: PMC9166834 DOI: 10.1007/s00213-021-05978-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 11/04/2022]
Abstract
RATIONALE Lysergic acid diethylamide (LSD) is used in psychiatric and psychological research and investigated as a potential treatment for medical and psychiatric disorders, including depression, anxiety, and cluster headache. OBJECTIVES Safety data on clinical safety are available from small studies but not from larger samples. We report safety pharmacology data from a large pooled study sample on acute effects of LSD in healthy subjects. METHODS We conducted a pooled analysis of four double-blind, randomized, placebo-controlled, crossover studies that included a total of 83 healthy subjects and 131 single-dose administrations of LSD. LSD administrations were matched to dose groups according to measured LSD peak plasma concentrations to adjust for uncertainties in the correct LSD dose in some studies. Single doses were 25, 50, 100, and 200 µg of LSD base. We investigated subjective effects (self-rated any drug effect, good drug effect, bad drug effect, and anxiety), blood pressure, heart rate, body temperature, duration of the acute LSD response, acute (12 h) and subacute (24 h) adverse effects, reports of flashbacks, and liver and kidney function before and after the studies. RESULTS LSD dose-dependently increased subjective, physiologic, and adverse effects. The dose-response curves for the proportions of subjects with a certain amount of a subjective effect were steeper and reached a higher maximum for positive acute subjective effects compared with negative acute subjective effects. Maximal ratings of > 50% good drug effects were reached in 37%, 91%, 96%, and 91% of the LSD administrations at 25, 50, 100, and 200 µg. Maximal ratings of > 50% bad drug effects were reached in 0%, 9%, 27%, 31% at 25, 50, 100, and 200 µg, respectively. Mean ratings of Oceanic Boundlessness were 10%, 25%, 41%, and 44%, and mean ratings of Anxious Ego-Dissolution were 3.4%, 13%, 20%, and 22% at 25, 50, 100, and 200 µg, respectively. The physiologic effects of LSD were moderate. None of the subjects had systolic blood pressure > 180 mmHg at any time. Peak heart rate > 100 beats/min was observed in 0%, 6%, 20%, and 25% of the subjects at 25, 50, 100, and 200 µg, respectively. Maximal heart rates of 129 and 121 beats/min were observed in one subject at the 50 and 200 µg doses, respectively. Peak body temperature > 38° was observed in 0%, 11%, 7%, and 34% at 25, 50, 100, and 200 µg, respectively. Mean acute adverse effect scores on the List of Complaints were 5.6, 9.2, 12, and 13 at 25, 50, 100, and 200 µg, respectively. Kidney and liver function parameters were unaltered. Six subjects reported transient flashback phenomena. CONCLUSIONS The single-dose administration of LSD is safe in regard to acute psychological and physical harm in healthy subjects in a controlled research setting.
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Affiliation(s)
- Friederike Holze
- grid.410567.1Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Schanzenstrasse 55, CH-4056 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Toya V. Caluori
- grid.410567.1Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Schanzenstrasse 55, CH-4056 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Patrick Vizeli
- grid.410567.1Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Schanzenstrasse 55, CH-4056 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Matthias E. Liechti
- grid.410567.1Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Schanzenstrasse 55, CH-4056 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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23
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Fischman LG. Knowing and being known: Psychedelic-assisted psychotherapy and the sense of authenticity. Front Psychiatry 2022; 13:933495. [PMID: 36203843 PMCID: PMC9530638 DOI: 10.3389/fpsyt.2022.933495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Participants in MDMA- and psychedelic-assisted psychotherapy often emerge from these treatments with new beliefs about themselves and the world. Studies have linked changed beliefs with mystical experiences reported by some participants during drug sessions. While there has been some debate about the epistemic value of drug-induced mystical experiences, and about the need for consent to treatments that may alter metaphysical beliefs, less attention has been given to the sense of authenticity that attends these experiences. In this paper, I consider the intersubjective context in which these changed beliefs arise. I suggest that the sense of authenticity people experience with MDMA- and psychedelic-assisted psychotherapy derives from a simultaneous feeling of knowing and being known. The medications used in these treatments reduce the defensive barriers which ordinarily prevent powerful feelings from being intersubjectively shared, allowing the subject to experience knowing and being known with the therapist and/or internalized or imagined others. In explaining this thesis, I discuss Ratcliffe's "existential feeling;" ipseity in incipient psychosis and psychedelic states; Winnicott's notions of the True Self, omnipotence, creativity, and transitional phenomena; implicit relational knowing and moments of meeting; infant-mother dyad research; predictive processing and the relaxed beliefs model of psychedelic action; the role of the "partner in thought" in knowing and feeling known. I propose that a "transitional space" model of MDMA- and psychedelic-assisted psychotherapy is well-suited for working through "not-me" or dissociated experience.
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Affiliation(s)
- Lawrence G Fischman
- Department of Psychiatry, School of Medicine, Tufts University, Boston, MA, United States
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24
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Kuc J, Kettner H, Rosas F, Erritzoe D, Haijen E, Kaelen M, Nutt D, Carhart-Harris RL. Psychedelic experience dose-dependently modulated by cannabis: results of a prospective online survey. Psychopharmacology (Berl) 2022; 239:1425-1440. [PMID: 34734314 PMCID: PMC9110465 DOI: 10.1007/s00213-021-05999-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022]
Abstract
RATIONALE Classic psychedelics are currently being studied as novel treatments for a range of psychiatric disorders. However, research on how psychedelics interact with other psychoactive substances remains scarce. OBJECTIVES The current study aimed to explore the subjective effects of psychedelics when used alongside cannabis. METHODS Participants (n = 321) completed a set of online surveys at 2 time points: 7 days before, and 1 day after a planned experience with a serotonergic psychedelic. The collected data included demographics, environmental factors (so-called setting) and five validated questionnaires: Mystical Experience Questionnaire (MEQ), visual subscales of Altered States of Consciousness Questionnaire (ASC-Vis), Challenging Experience Questionnaire (CEQ), Ego Dissolution Inventory (EDI) and Emotional Breakthrough Inventory (EBI). Participants were grouped according to whether they had reported using no cannabis (n = 195) or low (n = 53), medium (n = 45) or high (n = 28) dose, directly concomitant with the psychedelic. Multivariate analysis of covariance (MANCOVA) and contrasts was used to analyse differences in subjective effects between groups while controlling for potential confounding contextual 'setting' variables. RESULTS The simultaneous use of cannabis together with classic serotonergic psychedelics was associated with more intense psychedelic experience across a range of measures: a linear relationship was found between dose and MEQ, ASC-Vis and EDI scores, while a quadratic relationship was found for CEQ scores. No relationship was found between the dose of cannabis and the EBI. CONCLUSIONS Results imply a possible interaction between the cannabis and psychedelic on acute subjective experiences; however, design limitations hamper our ability to draw firm inferences on directions of causality and the clinical implications of any such interactions.
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Affiliation(s)
- Joanna Kuc
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, W12 0NN, UK.
| | - Hannes Kettner
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, W12 0NN UK
| | - Fernando Rosas
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, W12 0NN UK
| | - David Erritzoe
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, W12 0NN UK
| | - Eline Haijen
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, W12 0NN UK
| | - Mendel Kaelen
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, W12 0NN UK
| | - David Nutt
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, W12 0NN UK
| | - Robin L. Carhart-Harris
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, W12 0NN UK
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25
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Becker AM, Holze F, Grandinetti T, Klaiber A, Toedtli VE, Kolaczynska KE, Duthaler U, Varghese N, Eckert A, Grünblatt E, Liechti ME. Acute Effects of Psilocybin After Escitalopram or Placebo Pretreatment in a Randomized, Double-Blind, Placebo-Controlled, Crossover Study in Healthy Subjects. Clin Pharmacol Ther 2021; 111:886-895. [PMID: 34743319 PMCID: PMC9299061 DOI: 10.1002/cpt.2487] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022]
Abstract
The psychedelic psilocybin is being investigated for the treatment of depression and anxiety. Unclear is whether antidepressant treatments interact with psilocybin. The present study used a double‐blind, placebo‐controlled, crossover design with two experimental test sessions to investigate the response to psilocybin (25 mg) in healthy subjects after pretreatment with escitalopram or placebo. The treatment order was random and counterbalanced. Pretreatment consisted of 10 mg escitalopram daily for 7 days, followed by 20 mg daily for 7 days, including the day of psilocybin administration, or 14 days of placebo pretreatment before psilocybin administration. Psilocybin treatments were separated by at least 16 days. The outcome measures included self‐rating scales that evaluated subjective effects, autonomic effects, adverse effects, plasma brain‐derived neurotrophic factor (BDNF) levels, electrocardiogram QTc time, whole‐blood HTR2A and SCL6A4 gene expression, and pharmacokinetics. Escitalopram pretreatment had no relevant effect on positive mood effects of psilocybin but significantly reduced bad drug effects, anxiety, adverse cardiovascular effects, and other adverse effects of psilocybin compared with placebo pretreatment. Escitalopram did not alter the pharmacokinetics of psilocin. The half‐life of psychoactive free (unconjugated) psilocin was 1.8 hours (range 1.1–2.2 hours), consistent with the short duration of action of psilocybin. Escitalopram did not alter HTR2A or SCL6A4 gene expression before psilocybin administration, QTc intervals, or circulating BDNF levels before or after psilocybin administration. Further studies are needed with a longer antidepressant pretreatment time and patients with psychiatric disorders to further define interactions between antidepressants and psilocybin.
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Affiliation(s)
- Anna M Becker
- Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Friederike Holze
- Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Tanja Grandinetti
- Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Aaron Klaiber
- Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Vanja E Toedtli
- Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Karolina E Kolaczynska
- Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Urs Duthaler
- Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Nimmy Varghese
- Psychiatric University Hospital, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Anne Eckert
- Psychiatric University Hospital, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Matthias E Liechti
- Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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26
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Holze F, Avedisian I, Varghese N, Eckert A, Liechti ME. Role of the 5-HT 2A Receptor in Acute Effects of LSD on Empathy and Circulating Oxytocin. Front Pharmacol 2021; 12:711255. [PMID: 34326773 PMCID: PMC8313809 DOI: 10.3389/fphar.2021.711255] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/30/2021] [Indexed: 12/30/2022] Open
Abstract
The psychedelic lysergic acid diethylamide (LSD) has experienced a revival in research, including clinical trials that evaluate LSD-assisted psychotherapy. LSD induces perceptual alterations and influences emotion processing in ways that may support psychotherapy. Here, we investigated the effects of LSD on emotional empathy and mediating role of the serotonin 5-hydroxytryptamine-2A (5-HT2A) receptor by administering 25, 50, 100, and 200 µg LSD alone and 200 µg LSD combined with pretreatment with the 5-HT2A receptor antagonist ketanserin (40 mg) using a placebo-controlled, double-blind, random-order, crossover design in 16 healthy subjects. The Multifaceted Empathy Test (MET) was used to assess the effects of LSD on emotional empathy. Plasma oxytocin levels were also measured. LSD dose-dependently increased implicit and explicit emotional empathy, with the highest 200 µg LSD dose having a significant effect compared with placebo. The 200 µg dose of LSD also moderately increased plasma oxytocin levels compared with placebo. Ketanserin reduced the LSD-induced elevations of oxytocin but not the LSD-induced increases in emotional empathy. These findings confirm that LSD enhances empathy, and this effect may be partially independent of its primary action on 5-HT2A receptors to induce subjective psychedelic effects. In contrast, LSD-induced oxytocin release may depend on 5-HT2A receptor stimulation, which is consistent with the psychedelic effect of LSD. Further studies are needed to investigate whether LSD may also enhance empathy and potentially produce therapeutic effects in patients who have deficits in empathy and impairments in social functioning.
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Affiliation(s)
- Friederike Holze
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Isidora Avedisian
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Nimmy Varghese
- Psychiatric University Hospital, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Anne Eckert
- Psychiatric University Hospital, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Matthias E Liechti
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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27
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Vizeli P, Straumann I, Holze F, Schmid Y, Dolder PC, Liechti ME. Genetic influence of CYP2D6 on pharmacokinetics and acute subjective effects of LSD in a pooled analysis. Sci Rep 2021; 11:10851. [PMID: 34035391 PMCID: PMC8149637 DOI: 10.1038/s41598-021-90343-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/04/2021] [Indexed: 11/09/2022] Open
Abstract
Lysergic acid diethylamide (LSD) is a classic psychedelic substance that is used recreationally and investigated in psychiatric research. There are no pharmacogenetic studies on LSD. In vitro metabolic studies indicate that several cytochrome P450 (CYP) isoforms (e.g., CYP2D6, CYP1A2, and CYP2C9) are involved in LSD metabolism, but in vivo data are scarce. The present study examined the influence of genetic polymorphisms of CYP genes on the pharmacokinetics and acute effects of LSD in healthy subjects. We identified common genetic variants of CYPs (CYP2D6, CYP1A2, CYP2C9, CYP2C19, and CYP2B6) in 81 healthy subjects who were pooled from four randomized, placebo-controlled, double-blind Phase 1 studies. We found that genetically determined CYP2D6 functionality significantly influenced the pharmacokinetics of LSD. Individuals with no functional CYP2D6 (i.e., poor metabolizers) had longer LSD half-lives and approximately 75% higher parent drug and main metabolite 2-oxo-3-hydroxy LSD area-under-the-curve blood plasma concentrations compared with carriers of functional CYP2D6. Non-functional CYP2D6 metabolizers also exhibited greater alterations of mind and longer subjective effect durations in response to LSD compared with functional CYP2D6 metabolizers. No effect on the pharmacokinetics or acute effects of LSD were observed with other CYPs. These findings indicate that genetic polymorphisms of CYP2D6 significantly influence the pharmacokinetic and subjective effects of LSD. Given the potential therapeutic use of psychedelics, including LSD, the role of pharmacogenetic tests prior to LSD-assisted psychotherapy needs to be further investigated.
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Affiliation(s)
- Patrick Vizeli
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| | - Isabelle Straumann
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| | - Friederike Holze
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| | - Yasmin Schmid
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| | - Patrick C Dolder
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
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28
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Rucker JJ, Seth P. Psychedelics: Old drugs, new trips. J Psychopharmacol 2021; 35:316-318. [PMID: 33853423 DOI: 10.1177/02698811211003495] [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: 11/16/2022]
Affiliation(s)
- James J Rucker
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pallab Seth
- Centre for Neuropsychopharmacology, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
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29
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dos Santos RG, Bouso JC, Rocha JM, Rossi GN, Hallak JE. The Use of Classic Hallucinogens/Psychedelics in a Therapeutic Context: Healthcare Policy Opportunities and Challenges. Risk Manag Healthc Policy 2021; 14:901-910. [PMID: 33707976 PMCID: PMC7943545 DOI: 10.2147/rmhp.s300656] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/24/2021] [Indexed: 01/23/2023] Open
Abstract
Psychedelics or serotonergic hallucinogens are a group of substances that share the agonism of serotonergic 5-HT2A receptors as their main mechanism of action. Its main effects include changes in perception, cognitive process, and mood. Despite being used for centuries by different cultures in ritual contexts, these substances have currently aroused the interest of science and industry for their promising antidepressant, anxiolytic, and anti-addictive effects. Considering this evidence, this article aims to explore some of the possible health policy challenges to integrate these therapeutic tools into broad and heterogeneous health systems. As a main benefit, these substances produce rapid and enduring effects with the administration of single or few doses, which could lead to new treatment possibilities for patients with severe mental disorders resistant to the usual medications. The main challenge is associated with the fact that these substances remain scheduled in most countries and are associated with social stigma related to their recreational use (especially LSD and psilocybin). This situation makes it exceedingly difficult to conduct clinical trials, although international conventions allow such research. Ethically, this could be interpreted as a violation of human rights since thousands of people are prevented from having access to possible benefits. Interestingly, ritual ayahuasca use is more acceptable to the public than the use of psilocybin-containing mushrooms or LSD. The controlled, clinical use of LSD and psilocybin seems to be less criticized and is being explored by the industry. Rigorous scientific evidence coupled with industrial interests (LSD and psilocybin), together with respect for traditional uses (ayahuasca) and international conventions, seems to be the best way for these drugs to be integrated into health systems in the next years. Which highlights the need for an urgent dialogue between science, health system, society, and politics.
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Affiliation(s)
- Rafael Guimarães dos Santos
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute of Science and Technology – Translational Medicine, Ribeirão Preto, Brazil
- ICEERS Foundation, International Center for Ethnobotanical Education, Research and Services, Barcelona, Spain
| | - José Carlos Bouso
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- ICEERS Foundation, International Center for Ethnobotanical Education, Research and Services, Barcelona, Spain
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Juliana Mendes Rocha
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Giordano Novak Rossi
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Jaime E Hallak
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute of Science and Technology – Translational Medicine, Ribeirão Preto, Brazil
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30
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Davis AK, Xin Y, Sepeda ND, Garcia-Romeu A, Williams MT. Increases in Psychological Flexibility Mediate Relationship Between Acute Psychedelic Effects and Decreases in Racial Trauma Symptoms Among People of Color. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2021; 5:24705470211035607. [PMID: 34377878 PMCID: PMC8342866 DOI: 10.1177/24705470211035607] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/12/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Previous research showed acute psychedelic effects were associated with decreases in racial trauma (RT) symptoms among black, indigenous, and people of color (BIPOC). Among samples comprised primarily of white participants, positive outcomes of psychedelic experiences have been mediated by increases in psychological flexibility. Therefore, we examined whether changes in psychological flexibility from before to after a psychedelic experience mediated the relationship between acute psychedelic effects and changes in RT symptoms among BIPOC. METHODS This cross-sectional online survey study included 313 BIPOC (mean age = 33.1; SD = 11.2; female = 57%). A multiple linear regression analysis was used to examine the association between acute psychedelic effects and decreases in RT symptoms in a nonclinical setting; a path analysis was used to explore whether changes in psychological flexibility mediated this relationship. RESULTS Acute insight and challenging effects were significantly (p < .001) associated with decreases in RT symptoms following a psychedelic experience. Increases in psychological flexibility partially mediated relationships between greater intensity of psychological insight and less intensity of challenging experiences and decreases in RT symptoms (ps<.001). CONCLUSION This research suggests psychedelics confer potential benefits in decreasing RT symptoms among BIPOC and psychological flexibility may be an important mediator of these effects. Future research should test this hypothesis in a longitudinal clinical trial among BIPOC.
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Affiliation(s)
- Alan K. Davis
- The Ohio State University, Columbus, OH, USA
- Johns Hopkins School of
Medicine, Baltimore, MD, USA
| | - Yitong Xin
- The Ohio State University, Columbus, OH, USA
| | | | | | - Monnica T. Williams
- University of Ottawa, Ottawa, Ontario, Canada
- University of Connecticut, Storrs, Connecticut, USA
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31
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Argento E, Christie D, Mackay L, Callon C, Walsh Z. Psychedelic-Assisted Psychotherapy After COVID-19: The Therapeutic Uses of Psilocybin and MDMA for Pandemic-Related Mental Health Problems. Front Psychiatry 2021; 12:716593. [PMID: 34552518 PMCID: PMC8450400 DOI: 10.3389/fpsyt.2021.716593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/11/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Devon Christie
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Mackay
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cody Callon
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Zach Walsh
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Psychology, University of British Columbia, Kelowna, BC, Canada
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