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Henningfield JE, Belouin SJ. Dedication: Roland R. Griffiths (July 19, 1946-October 16, 2023). Neuropharmacology 2024; 252:109945. [PMID: 38583702 DOI: 10.1016/j.neuropharm.2024.109945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- J E Henningfield
- Pinney Associates, 4800 Montgomery Ln Suite 400, Bethesda, MD, 20814, USA; Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - S J Belouin
- United States Public Health Service (USPHS), Germantown, MD, USA; Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, MD, USA; National Institutes of Health (NIH) Clinical Research Center, Pain and Palliative Care, Bethesda, MD, USA.
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Krupp KT, Yaeger JDW, Ledesma LJ, Withanage MHH, Gale JJ, Howe CB, Allen TJ, Sathyanesan M, Newton SS, Summers CH. Single administration of a psychedelic [(R)-DOI] influences coping strategies to an escapable social stress. Neuropharmacology 2024; 252:109949. [PMID: 38636726 PMCID: PMC11073902 DOI: 10.1016/j.neuropharm.2024.109949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/08/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
Psychedelic compounds have potentially rapid, long-lasting anxiolytic, antidepressive and anti-inflammatory effects. We investigated whether the psychedelic compound (R)-2,5-dimethoxy-4-iodoamphetamine [(R)-DOI], a selective 5-HT2A receptor partial agonist, decreases stress-related behavior in male mice exposed to repeated social aggression. Additionally, we explored the likelihood that these behavioral changes are related to anti-inflammatory properties of [(R)-DOI]. Animals were subjected to the Stress Alternatives Model (SAM), an escapable social stress paradigm in which animals develop reactive coping strategies - remaining in the SAM arena (Stay) with a social aggressor, or dynamically initiated stress coping strategies that involve utilizing the escape holes (Escape) to avoid aggression. Mice expressing these behavioral phenotypes display behaviors like those in other social aggression models that separate animals into stress-vulnerable (as for Stay) or stress-resilient (as for Escape) groups, which have been shown to have distinct inflammatory responses to social stress. These results show that Stay animals have heightened cytokine gene expression, and both Stay and Escape mice exhibit plasma and neural concentrations of the inflammatory cytokine tumor necrosis factor-α (TNFα) compared to unstressed control mice. Additionally, these results suggest that a single administration of (R)-DOI to Stay animals in low doses, can increase stress coping strategies such as increasing attention to the escape route, promoting escape behavior, and reducing freezing during socially aggressive interaction in the SAM. Lower single doses of (R)-DOI, in addition to shifting behavior to suggest anxiolytic effects, also concomitantly reduce plasma and limbic brain levels of the inflammatory cytokine TNFα.
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Affiliation(s)
- Kevin T Krupp
- Department of Biology, University of South Dakota, Vermillion, SD, 57069, USA; Neuroscience Group, Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | - Jazmine D W Yaeger
- Veterans Affairs Research Service, Sioux Falls VA Health Care System, Sioux Falls, SD, 57105, USA; Pediatrics and Rare Diseases Group, Sanford Research, Sioux Falls, SD, 57104, USA
| | - Leighton J Ledesma
- Neuroscience Group, Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA; Veterans Affairs Research Service, Sioux Falls VA Health Care System, Sioux Falls, SD, 57105, USA
| | | | - J J Gale
- Department of Biology, University of South Dakota, Vermillion, SD, 57069, USA; Neuroscience Group, Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | - Chase B Howe
- Department of Biology, University of South Dakota, Vermillion, SD, 57069, USA
| | - Trevor J Allen
- Department of Biology, University of South Dakota, Vermillion, SD, 57069, USA
| | - Monica Sathyanesan
- Neuroscience Group, Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | - Samuel S Newton
- Neuroscience Group, Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | - Cliff H Summers
- Department of Biology, University of South Dakota, Vermillion, SD, 57069, USA; Neuroscience Group, Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA; Veterans Affairs Research Service, Sioux Falls VA Health Care System, Sioux Falls, SD, 57105, USA.
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Soliman PS, Curley DE, Capone C, Eaton E, Haass-Koffler CL. In the new era of psychedelic assisted therapy: A systematic review of study methodology in randomized controlled trials. Psychopharmacology (Berl) 2024; 241:1101-1110. [PMID: 38683460 DOI: 10.1007/s00213-024-06598-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Recent years have seen a resurgence in randomized, placebo controlled trials (RCTs) utilizing non-classical psychedelics (e.g. 3,4-methyl enedioxy methamphetamine [MDMA]), and classical psychedelics (e.g. psilocybin, lysergic acid diethylamide [LSD], and N,N-dimethyltryptamine [DMT/ayahuasca]) in conjunction with assisted therapy (AT) for psychiatric disorders. A notable methodological challenge in psychedelic AT, however, is the complexity of blinding procedures. The lack of efficacious blinding can introduce considerable response bias, reduce internal validity, and compromise participant retention. This systematic review examines design and blinding techniques in RCTs utilizing psychedelics and placebo for the treatment of psychiatric disorders. The aim of this work is to identify factors that may inform future RTC design for conducting psychedelics research. We conducted a systematic review of PubMed, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Psycinfo, Embase, and Web of Science Core Collection to examine: (1) placebo selection, (2) study design, and (3) integrity of blinding measures. Sixteen publications were identified as meeting the criteria for a systematic review. Our findings suggest that traditional placebo administration is insufficient to control for expectancy confounds. Consequently, experimental methodology that limits personnel unblinding and the use of an active placebo are important considerations when designing prospective clinical studies involving psychedelics.
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Affiliation(s)
- Paul S Soliman
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Dallece E Curley
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Neuroscience, Neuroscience Graduate Program, Brown University, Providence, RI, USA
| | - Christy Capone
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Providence Veteran Administration Medical Center, Providence, RI, USA
| | - Erica Eaton
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Providence Veteran Administration Medical Center, Providence, RI, USA
| | - Carolina L Haass-Koffler
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA.
- Carney Institute for Brain Science, Brown University, Providence, RI, USA.
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Wang SM, Kim S, Choi WS, Lim HK, Woo YS, Pae CU, Bahk WM. Current Understanding on Psilocybin for Major Depressive Disorder: A Review Focusing on Clinical Trials. Clin Psychopharmacol Neurosci 2024; 22:222-231. [PMID: 38627070 PMCID: PMC11024689 DOI: 10.9758/cpn.23.1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 04/20/2024]
Abstract
Previous studies suggested effectiveness of psilocybin in the field of mental health. FDA designated psilocybin as a "breakthrough therapy" for the treatment of treatment-resistant depression (TRD) in 2018. This paper provided a review of psilocybin's potential role in treatment of depression by focusing on published clinical trials. Studies showed that psilocybin, an agonist on 5-HT2A receptors, manifests antidepressant and anxiolytic effects by increasing glutamate transmission, reducing brain inflammation, decreasing default mode network activity. In terms of clinical trials, eleven studies (six open-label and five double blinded randomized clinical trials [DB-RCTs]) trials exploring psilocybin's impact on depression were found. Among open-label studies, a pilot study on TRD patients demonstrated significant reductions in depressive symptoms after two psilocybin sessions. Psilocybin also improved cognitive bias associated with depression. Extension studies confirmed sustained improvements and high remission rates. Among five DB-RCTs, two showed that psilocybin led to significant reductions in anxiety and depression in cancer patients, and the improvements sustained for over six months. In MDD, psilocybin showed rapid reductions in depression, with higher remission rates compared to escitalopram in a DB-RCT. Another DB-RCT showed that psilocybin induced higher decrease in depression around 6 hours after their administrations than placebo. The last DB-RCT showed that in patients with TRD, a single dose of psilocybin 25 mg, but not psilocybin 10 mg, resulted in superior antidepressant effect than psilocybin 1 mg. Overall, psilocybin showed promise in treating depression and anxiety, with notable safety profiles. Further research should explore optimal dosages and long-term effects.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sunghwan Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Won-Seok Choi
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hyun Kook Lim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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Bryson N, Alexander R, Ehlers MD. RE104: Synthesis and Activity of a Novel Serotonergic Psychedelic Prodrug of 4-Hydroxy- N, N-diisopropyltryptamine. ACS Chem Neurosci 2024. [PMID: 38758589 DOI: 10.1021/acschemneuro.4c00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Results from randomized clinical trials of psilocybin in depressive disorders highlight the therapeutic potential of serotonergic psychedelic compounds in mental health disorders. The synthetic 5-hydroxytryptamine 2A receptor agonist 4-hydroxy-N,N-diisopropyltryptamine (4-OH-DiPT) is structurally similar to psilocin but is reported to have a shorter duration (2-3 h) of psychedelic effects, suggesting the potential for psilocybin-like therapeutic activity with reduced clinical resource burden. Here, we describe the preclinical and translational characterization of RE104, a 4-OH-DiPT prodrug comprising a glutarate moiety designed to cleave rapidly in situ and thus provide reasonable bioavailability of the active drug. Plasma concentration of 4-HO-DiPT over time in PK experiments in rats was correlated with head-twitch intensity. The half-life of 4-OH-DiPT was 40 min after subcutaneous administration of RE104 in rats. In a forced swim test, a single dose of RE104 (1 mg/kg) significantly reduced mean immobility time at 1 week compared with vehicle (P < 0.001), confirming translational antidepressant potential. Taken together, these data with RE104 show that the glutarate ester can act as an efficient prodrug strategy for 4-HO-DiPT, a unique short-duration psychedelic with potential in depressive disorders.
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Affiliation(s)
- Nathan Bryson
- Reunion Neuroscience, Inc., Toronto, Ontario M5V 2C3, Canada
| | | | - Michael D Ehlers
- Apple Tree Partners, Cambridge, Massachusetts 02142, United States
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6
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Moreton SG, Barr NN, Giese KJ. Investigating the relationship between changes in metaphysical beliefs and death anxiety following a significant psychedelic experience. Death Stud 2024:1-10. [PMID: 38753981 DOI: 10.1080/07481187.2024.2352726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Research examining the potential of the psychedelic experience to alter attitudes toward death is steadily emerging. However, the specific mechanisms leading to this change are not well understood. The present study investigated the potential relationship between changes in metaphysical beliefs and changes in death anxiety following a single significant psychedelic experience. A total of 155 participants completed a retrospective questionnaire that included questions about their acute experience and changes in death anxiety and metaphysical beliefs following a significant psychedelic experience. Although some participants reported an increase in death anxiety, there was an overall significant reduction in death anxiety from before to after the experience. Improvements in death anxiety were positively correlated with changes in belief in panpsychism, but no other measured metaphysical beliefs. The findings from this exploratory study provide direction for future research looking at the relationship between changes in metaphysical beliefs and death anxiety in the context of psychedelic experiences.
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Affiliation(s)
- Sam G Moreton
- Faculty of the Arts, Social Sciences and Humanities, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Noah N Barr
- Faculty of the Arts, Social Sciences and Humanities, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Kayla J Giese
- Faculty of the Arts, Social Sciences and Humanities, School of Psychology, University of Wollongong, Wollongong, Australia
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7
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Schindler EAD, Sewell RA, Gottschalk CH, Flynn LT, Zhu Y, Pittman BP, Cozzi NV, D'Souza DC. Psilocybin pulse regimen reduces cluster headache attack frequency in the blinded extension phase of a randomized controlled trial. J Neurol Sci 2024; 460:122993. [PMID: 38581739 DOI: 10.1016/j.jns.2024.122993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/21/2024] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND In a recent randomized, double-blind, placebo-controlled study, we observed a nonsignificant reduction of attack frequency in cluster headache after pulse administration of psilocybin (10 mg/70 kg, 3 doses, 5 days apart each). We carried out a blinded extension phase to consider the safety and efficacy of repeating the pulse regimen. METHODS Eligible participants returned to receive a psilocybin pulse at least 6 months after their first round of study participation. Participants kept headache diaries starting two weeks before and continuing through eight weeks after the first drug session. Ten participants completed the extension phase and all ten were included in the final analysis. RESULTS In the three weeks after the start of the pulse, cluster attack frequency was significantly reduced from baseline (18.4 [95% confidence interval 8.4 to 28.4] to 9.8 [4.3 to 15.2] attacks/week; p = 0.013, d' = 0.97). A reduction of approximately 50% was seen regardless of individual response to psilocybin in the first round. Psilocybin was well-tolerated without any unexpected or serious adverse events. DISCUSSION This study shows a significant reduction in cluster attack frequency in a repeat round of pulse psilocybin administration and suggests that prior response may not predict the effect of repeated treatment. To gauge the full potential of psilocybin as a viable medicine in cluster headache, future work should investigate the safety and therapeutic efficacy in larger, more representative samples over a longer time period, including repeating the treatment. CLINICAL TRIALS REGISTRATION NCT02981173.
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Affiliation(s)
- Emmanuelle A D Schindler
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America; Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America; Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America.
| | - R Andrew Sewell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | | | - L Taylor Flynn
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | - Yutong Zhu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Nicholas V Cozzi
- Neuropharmacology Laboratory, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Alexander Shulgin Research Institute, Lafayette, CA, United States of America
| | - Deepak C D'Souza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
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8
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Copa D, Erritzoe D, Giribaldi B, Nutt D, Carhart-Harris R, Tagliazucchi E. Predicting the outcome of psilocybin treatment for depression from baseline fMRI functional connectivity. J Affect Disord 2024; 353:60-69. [PMID: 38423367 DOI: 10.1016/j.jad.2024.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Psilocybin is a serotonergic psychedelic drug under assessment as a potential therapy for treatment-resistant and major depression. Heterogeneous treatment responses raise interest in predicting the outcome from baseline data. METHODS A machine learning pipeline was implemented to investigate baseline resting-state functional connectivity measured with functional magnetic resonance imaging (fMRI) as a predictor of symptom severity in psilocybin monotherapy for treatment-resistant depression (16 patients administered two 5 mg capsules followed by 25 mg, separated by one week). Generalizability was tested in a sample of 22 patients who participated in a psilocybin vs. escitalopram trial for moderate-to-severe major depression (two separate doses of 25 mg of psilocybin 3 weeks apart plus 6 weeks of daily placebo vs. two separate doses of 1 mg of psilocybin 3 weeks apart plus 6 weeks of daily oral escitalopram). The analysis was repeated using both samples combined. RESULTS Functional connectivity of visual, default mode and executive networks predicted early symptom improvement, while the salience network predicted responders up to 24 weeks after treatment (accuracy≈0.9). Generalization performance was borderline significant. Consistent results were obtained from the combined sample analysis. Fronto-occipital and fronto-temporal coupling predicted early and late symptom reduction, respectively. LIMITATIONS The number of participants and differences between the two datasets limit the generalizability of the findings, while the lack of a placebo arm limits their specificity. CONCLUSIONS Baseline neurophysiological measurements can predict the outcome of psilocybin treatment for depression. Future research based on larger datasets should strive to assess the generalizability of these predictions.
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Affiliation(s)
- Débora Copa
- Universidad de Buenos Aires, Facultad de Ingeniería, Instituto de Bioingeniería, Buenos Aires, Argentina.
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom
| | - Bruna Giribaldi
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom
| | - David Nutt
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom
| | - Robin Carhart-Harris
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom; Psychedelics Division, Neuroscape, Department of Neurology, University of California, San Francisco, USA
| | - Enzo Tagliazucchi
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física, Ciudad Universitaria, Buenos Aires, Argentina; CONICET - Universidad de Buenos Aires, Instituto de Física Interdisciplinaria y Aplicada (INFINA), Ciudad Universitaria, Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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M. Ro̷rsted E, Jensen AA, Smits G, Frydenvang K, Kristensen JL. Discovery and Structure-Activity Relationships of 2,5-Dimethoxyphenylpiperidines as Selective Serotonin 5-HT 2A Receptor Agonists. J Med Chem 2024; 67:7224-7244. [PMID: 38648420 PMCID: PMC11089506 DOI: 10.1021/acs.jmedchem.4c00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
Classical psychedelics such as psilocybin, lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT) are showing promising results in clinical trials for a range of psychiatric indications, including depression, anxiety, and substance abuse disorder. These compounds are characterized by broad pharmacological activity profiles, and while the acute mind-altering effects can be ascribed to their shared agonist activity at the serotonin 2A receptor (5-HT2AR), their apparent persistent therapeutic effects are yet to be decidedly linked to activity at this receptor. We report herein the discovery of 2,5-dimethoxyphenylpiperidines as a novel class of selective 5-HT2AR agonists and detail the structure-activity investigations leading to the identification of LPH-5 [analogue (S)-11] as a selective 5-HT2AR agonist with desirable drug-like properties.
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Affiliation(s)
- Emil M. Ro̷rsted
- Lophora, Charlottenlund, Copenhagen 2920, Denmark
- Department
of Drug Design and Pharmacology, University
of Copenhagen, Universitetsparken
2, Copenhagen Ø 2100, Denmark
| | - Anders A. Jensen
- Lophora, Charlottenlund, Copenhagen 2920, Denmark
- Department
of Drug Design and Pharmacology, University
of Copenhagen, Universitetsparken
2, Copenhagen Ø 2100, Denmark
| | - Gints Smits
- Latvian
Institute of Organic Synthesis, Aizkraukles 21, Riga 1006, Latvia
| | - Karla Frydenvang
- Department
of Drug Design and Pharmacology, University
of Copenhagen, Universitetsparken
2, Copenhagen Ø 2100, Denmark
| | - Jesper L. Kristensen
- Lophora, Charlottenlund, Copenhagen 2920, Denmark
- Department
of Drug Design and Pharmacology, University
of Copenhagen, Universitetsparken
2, Copenhagen Ø 2100, Denmark
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11
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Romeo B, Kervadec E, Fauvel B, Strika-Bruneau L, Amirouche A, Verroust V, Piolino P, Benyamina A. Safety and risk assessment of psychedelic psychotherapy: A meta-analysis and systematic review. Psychiatry Res 2024; 335:115880. [PMID: 38579460 DOI: 10.1016/j.psychres.2024.115880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
Psychotherapies assisted by psychedelic substances have shown promising results in the treatment of psychiatric disorders. The aim of this systematic review and meta-analysis was to evaluate safety data in human subjects. We carried out a search on MEDLINE, Embase and PsycINFO databases between 2000 and 2022. Standardized mean differences between different dose ranges and between acute and subacute phases were calculated for cardiovascular data after psychedelic administration. Risk differences were calculated for serious adverse events and common side effects. Thirty studies were included in this meta-analysis. There were only nine serious adverse events for over 1000 administrations of psychedelic substances (one during the acute phase and 8 during the post-acute phase). There were no suicide attempts during the acute phase and 3 participants engaged in self-harm during the post-acute phase. There was an increased risk for elevated heart rate, systolic and diastolic blood pressure for all dose range categories, as well as an increased risk of nausea during the acute phase. Other common side effects included headaches, anxiety, and decreased concentration or appetite. This meta-analysis demonstrates that psychedelics are well-tolerated, with a low risk of emerging serious adverse events in a controlled setting with appropriate inclusion criteria.
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Affiliation(s)
- B Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France.
| | - E Kervadec
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France
| | - B Fauvel
- Laboratoire Mémoire, Cerveau et Cognition (UR 7536), Institut de Psychologie, Université de Paris Cité, Paris, France
| | - L Strika-Bruneau
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France
| | - A Amirouche
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France
| | - V Verroust
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France; Université Picardie-Jules Verne, France
| | - P Piolino
- Laboratoire Mémoire, Cerveau et Cognition (UR 7536), Institut de Psychologie, Université de Paris Cité, Paris, France
| | - A Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France
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12
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Abstract
OBJECTIVE To determine the efficacy of psilocybin as an antidepressant compared with placebo or non-psychoactive drugs. DESIGN Systematic review and meta-analysis. DATA SOURCES Five electronic databases of published literature (Cochrane Central Register of Controlled Trials, Medline, Embase, Science Citation Index and Conference Proceedings Citation Index, and PsycInfo) and four databases of unpublished and international literature (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ProQuest Dissertations and Theses Global, and PsycEXTRA), and handsearching of reference lists, conference proceedings, and abstracts. DATA SYNTHESIS AND STUDY QUALITY Information on potential treatment effect moderators was extracted, including depression type (primary or secondary), previous use of psychedelics, psilocybin dosage, type of outcome measure (clinician rated or self-reported), and personal characteristics (eg, age, sex). Data were synthesised using a random effects meta-analysis model, and observed heterogeneity and the effect of covariates were investigated with subgroup analyses and metaregression. Hedges' g was used as a measure of treatment effect size, to account for small sample effects and substantial differences between the included studies' sample sizes. Study quality was appraised using Cochrane's Risk of Bias 2 tool, and the quality of the aggregated evidence was evaluated using GRADE guidelines. ELIGIBILITY CRITERIA Randomised trials in which psilocybin was administered as a standalone treatment for adults with clinically significant symptoms of depression and change in symptoms was measured using a validated clinician rated or self-report scale. Studies with directive psychotherapy were included if the psychotherapeutic component was present in both experimental and control conditions. Participants with depression regardless of comorbidities (eg, cancer) were eligible. RESULTS Meta-analysis on 436 participants (228 female participants), average age 36-60 years, from seven of the nine included studies showed a significant benefit of psilocybin (Hedges' g=1.64, 95% confidence interval (CI) 0.55 to 2.73, P<0.001) on change in depression scores compared with comparator treatment. Subgroup analyses and metaregressions indicated that having secondary depression (Hedges' g=3.25, 95% CI 0.97 to 5.53), being assessed with self-report depression scales such as the Beck depression inventory (3.25, 0.97 to 5.53), and older age and previous use of psychedelics (metaregression coefficient 0.16, 95% CI 0.08 to 0.24 and 4.2, 1.5 to 6.9, respectively) were correlated with greater improvements in symptoms. All studies had a low risk of bias, but the change from baseline metric was associated with high heterogeneity and a statistically significant risk of small study bias, resulting in a low certainty of evidence rating. CONCLUSION Treatment effects of psilocybin were significantly larger among patients with secondary depression, when self-report scales were used to measure symptoms of depression, and when participants had previously used psychedelics. Further research is thus required to delineate the influence of expectancy effects, moderating factors, and treatment delivery on the efficacy of psilocybin as an antidepressant. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023388065.
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Affiliation(s)
- Athina-Marina Metaxa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Centre for Public Health, ICS-A Royal Hospitals, Belfast, Ireland, UK
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13
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Geyer MA. A Brief Historical Overview of Psychedelic Research. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:464-471. [PMID: 38000715 DOI: 10.1016/j.bpsc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
Classical serotonergic psychedelics such as lysergic acid diethylamide or the naturally occurring compounds psilocybin and mescaline produce profound changes in mood, thought, intuition, sensory perception, the experience of time and space, and even the experience of self. Research examining psychedelic compounds has had a complex and turbulent evolution. Many cultures throughout the world have used psychedelic plants not only for mystical, ritualistic, or divinatory purposes but also for curing illnesses. Much of the genesis and progress of modern investigations into the effects and underlying mechanisms of action of psychedelics have been intertwined with studies of the neurotransmitter serotonin. Early hypotheses that serotonergic systems mediate psychedelic effects were supported initially by preclinical animal studies and subsequently confirmed by pharmacological studies in healthy humans. The use of psychedelic compounds as putative psychotomimetics that reproduce some features of naturally occurring psychotic disorders met with some limited success. More recent studies are exploring psychedelics as potential psychotherapeutic agents. Recent indications that even 1 or 2 psychedelic treatments produce robust and sustained reductions in clinical symptoms in a variety of psychiatric disorders have prompted an enormous resurgence of interest in the nature and mechanisms contributing to their effects.
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Affiliation(s)
- Mark A Geyer
- UC San Diego Center for Psychedelic Research, Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sakai K, Bradley ER, Zamaria JA, Agin-Liebes G, Kelley DP, Fish A, Martini V, Ferris MC, Morton E, Michalak EE, O'Donovan A, Woolley JD. Content analysis of Reddit posts about coadministration of selective serotonin reuptake inhibitors and psilocybin mushrooms. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06585-x. [PMID: 38687360 DOI: 10.1007/s00213-024-06585-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/30/2024] [Indexed: 05/02/2024]
Abstract
RATIONALE Treatments with the serotonergic psychedelic psilocybin are being investigated for multiple neuropsychiatric disorders. Because many patients with these disorders use selective serotonin reuptake inhibitors (SSRIs), understanding interactions between psilocybin and SSRIs is critical for evaluating the safety, efficacy, and scalability of psilocybin-based treatments. Current knowledge about these interactions is limited, as most clinical psilocybin research has prohibited concomittant SSRI use. OBJECTIVES We aimed to explore potential interactions between psilocybin and SSRIs by characterizing peoples' real-world experiences using psilocybin mushrooms and SSRIs together. METHODS We conducted a systematic search of Reddit for posts describing psilocybin mushroom and SSRI coadministration. We identified 443 eligible posts and applied qualitative content analysis to each. RESULTS 8% of posts reported negative physical or psychological effects resulting from coadministration. These included 13 reports that may reflect serotonin toxicity, and 1 concerning for a psychotic/manic episode. 54% of posts described reduced intensity of the acute psilocybin experience, but 39% reported unchanged intensity with SSRI coadministration. CONCLUSIONS Psilocybin's interactions with SSRIs are likely complex and may depend on multiple factors. Prospective studies are needed to evaluate whether psilocybin treatments are reliably safe and effective in the setting of SSRI use.
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Affiliation(s)
- Kimberly Sakai
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA
| | - Ellen R Bradley
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA.
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA.
| | - Joseph A Zamaria
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA
- School of Education, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Gabrielle Agin-Liebes
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - D Parker Kelley
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA
| | - Alexander Fish
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Valeria Martini
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA
- Psychology Department, Palo Alto University, Palo Alto, CA, 94304, USA
| | - Michelle C Ferris
- Psychology Department, Palo Alto University, Palo Alto, CA, 94304, USA
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 2A1, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 2A1, Canada
| | - Aoife O'Donovan
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA
| | - Joshua D Woolley
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA
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Thomann J, Kolaczynska KE, Stoeckmann OV, Rudin D, Vizeli P, Hoener MC, Pryce CR, Vollenweider FX, Liechti ME, Duthaler U. In vitro and in vivo metabolism of psilocybin's active metabolite psilocin. Front Pharmacol 2024; 15:1391689. [PMID: 38741590 PMCID: PMC11089204 DOI: 10.3389/fphar.2024.1391689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
In vivo, psilocybin is rapidly dephosphorylated to psilocin which induces psychedelic effects by interacting with the 5-HT2A receptor. Psilocin primarily undergoes glucuronidation or conversion to 4-hydroxyindole-3-acetic acid (4-HIAA). Herein, we investigated psilocybin's metabolic pathways in vitro and in vivo, conducting a thorough analysis of the enzymes involved. Metabolism studies were performed using human liver microsomes (HLM), cytochrome P450 (CYP) enzymes, monoamine oxidase (MAO), and UDP-glucuronosyltransferase (UGT). In vivo, metabolism was examined using male C57BL/6J mice and human plasma samples. Approximately 29% of psilocin was metabolized by HLM, while recombinant CYP2D6 and CYP3A4 enzymes metabolized nearly 100% and 40% of psilocin, respectively. Notably, 4-HIAA and 4-hydroxytryptophol (4-HTP) were detected with HLM but not with recombinant CYPs. MAO-A transformed psilocin into minimal amounts of 4-HIAA and 4-HTP. 4-HTP was only present in vitro. Neither 4-HIAA nor 4-HTP showed relevant interactions at assessed 5-HT receptors. In contrast to in vivo data, UGT1A10 did not extensively metabolize psilocin in vitro. Furthermore, two putative metabolites were observed. N-methyl-4-hydroxytryptamine (norpsilocin) was identified in vitro (CYP2D6) and in mice, while an oxidized metabolite was detected in vitro (CYP2D6) and in humans. However, the CYP2D6 genotype did not influence psilocin plasma concentrations in the investigated study population. In conclusion, MAO-A, CYP2D6, and CYP3A4 are involved in psilocin's metabolism. The discovery of putative norpsilocin in mice and oxidized psilocin in humans further unravels psilocin's metabolism. Despite limitations in replicating phase II metabolism in vitro, these findings hold significance for studying drug-drug interactions and advancing research on psilocybin as a therapeutic agent.
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Affiliation(s)
- Jan Thomann
- Division of Clinical Pharmacology and Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Karolina E. Kolaczynska
- Division of Clinical Pharmacology and Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Oliver V. Stoeckmann
- Division of Clinical Pharmacology and Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Deborah Rudin
- Division of Clinical Pharmacology and Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Patrick Vizeli
- Division of Clinical Pharmacology and Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Marius C. Hoener
- Neuroscience Research, Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Christopher R. Pryce
- Department of Psychiatry, Psychotherapy and Psychosomatics, Preclinical Laboratory for Translational Research Into Affective Disorders, University of Zurich, Zurich, Switzerland
| | - Franz X. Vollenweider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Neurophenomenology and Consciousness, University of Zurich, Zurich, Switzerland
| | - Matthias E. Liechti
- Division of Clinical Pharmacology and Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Urs Duthaler
- Division of Clinical Pharmacology and Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland
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Bellman V. Review of Psilocybin Use for Depression among Cancer Patients after Approval in Oregon. Cancers (Basel) 2024; 16:1702. [PMID: 38730654 PMCID: PMC11083170 DOI: 10.3390/cancers16091702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Despite the legalization of psilocybin therapy for depression in terminal illnesses such as advanced cancer through Oregon's Measure 109 in 2020, significant challenges have impeded its implementation. This review synthesizes the empirical data supporting the utilization of psilocybin therapy for addressing cancer-related depression, including an evaluation of its purported benefits and potential adverse effects. It provides a comprehensive examination of therapeutic strategies, dosing regimens, and barriers to ensuring responsible and equitable access. Salient issues explored include the development of ethical protocols, integration within healthcare systems, ensuring statewide availability, resolving legal ambiguities, and defining clinical standards. Oregon's pioneering role serves as a case study, highlighting the necessity of addressing regulatory, logistical, and ethical obstacles to ensure the establishment of rigorous and equitable psilocybin care models.
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Affiliation(s)
- Val Bellman
- Psychiatry Residency Training Program, University of Missouri Kansas City, Kansas City, MO 64108, USA
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Viña SM. Religion, Psychedelics, Risky Behavior, and Violence. J Psychoactive Drugs 2024:1-12. [PMID: 38660976 DOI: 10.1080/02791072.2024.2346132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
Research has found that psychedelic use is associated with positive behavioral changes, however research has yet to explore the relationship between socio-cultural conditions on this relationship. This paper intends to fill this gap by testing the effects of religious participation and beliefs on the relationship between psychedelic use and behaviors. This study examines the relationship between Lifetime Classic Psychedelic Use (LCPU), different aspects of religion (such as salience and attendance), and the likelihood of committing a violent assault. The analysis uses pooled data from the National Survey of Drug Use and Health (NSDUH) from 2015 to 2019, with a sample size of 282,768. Binary logistic regression models conducted in Stata 17 reveal that LCPU and religion (salience and influence) are independently associated with reduced violence. Additionally, two-way interactions indicate that the association between risky behavior and violence is smaller among individuals with high levels of religious salience. Furthermore, a three-way interaction suggests that the association between risky behavior and violence is smaller for those who have used psychedelics, with the largest effect observed among individuals with high religious salience. These results show that religious factors can influence the relationship between psychedelic use and behaviors, with both attendance and salience operating simultaneously.
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Affiliation(s)
- Sean M Viña
- The University of the Incarnate Word, Department of Sociology, San Antonio, Texas, USA
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Varty GB, Canal CE, Mueller TA, Hartsel JA, Tyagi R, Avery K, Morgan ME, Reichelt AC, Pathare P, Stang E, Palfreyman MG, Nivorozhkin A. Synthesis and Structure-Activity Relationships of 2,5-Dimethoxy-4-Substituted Phenethylamines and the Discovery of CYB210010: A Potent, Orally Bioavailable and Long-Acting Serotonin 5-HT 2 Receptor Agonist. J Med Chem 2024; 67:6144-6188. [PMID: 38593423 DOI: 10.1021/acs.jmedchem.3c01961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Structure-activity studies of 4-substituted-2,5-dimethoxyphenethylamines led to the discovery of 2,5-dimethoxy-4-thiotrifluoromethylphenethylamines, including CYB210010, a potent and long-acting serotonin 5-HT2 receptor agonist. CYB210010 exhibited high agonist potency at 5-HT2A and 5-HT2C receptors, modest selectivity over 5-HT2B, 5-HT1A, 5-HT6, and adrenergic α2A receptors, and lacked activity at monoamine transporters and over 70 other proteins. CYB210010 (0.1-3 mg/kg) elicited a head-twitch response (HTR) and could be administered subchronically at threshold doses without behavioral tolerance. CYB210010 was orally bioavailable in three species, readily and preferentially crossed into the CNS, engaged frontal cortex 5-HT2A receptors, and increased the expression of genes involved in neuroplasticity in the frontal cortex. CYB210010 represents a new tool molecule for investigating the therapeutic potential of 5-HT2 receptor activation. In addition, several other compounds with high 5-HT2A receptor potency, yet with little or no HTR activity, were discovered, providing the groundwork for the development of nonpsychedelic 5-HT2A receptor ligands.
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Affiliation(s)
- Geoffrey B Varty
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
| | - Clinton E Canal
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
- College of Pharmacy, Department of Pharmaceutical Sciences, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, United States
| | - Tina A Mueller
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
- BioIVT, Hicksville, New York 11803, United States
| | - Joshua A Hartsel
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
- Consultant, UPS PO Box #105-650, 25422 Trabuco Road, Lake Forest, California 92630, United States
| | - Richa Tyagi
- College of Pharmacy, Department of Pharmaceutical Sciences, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, United States
| | - Ken Avery
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
| | - Michael E Morgan
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
| | - Amy C Reichelt
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
- Faculty of Biomedicine, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Pradip Pathare
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
| | - Erik Stang
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
| | | | - Alex Nivorozhkin
- Cybin IRL Limited, North Wall Quay, 1 Spencer Dock, Dublin 1 DO1 X9R7, Ireland
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Downey AE, Chaphekar AV, Woolley J, Raymond-Flesch M. Psilocybin therapy and anorexia nervosa: a narrative review of safety considerations for researchers and clinicians. J Eat Disord 2024; 12:49. [PMID: 38659049 PMCID: PMC11040882 DOI: 10.1186/s40337-024-01005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Clinical trials using psilocybin therapy to treat anorexia nervosa (AN) are currently underway. The safety and tolerability of psilocybin is of utmost importance in individuals with AN who may present unique medical vulnerabilities. The purpose of this review is to describe how the common physiologic adverse effects of psilocybin may impact medical complications experienced by individuals with AN in clinical trials of psilocybin therapy. MAIN BODY The physiologic underpinnings of common adverse effects following psilocybin administration are described, including tachycardia, hypertension, electrocardiogram changes, nausea, headache, and lightheadedness. These anticipated physiologic changes are described in relation to the common medical correlates seen in individuals with AN. Risk mitigation strategies for each adverse effect are proposed. CONCLUSION Early evidence suggests that psilocybin therapy is well-tolerated in individuals with AN. Understanding the unique medical complications of AN, and how they may be impacted by common physiologic adverse effects of psilocybin administration, leads to tailored risk mitigation strategies to enhance safety and tolerability of this novel intervention.
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Affiliation(s)
- Amanda E Downey
- Department of Pediatrics, University of California, San Francisco, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
| | - Anita V Chaphekar
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Joshua Woolley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- San Francisco Veteran's Affairs Medical Center, San Francisco, CA, USA
| | - Marissa Raymond-Flesch
- Department of Pediatrics, University of California, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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21
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Maia JM, de Oliveira BSA, Branco LGS, Soriano RN. Therapeutic potential of psychedelics: History, advancements, and unexplored frontiers. Prog Neuropsychopharmacol Biol Psychiatry 2024; 131:110951. [PMID: 38307161 DOI: 10.1016/j.pnpbp.2024.110951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/20/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
Psychedelics (serotonergic hallucinogens) are psychoactive substances that can alter perception and mood, and affect cognitive functions. These substances activate 5-HT2A receptors and may exert therapeutic effects. Some of the disorders for which psychedelic-assisted therapy have been studied include depression, addiction, anxiety and post-traumatic stress disorder. Despite the increasing number of studies reporting clinical effectiveness, with fewer negative symptoms and, additionally, minimal side effects, questions remain to be explored in the field of psychedelic medicine. Although progress has been achieved, there is still little understanding of the relationship among human brain and the modulation induced by these drugs. The present article aimed to describe, review and highlight the most promising findings in the literature regarding the (putative) therapeutic effects of psychedelics.
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Affiliation(s)
- Juliana Marino Maia
- Department of Medicine, Federal University of Juiz de Fora, Governador Valadares, MG 35032-620, Brazil
| | | | - Luiz G S Branco
- Department of Basic and Oral Biology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040-904, Brazil; Department of Physiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040-900, Brazil.
| | - Renato Nery Soriano
- Division of Physiology and Biophysics, Department of Basic Life Sciences, Federal University of Juiz de Fora, Governador Valadares, MG 35020-360, Brazil
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22
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Armstrong M, Castellanos J, Christie D. Chronic pain as an emergent property of a complex system and the potential roles of psychedelic therapies. Front Pain Res (Lausanne) 2024; 5:1346053. [PMID: 38706873 PMCID: PMC11066302 DOI: 10.3389/fpain.2024.1346053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Despite research advances and urgent calls by national and global health organizations, clinical outcomes for millions of people suffering with chronic pain remain poor. We suggest bringing the lens of complexity science to this problem, conceptualizing chronic pain as an emergent property of a complex biopsychosocial system. We frame pain-related physiology, neuroscience, developmental psychology, learning, and epigenetics as components and mini-systems that interact together and with changing socioenvironmental conditions, as an overarching complex system that gives rise to the emergent phenomenon of chronic pain. We postulate that the behavior of complex systems may help to explain persistence of chronic pain despite current treatments. From this perspective, chronic pain may benefit from therapies that can be both disruptive and adaptive at higher orders within the complex system. We explore psychedelic-assisted therapies and how these may overlap with and complement mindfulness-based approaches to this end. Both mindfulness and psychedelic therapies have been shown to have transdiagnostic value, due in part to disruptive effects on rigid cognitive, emotional, and behavioral patterns as well their ability to promote neuroplasticity. Psychedelic therapies may hold unique promise for the management of chronic pain.
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Affiliation(s)
- Maya Armstrong
- Department of Family & Community Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Joel Castellanos
- Division of Pain Medicine, Department of Anesthesiology, University of California, San Diego, CA, United States
| | - Devon Christie
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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23
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Wang JR, Mendez Araque SJ, Micciche G, McMillan A, Coughlin E, Mattiola R, English D, Kaliebe K. Palliative care patients' attitudes and openness towards psilocybin-assisted psychotherapy for existential distress. Front Psychiatry 2024; 15:1301960. [PMID: 38699449 PMCID: PMC11063770 DOI: 10.3389/fpsyt.2024.1301960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Patients with incurable illnesses often experience existential distress, profoundly impacting their well-being. Current medical approaches have limitations in addressing these burdens. Psilocybin, a promising psychedelic compound, may offer therapeutic benefits. This pilot survey study aimed to investigate the attitudes and openness toward psilocybin-assisted psychotherapy (PAT) among patients with incurable illnesses. The objective is to assess patients' attitudes toward PAT and identify potential barriers and concerns, including exploring the association between beliefs in psilocybin's therapeutic benefits and interest in receiving this treatment. Methods The survey study was conducted at the Tampa General Hospital Palliative Care Outpatient office in the United States. Participants were 32 English-fluent patients, aged 18 or older, with incurable illnesses. The survey included demographic questions, a validated tool to measure existential distress, and questions about knowledge and concerns regarding psilocybin. Attitudes toward PAT and interest in its future use were assessed using Likert scale responses. Results Among the 31 analyzed participants, 51.6% expressed interest in future psilocybin treatment, while 32.3% did not indicate interest. Belief in the psilocybin's therapeutic benefits for stress and anxiety significantly correlated with interest in use. Concerns included risk of psychosis, lack of trained providers, and potential for exploitation. No demographic factors were associated with interest or levels of distress. Conclusions This pilot study provides insights into the attitudes and concerns toward PAT among patients with incurable illnesses. Over half of participants expressed interest. However, concerns regarding its use were identified, with patients' concern for the risk of exploitation associated with PAT as an especially novel concern documented in this patient population. This highlighted the need for further education of risks and benefits or PAT by trained clinicians and rigorous training of clinicians with the establishment of safeguards against exploitation. Further research is necessary to explore the potential benefits of PAT and related non-psilocybin psychedelic compounds in addressing existential distress among patients with incurable illnesses.
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Affiliation(s)
- Julia Ruixi Wang
- MD Program, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Samuel J. Mendez Araque
- MD Program, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Gina Micciche
- Undergraduate Studies, College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Andrew McMillan
- Undergraduate Studies, College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Emily Coughlin
- Department of Medical Education, University of South Florida, Tampa, FL, United States
| | - Rosalie Mattiola
- MD Program, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Diana English
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, United States
- Department of Internal Medicine, University of South Florida, Tampa, FL, United States
| | - Kristopher Kaliebe
- Department of Psychiatry, University of South Florida, Tampa, FL, United States
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24
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Sloshower J, Zeifman RJ, Guss J, Krause R, Safi-Aghdam H, Pathania S, Pittman B, D'Souza DC. Psychological flexibility as a mechanism of change in psilocybin-assisted therapy for major depression: results from an exploratory placebo-controlled trial. Sci Rep 2024; 14:8833. [PMID: 38632313 PMCID: PMC11024097 DOI: 10.1038/s41598-024-58318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
Several phase II studies have demonstrated that psilocybin-assisted therapy shows therapeutic potential across a spectrum of neuropsychiatric conditions, including major depressive disorder (MDD). However, the mechanisms underlying its often persisting beneficial effects remain unclear. Observational research suggests that improvements in psychological flexibility may mediate therapeutic effects. However, no psychedelic trials to date have substantiated this finding in a clinical sample. In an exploratory placebo-controlled, within-subject, fixed-order study, individuals with moderate to severe MDD were administered placebo (n = 19) followed by psilocybin (0.3 mg/kg) (n = 15) 4 weeks later. Dosing sessions were embedded within a manualized psychotherapy that incorporated principles of Acceptance and Commitment Therapy. Depression severity, psychological flexibility, mindfulness, and values-congruent living were measured over a 16-weeks study period. Psychological flexibility, several facets of mindfulness, and values-congruent living significantly improved following psilocybin and were maintained through week 16. Additionally, improvements in psychological flexibility and experiential acceptance were strongly associated with reductions in depression severity following psilocybin. These findings support the theoretical premise of integrating psilocybin treatment with psychotherapeutic platforms that target psychological flexibility and add to emerging evidence that increasing psychological flexibility may be an important putative mechanism of change in psilocybin-assisted therapy for MDD and potentially, other mental health conditions.
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Affiliation(s)
- Jordan Sloshower
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.
- West Rock Wellness PLLC, New Haven, CT, USA.
| | - Richard J Zeifman
- NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jeffrey Guss
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert Krause
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Nursing, New Haven, CT, USA
- Centered PLLC, New Haven, CT, USA
| | - Hamideh Safi-Aghdam
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Surbhi Pathania
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
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25
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Honk L, Stenfors CUD, Goldberg SB, Hendricks PS, Osika W, Dourron HM, Lebedev A, Petrovic P, Simonsson O. Longitudinal associations between psychedelic use and psychotic symptoms in the United States and the United Kingdom. J Affect Disord 2024; 351:194-201. [PMID: 38280572 PMCID: PMC10922895 DOI: 10.1016/j.jad.2024.01.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 01/29/2024]
Abstract
It has long been speculated that psychedelic use could provoke the onset of psychosis, but there is little evidence to support this conjecture. Using a longitudinal research design with samples representative of the US and UK adult populations with regard to sex, age, and ethnicity (n = 9732), we investigated associations between psychedelic use and change in the number of psychotic symptoms during the two-month study period. In covariate-adjusted regression models, psychedelic use during the study period was not associated with a change in the number of psychotic symptoms unless it interacted with a personal or family history of bipolar disorder, in which case the number of symptoms increased, or with a personal (but not family) history of psychotic disorders, in which case the number of symptoms decreased. Taken together, these findings indicate that psychedelic use may affect psychotic symptoms in individuals with a personal or family history of certain disorders characterized by psychotic symptomatology.
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Affiliation(s)
- Ludwig Honk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | | | - Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Peter S Hendricks
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Walter Osika
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Haley Maria Dourron
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander Lebedev
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Predrag Petrovic
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Otto Simonsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Department of Sociology, University of Oxford, Oxford, United Kingdom
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26
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Orłowski P, Hobot J, Ruban A, Szczypiński J, Bola M. Naturalistic use of psychedelics does not modulate processing of self-related stimuli (but it might modulate attentional mechanisms): An event-related potentials study. Psychophysiology 2024:e14583. [PMID: 38584307 DOI: 10.1111/psyp.14583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
Classic psychedelics are able to profoundly alter the state of consciousness and lead to acute experiences of ego dissolution - the blurring of the distinction between representations of self and the external world. However, whether repeated use of psychedelics is associated with more prolonged and permanent modifications to the concept of self remains to be investigated. Therefore, we conducted a preregistered, cross-sectional study in which experienced psychedelics users (15 or more lifetime experiences with psychedelics; N = 56) were compared to nonusers (N = 57) in terms of neural reactivity to a Self-name (i.e., each participant's own name) stimulus, which is known to robustly activate a representation of self. Two control stimuli were additionally used: an Other-name stimulus, as a passive control condition in which no reaction was required, and a Target-name stimulus, to which participants provided a manual response and which thus constituted an active control condition. Analysis of the amplitude of the P300 ERP component evoked by the Self- or Target-names revealed no difference between the psychedelics users and nonusers. However, psychedelic users exhibited increased P300 amplitude during perception of Other-names. In addition, in comparison to nonusers, psychedelics users exhibited a smaller increase in P300 amplitude when processing the task-relevant Target-names (in relation to both Self- and Other-names). Therefore, our data suggests that regular naturalistic use of psychedelics may not be related to long-term changes in the representation of self, but it might potentially affect the allocation of attentional resources to task-relevant stimuli.
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Affiliation(s)
- Paweł Orłowski
- Centre for Brain Research, Jagiellonian University, Kraków, Poland
- Doctoral School in the Social Sciences, Jagiellonian University, Kraków, Poland
| | - Justyna Hobot
- Consciousness Lab, Psychology Institute, Jagiellonian University, Kraków, Poland
| | - Anastasia Ruban
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Jan Szczypiński
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Michał Bola
- Centre for Brain Research, Jagiellonian University, Kraków, Poland
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Mortaheb S, Fort LD, Mason NL, Mallaroni P, Ramaekers JG, Demertzi A. Dynamic Functional Hyperconnectivity after Psilocybin Intake is Primarily Associated with Oceanic Boundlessness. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00084-3. [PMID: 38588855 DOI: 10.1016/j.bpsc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Psilocybin is a widely studied psychedelic substance, which leads to the psychedelic state, a specific altered state of consciousness. To date, the relationship between the psychedelic state's neurobiological and experiential patterns remains under-characterized as they are often analyzed separately. We investigated the relationship between neurobiological and experiential patterns after psilocybin by focusing on the link between dynamic cerebral connectivity and retrospective questionnaire assessment. METHODS Healthy participants were randomized to receive either psilocybin (n=22) or placebo (n=27) and scanned for six minutes in eyes open resting state during the peak subjective drug effect (102 minutes post-treatment) in ultra-high field 7T MRI. The 5D-ASC Rating Scale was administered 360 minutes after drug intake. RESULTS Under psilocybin, there were alterations across all dimensions of the 5D-ASC scale, and widespread increases in averaged brain functional connectivity. Further time-varying functional connectivity analysis unveiled a recurrent hyperconnected pattern characterized by low BOLD signal amplitude, suggesting heightened cortical arousal. In terms of neuro-experiential links, canonical correlation analysis showed higher transition probabilities to the hyperconnected pattern with feelings of oceanic boundlessness, and secondly with visionary restructuralization. CONCLUSIONS Psilocybin generates profound alterations both at the brain and at the experiential level. We suggest that the brain's tendency to enter a hyperconnected-hyperarousal pattern under psilocybin represents the potential to entertain variant mental associations. These findings illuminate the intricate interplay between brain dynamics and subjective experience under psilocybin, providing insights into the neurophysiology and neuro-experiential qualities of the psychedelic state.
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Affiliation(s)
- Sepehr Mortaheb
- Physiology of Cognition, GIGA-CRC In Vivo Imaging, University of Liège, Belgium; Fund for Scientific Research FNRS, Brussels, Belgium
| | - Larry D Fort
- Physiology of Cognition, GIGA-CRC In Vivo Imaging, University of Liège, Belgium; Fund for Scientific Research FNRS, Brussels, Belgium
| | - Natasha L Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Pablo Mallaroni
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Athena Demertzi
- Physiology of Cognition, GIGA-CRC In Vivo Imaging, University of Liège, Belgium; Fund for Scientific Research FNRS, Brussels, Belgium; Psychology & Neuroscience of Cognition (PsyNCog), University of Liège, Belgium.
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28
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Molla H, Lee R, Tare I, de Wit H. Greater subjective effects of a low dose of LSD in participants with depressed mood. Neuropsychopharmacology 2024; 49:774-781. [PMID: 38042914 PMCID: PMC10948752 DOI: 10.1038/s41386-023-01772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023]
Abstract
Recent studies and anecdotal reports suggest that psychedelics can improve mood states, even at low doses. However, few placebo-controlled studies have examined the acute effects of low doses of LSD in individuals with psychiatric symptoms. In the current study, we examined the acute and sub-acute effect of a low dose of LSD (26 µg) on subjective effects and mood in volunteers with mild depressed mood. The study used a randomized, double-blind, crossover design to compare the effects of LSD in two groups of adults: participants who scored high (≥17; n = 20) or low (<17; n = 19) on the Beck Depression-II inventory (BDI) at screening. Participants received a single low dose of LSD (26 µg) and placebo during two 5-h laboratory sessions, separated by at least one week. Subjective, physiological, and mood measures were assessed at regular intervals throughout the sessions, and behavioral measures of creativity and emotion recognition were obtained at expected peak effect. BDI depression scores and mood ratings were assessed 48-h after each session. Relative to placebo, LSD (26 µg) produced expected, mild physiological and subjective effects on several measures in both groups. However, the high BDI group reported significantly greater drug effects on several indices of acute effects, including ratings of vigor, elation, and affectively positive scales of a measure of psychedelic effects (5D-ASC). The high BDI group also reported a greater decline in BDI depression scores 48-h after LSD, compared to placebo. These findings suggest that an acute low dose of LSD (26 µg) elicits more pronounced positive mood and stimulant-like effects, as well as stronger altered states of consciousness in individuals with depressive symptoms, compared to non-depressed individuals.
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Affiliation(s)
- Hanna Molla
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave MC3077, Chicago, IL, 60637, USA
| | - Royce Lee
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave MC3077, Chicago, IL, 60637, USA
| | - Ilaria Tare
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave MC3077, Chicago, IL, 60637, USA
| | - Harriet de Wit
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave MC3077, Chicago, IL, 60637, USA.
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Beaussant Y, Tarbi E, Nigam K, Miner S, Sager Z, Sanders JJ, Ljuslin M, Guérin B, Thambi P, Tulsky JA, Agrawal M. Acceptability of psilocybin-assisted group therapy in patients with cancer and major depressive disorder: Qualitative analysis. Cancer 2024; 130:1147-1157. [PMID: 38105653 DOI: 10.1002/cncr.35024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The present study explored the acceptability of psilocybin-assisted group therapy from the perspective of patients with cancer and depression who participated in a clinical trial assessing the safety and efficacy of this novel intervention. METHODS Guided by the conceptual framework of acceptability, the authors conducted semi-structured interviews with participants of the psilocybin trial. Data were analyzed using template and thematic analyses. RESULTS Participants' (n = 28) perspectives on the acceptability of the group and simultaneous sessions was generally positive, both in terms of safety and efficacy: first, the groups contributed to increase participants' sense of safety and preparedness as they were engaging in the therapy; and second, the groups fostered a sense of connection and of belonging, which served to enrich and deepen the meaning of participants' experience, ultimately opening a dimension of self-transcendence and compassion. Other subthemes related to factors influencing the acceptability of the group approach included: 1) the importance of the therapeutic framework, 2) the complementary value of individual sessions, 3) disruptive factors related to the group and/or simultaneous setting, and 4) opportunities and challenges related to group size and how to structure interactions. CONCLUSIONS This study enhances understanding of what promotes acceptability of the psilocybin-assisted therapy group model for the treatment of MDD in cancer patients. PLAIN LANGUAGE SUMMARY We conducted exit interviews with participants of a phase 2 trial of psilocybin-assisted therapy (PAT) conducted in a community cancer center, to assess the acceptability of a novel psilocybin delivery model combining simultaneous individual therapy and group sessions. Our findings support the acceptability of this intervention and suggest that in addition to being feasible, it might also enhance participants' perceived safety and efficacy compared to uniquely individual or group delivery models of PAT. Our analysis highlights critical factors conditioning acceptability and suggests new ways PAT may be scaled and integrated into cancer care.
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Affiliation(s)
- Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elise Tarbi
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Nursing, University of Vermont, Burlington, Vermont, USA
| | - Kabir Nigam
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Skye Miner
- Department of Medical Humanities and Bioethics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Zachary Sager
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Justin J Sanders
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Michael Ljuslin
- Harvard Medical School, Boston, Massachusetts, USA
- University of Geneva, Geneva, Switzerland
- Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Benjamin Guérin
- Department of Philosophy, University of Franche Comté, Besançon, France
| | - Paul Thambi
- Sunstone Therapies, Rockville, Maryland, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Yerubandi A, Thomas JE, Bhuiya NMMA, Harrington C, Villa Zapata L, Caballero J. Acute Adverse Effects of Therapeutic Doses of Psilocybin: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e245960. [PMID: 38598236 PMCID: PMC11007582 DOI: 10.1001/jamanetworkopen.2024.5960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Psilocybin has been studied in the treatment of depression and anxiety disorders. Clinical studies have mainly focused on efficacy, with systematic reviews showing favorable efficacy; however, none have primarily focused on psilocybin safety. Objective To evaluate the acute adverse effects of psilocybin at therapeutic doses in the treatment of depression and anxiety. Data Sources MEDLINE via PubMed, Web of Science, and ClinicalTrials.gov were searched for publications available between 1966 and November 30, 2023. Study Selection Randomized, double-blind clinical trials that reported adverse effects of psilocybin in patients treated for depression and anxiety were screened. Data Extraction and Synthesis Data were independently extracted by 2 authors and verified by 2 additional authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The inverse variance method with the Hartung-Knapp adjustment for the random-effects model was used, with a continuity correction of 0.5 for studies with 0 cell frequencies. Sensitivity analysis was conducted by sequentially removing 1 study at a time to assess the robustness of the results. Main Outcomes and Measures The primary outcome was considered as the adverse effects of psilocybin at high and moderate (ie, therapeutic) dose regimens and compared with placebo, low-dose psilocybin, or other comparator in the treatment of depression and/or anxiety. Results Six studies met the inclusion criteria with a total sample of 528 participants (approximately 51% female; median age 39.8 years; IQR, 39.8-41.2). Seven adverse effects were reported in multiple studies and included in the analysis. Among these, headache (relative risk [RR], 1.99; 95% CI 1.06-3.74), nausea (RR, 8.85; 95% CI, 5.68-13.79), anxiety (RR, 2.27; 95% CI, 1.11-4.64), dizziness (RR, 5.81; 95% CI, 1.02-33.03), and elevated blood pressure (RR, 2.29; 95% CI, 1.15- 4.53) were statistically significant. Psilocybin use was not associated with risk of paranoia and transient thought disorder. Conclusions and Relevance In this meta-analysis, the acute adverse effect profile of therapeutic single-dose psilocybin appeared to be tolerable and resolved within 48 hours. However, future studies need to more actively evaluate the appropriate management of adverse effects.
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Affiliation(s)
- Akhila Yerubandi
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens
| | - Jennifer E. Thomas
- Department of Clinical and Administrative Sciences, Larkin University, Miami, Florida
| | | | - Catherine Harrington
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida
| | - Lorenzo Villa Zapata
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens
| | - Joshua Caballero
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens
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Agrawal M, Richards W, Beaussant Y, Shnayder S, Ameli R, Roddy K, Stevens N, Richards B, Schor N, Honstein H, Jenkins B, Bates M, Thambi P. Psilocybin-assisted group therapy in patients with cancer diagnosed with a major depressive disorder. Cancer 2024; 130:1137-1146. [PMID: 38105655 DOI: 10.1002/cncr.35010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Depression is common in patients with cancer and is associated with lower treatment adherence and reduced quality of life. Antidepressants and psychotherapy have limited success in improving depression among patients with cancer. This study explored the safety, feasibility, and efficacy of psilocybin-assisted therapy in patients with cancer and major depressive disorder. METHODS This phase 2, open-label trial enrolled patients with curable and noncurable cancer and major depressive disorder at a single community oncology practice site. A single 25-mg dose of psilocybin was administered simultaneously to cohorts of three to four participants with individual (4.25 hours in 1:1 therapist-to-patient ratio) and group therapeutic support (3.75 hours) before, during, and after psilocybin administration. Outcomes included depression severity, anxiety, pain, demoralization, and disability. RESULTS Thirty participants completed the study. No psilocybin-related serious adverse events occurred; treatment-related adverse events (e.g., nausea, headache) were generally mild and expected. There were no laboratory or electrocardiogram abnormalities. No suicidality was reported. Efficacy was suggested with a robust reduction in depression severity scores from baseline to posttreatment of 19.1 points (95% CI, 22.3 to -16.0; p < .0001) by week 8. Eighty percent of participants demonstrated a sustained response to psilocybin treatment; 50% showed full remission of depressive symptoms at week 1, which was sustained for 8 weeks. CONCLUSIONS Psilocybin-assisted therapy in group cohort administration was safe and feasible in patients with cancer and depression. Efficacy was suggested based on clinically meaningful reductions in depressive symptoms. The novel, group-oriented format, compact delivery time, community cancer center setting, and one-to-one therapist-to-patient ratio could also add to therapeutic gains and efficiency of administration. TRIAL REGISTRATION NCT04593563. PLAIN LANGUAGE SUMMARY Depression is common in patients with cancer and associated with lower treatment adherence, reduced quality of life, and limited response to antidepressants and psychotherapy. We conducted a phase 2 trial to study a single dose of psilocybin administered in a group therapy setting with one-to-one therapist-to-participant psychological support to patients with curable and noncurable cancer and major depressive disorder. Findings of the study showed safety (no treatment-related serious adverse events or suicidality) with psilocybin and suggested efficacy, with a significant reduction in depression severity scores from baseline to posttreatment. Further investigation is warranted.
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Affiliation(s)
| | | | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah Shnayder
- Teachers College, Columbia University, New York, New York, USA
| | - Rezvan Ameli
- Sunstone Therapies, Rockville, Maryland, USA
- Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | - Nick Schor
- Sunstone Therapies, Rockville, Maryland, USA
| | | | | | - Mark Bates
- Sunstone Therapies, Rockville, Maryland, USA
| | - Paul Thambi
- Sunstone Therapies, Rockville, Maryland, USA
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Tolle HM, Farah JC, Mallaroni P, Mason NL, Ramaekers JG, Amico E. The unique neural signature of your trip: Functional connectome fingerprints of subjective psilocybin experience. Netw Neurosci 2024; 8:203-225. [PMID: 38562294 PMCID: PMC10898784 DOI: 10.1162/netn_a_00349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/23/2023] [Indexed: 04/04/2024] Open
Abstract
The emerging neuroscientific frontier of brain fingerprinting has recently established that human functional connectomes (FCs) exhibit fingerprint-like idiosyncratic features, which map onto heterogeneously distributed behavioral traits. Here, we harness brain-fingerprinting tools to extract FC features that predict subjective drug experience induced by the psychedelic psilocybin. Specifically, in neuroimaging data of healthy volunteers under the acute influence of psilocybin or a placebo, we show that, post psilocybin administration, FCs become more idiosyncratic owing to greater intersubject dissimilarity. Moreover, whereas in placebo subjects idiosyncratic features are primarily found in the frontoparietal network, in psilocybin subjects they concentrate in the default mode network (DMN). Crucially, isolating the latter revealed an FC pattern that predicts subjective psilocybin experience and is characterized by reduced within-DMN and DMN-limbic connectivity, as well as increased connectivity between the DMN and attentional systems. Overall, these results contribute to bridging the gap between psilocybin-mediated effects on brain and behavior, while demonstrating the value of a brain-fingerprinting approach to pharmacological neuroimaging.
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Affiliation(s)
- Hanna M. Tolle
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Juan Carlos Farah
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Pablo Mallaroni
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Natasha L. Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Johannes G. Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Enrico Amico
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
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Sinha JK, Trisal A, Ghosh S, Gupta S, Singh KK, Han SS, Mahapatra M, Abomughaid MM, Abomughayedh AM, Almutary AG, Iqbal D, Bhaskar R, Mishra PC, Jha SK, Jha NK, Singh AK. Psychedelics for alzheimer's disease-related dementia: Unveiling therapeutic possibilities and pathways. Ageing Res Rev 2024; 96:102211. [PMID: 38307424 DOI: 10.1016/j.arr.2024.102211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/04/2024]
Abstract
Psychedelics have traditionally been used for spiritual and recreational purposes, but recent developments in psychotherapy have highlighted their potential as therapeutic agents. These compounds, which act as potent 5-hydroxytryptamine (5HT) agonists, have been recognized for their ability to enhance neural plasticity through the activation of the serotoninergic and glutamatergic systems. However, the implications of these findings for the treatment of neurodegenerative disorders, particularly dementia, have not been fully explored. In recent years, studies have revealed the modulatory and beneficial effects of psychedelics in the context of dementia, specifically Alzheimer's disease (AD)-related dementia, which lacks a definitive cure. Psychedelics such as N,N-dimethyltryptamine (DMT), lysergic acid diethylamide (LSD), and Psilocybin have shown potential in mitigating the effects of this debilitating disease. These compounds not only target neurotransmitter imbalances but also act at the molecular level to modulate signalling pathways in AD, including the brain-derived neurotrophic factor signalling pathway and the subsequent activation of mammalian target of rapamycin and other autophagy regulators. Therefore, the controlled and dose-dependent administration of psychedelics represents a novel therapeutic intervention worth exploring and considering for the development of drugs for the treatment of AD-related dementia. In this article, we critically examined the literature that sheds light on the therapeutic possibilities and pathways of psychedelics for AD-related dementia. While this emerging field of research holds great promise, further studies are necessary to elucidate the long-term safety, efficacy, and optimal treatment protocols. Ultimately, the integration of psychedelics into the current treatment paradigm may provide a transformative approach for addressing the unmet needs of individuals living with AD-related dementia and their caregivers.
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Affiliation(s)
| | - Anchal Trisal
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Shampa Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
| | - Saurabh Gupta
- Department of Biotechnology, GLA University, Mathura, Uttar Pradesh, India
| | - Krishna Kumar Singh
- Symbiosis Centre for Information Technology (SCIT), Rajiv Gandhi InfoTech Park, Hinjawadi, Pune, Maharashtra 411057, India
| | - Sung Soo Han
- School of Chemical Engineering, Yeungnam University, Gyeonsang 38541, the Republic of Korea; Research Institute of Cell Culture, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, the Republic of Korea
| | | | - Mosleh Mohammad Abomughaid
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, University of Bisha, Bisha 61922, Saudi Arabia
| | - Ali M Abomughayedh
- Pharmacy Department, Aseer Central Hospital, Ministry of Health, Saudi Arabia
| | - Abdulmajeed G Almutary
- Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, Abu Dhabi P.O. Box 59911, United Arab Emirates
| | - Danish Iqbal
- Department of Health Information Management, College of Applied Medical Sciences, Buraydah Private Colleges, Buraydah 51418, Saudi Arabia
| | - Rakesh Bhaskar
- School of Chemical Engineering, Yeungnam University, Gyeonsang 38541, the Republic of Korea; Research Institute of Cell Culture, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, the Republic of Korea.
| | - Prabhu Chandra Mishra
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, India
| | - Saurabh Kumar Jha
- Department of Zoology, Kalindi College, University of Delhi, 110008, India.
| | - Niraj Kumar Jha
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Centre of Research Impact and Outcome, Chitkara University, Rajpura 140401, Punjab, India; School of Bioengineering & Biosciences, Lovely Professional University, Phagwara 144411, India; Department of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, India.
| | - Abhishek Kumar Singh
- Manipal Centre for Biotherapeutics Research, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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Thrul J, Kozak Z, Carducci MA, Garcia-Romeu A, Yaden DB. Innovations in group-based psilocybin-assisted therapy of major depression in patients with cancer. Cancer 2024; 130:1028-1030. [PMID: 38105654 DOI: 10.1002/cncr.35127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Several recent studies have investigated psilocybin as a novel therapeutic compound for the treatment of existential distress in patients with cancer, demonstrating persistent, positive effects on mood. This editorial discusses two articles in the current issue of Cancer that report findings of a group‐based psilocybin‐assisted intervention for treatment of depression in patients diagnosed with cancer.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
| | - Zofia Kozak
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael A Carducci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - David B Yaden
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Singer B, Meling D, Hirsch-Hoffmann M, Michels L, Kometer M, Smigielski L, Dornbierer D, Seifritz E, Vollenweider FX, Scheidegger M. Psilocybin enhances insightfulness in meditation: a perspective on the global topology of brain imaging during meditation. Sci Rep 2024; 14:7211. [PMID: 38531905 PMCID: PMC10966054 DOI: 10.1038/s41598-024-55726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
In this study, for the first time, we explored a dataset of functional magnetic resonance images collected during focused attention and open monitoring meditation before and after a five-day psilocybin-assisted meditation retreat using a recently established approach, based on the Mapper algorithm from topological data analysis. After generating subject-specific maps for two groups (psilocybin vs. placebo, 18 subjects/group) of experienced meditators, organizational principles were uncovered using graph topological tools, including the optimal transport (OT) distance, a geometrically rich measure of similarity between brain activity patterns. This revealed characteristics of the topology (i.e. shape) in space (i.e. abstract space of voxels) and time dimension of whole-brain activity patterns during different styles of meditation and psilocybin-induced alterations. Most interestingly, we found that (psilocybin-induced) positive derealization, which fosters insightfulness specifically when accompanied by enhanced open-monitoring meditation, was linked to the OT distance between open-monitoring and resting state. Our findings suggest that enhanced meta-awareness through meditation practice in experienced meditators combined with potential psilocybin-induced positive alterations in perception mediate insightfulness. Together, these findings provide a novel perspective on meditation and psychedelics that may reveal potential novel brain markers for positive synergistic effects between mindfulness practices and psilocybin.
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Affiliation(s)
- Berit Singer
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland.
| | - Daniel Meling
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Freiburg, Germany
| | - Matthias Hirsch-Hoffmann
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Neuroscience Center Zurich (ZNZ), University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Michael Kometer
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland
| | - Lukasz Smigielski
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland
| | - Dario Dornbierer
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland
| | - Franz X Vollenweider
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland.
| | - Milan Scheidegger
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Neuroscience Center Zurich (ZNZ), University of Zurich and ETH Zurich, Zurich, Switzerland
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Juliani A, Safron A, Kanai R. Deep CANALs: a deep learning approach to refining the canalization theory of psychopathology. Neurosci Conscious 2024; 2024:niae005. [PMID: 38533457 PMCID: PMC10965250 DOI: 10.1093/nc/niae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 03/28/2024] Open
Abstract
Psychedelic therapy has seen a resurgence of interest in the last decade, with promising clinical outcomes for the treatment of a variety of psychopathologies. In response to this success, several theoretical models have been proposed to account for the positive therapeutic effects of psychedelics. One of the more prominent models is "RElaxed Beliefs Under pSychedelics," which proposes that psychedelics act therapeutically by relaxing the strength of maladaptive high-level beliefs encoded in the brain. The more recent "CANAL" model of psychopathology builds on the explanatory framework of RElaxed Beliefs Under pSychedelics by proposing that canalization (the development of overly rigid belief landscapes) may be a primary factor in psychopathology. Here, we make use of learning theory in deep neural networks to develop a series of refinements to the original CANAL model. Our primary theoretical contribution is to disambiguate two separate optimization landscapes underlying belief representation in the brain and describe the unique pathologies which can arise from the canalization of each. Along each dimension, we identify pathologies of either too much or too little canalization, implying that the construct of canalization does not have a simple linear correlation with the presentation of psychopathology. In this expanded paradigm, we demonstrate the ability to make novel predictions regarding what aspects of psychopathology may be amenable to psychedelic therapy, as well as what forms of psychedelic therapy may ultimately be most beneficial for a given individual.
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Affiliation(s)
- Arthur Juliani
- Microsoft Research , Microsoft, 300 Lafayette St, New York, NY 10012, USA
| | - Adam Safron
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21205, USA
| | - Ryota Kanai
- Neurotechnology R & D Unit, Araya Inc, 6F Sanpo Sakuma Building, 1-11 Kandasakumacho, Chiyoda-ku, Tokyo 101-0025, Japan
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Hoener S, Wolfgang A, Nissan D, Howe E. Ethical considerations for psychedelic-assisted therapy in military clinical settings. J Med Ethics 2024; 50:258-262. [PMID: 37253556 DOI: 10.1136/jme-2023-108943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
Psychedelic treatments, particularly 3,4-methylenedioxymethamphetamine (MDMA)-assisted and psilocybin-assisted therapies, have recently seen renewed interest in their clinical potential to treat various mental health conditions. Clinical trials for both MDMA-assisted and psilocybin-assisted therapies have shown to be highly efficacious for post-traumatic stress disorder and major depression. Recent research trials for psychedelic-assisted therapies (PAT) have demonstrated that although they are resource-intensive, their effects are rapid-acting, durable and cost-effective. These results have generated enthusiasm among researchers seeking to investigate psychedelic therapies in active-duty service members of the US military, particularly those with treatment refractory mental health conditions. At the same time, psychedelics remain in early stages of clinical investigation, have not yet achieved regulatory approval for general clinical use and may confer unique psychological and neurobiological effects that could raise novel ethical considerations when treating active-duty service members. Should psychedelics achieve regulatory approval, military relevant considerations may include issues of access to these treatments, appropriate procedures for informed consent, confidentiality standards, and possible unanticipated mental health risks and other psychological sequelae. A service member's deployability, as well as their ability to return to full military duty following PAT, may also be of unique concern. The authors argue that MDMA-assisted therapy currently represents a promising treatment that should be more rapidly investigated as a clinical therapy for service members while still taking a measured approach that accounts for the many military-specific uncertainties that remain.
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Affiliation(s)
- Scott Hoener
- Department of Psychiatry, Naval Medical Center San Diego, San Diego, CA, USA
| | - Aaron Wolfgang
- Department of Psychiatry, Brooke Army Medical Center, Fort Sam Houston, TX, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - David Nissan
- Department of Psychiatry, Naval Medical Center San Diego, San Diego, CA, USA
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - Edmund Howe
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
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Levin AW, Lancelotta R, Sepeda ND, Gukasyan N, Nayak S, Wagener TL, Barrett FS, Griffiths RR, Davis AK. The therapeutic alliance between study participants and intervention facilitators is associated with acute effects and clinical outcomes in a psilocybin-assisted therapy trial for major depressive disorder. PLoS One 2024; 19:e0300501. [PMID: 38483940 PMCID: PMC10939230 DOI: 10.1371/journal.pone.0300501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
We examined if the therapeutic alliance between study participants and intervention facilitators in a psilocybin-assisted therapy (PAT) trial changed over time and whether there were relationships between alliance, acute psilocybin experiences, and depression outcomes. In a randomized, waiting list-controlled clinical trial for major depressive disorder in adults (N = 24), participants were randomized to an immediate (N = 13) or delayed (N = 11) condition with two oral doses of psilocybin (20mg/70kg and 30mg/70kg). Ratings of therapeutic alliance significantly increased from the final preparation session to one-week post-intervention (p = .03, d = .43). A stronger total alliance at the final preparation session predicted depression scores at 4 weeks (r = -.65, p = .002), 6 months (r = -.47, p = .036), and 12 months (r = -.54, p = .014) post-intervention. A stronger total alliance in the final preparation session was correlated with higher peak ratings of mystical experiences (r = .49, p = .027) and psychological insight (r = .52, p = .040), and peak ratings of mystical experience and psychological insight were correlated with depression scores at 4 weeks (r = -.45, p = .030 for mystical; r = -.75, p < .001 for insight). Stronger total alliance one week after the final psilocybin session predicted depression scores at 4 weeks (r = -.85, p < .001), 3 months (r = -.52, p = .010), 6 months (r = -.77, p < .001), and 12 months (r = -.61, p = .001) post-intervention. These findings highlight the importance of the therapeutic relationship in PAT. Future research should explore therapist and participant characteristics which maximize the therapeutic alliance and evaluate its relationship to treatment outcomes. Trial registration: Registration: Clinicaltrials.gov NCT03181529. https://classic.clinicaltrials.gov/ct2/show/NCT03181529.
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Affiliation(s)
- Adam W. Levin
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
- Department of Psychiatry, The Ohio State University, Columbus, Ohio, United States of America
| | - Rafaelle Lancelotta
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
| | - Nathan D. Sepeda
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Natalie Gukasyan
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Sandeep Nayak
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Frederick S. Barrett
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Roland R. Griffiths
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Alan K. Davis
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
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Rosenblat JD, Meshkat S, Doyle Z, Kaczmarek E, Brudner RM, Kratiuk K, Mansur RB, Schulz-Quach C, Sethi R, Abate A, Ali S, Bawks J, Blainey MG, Brietzke E, Cronin V, Danilewitz J, Dhawan S, Di Fonzo A, Di Fonzo M, Drzadzewski P, Dunlop W, Fiszter H, Gomes FA, Grewal S, Leon-Carlyle M, McCallum M, Mofidi N, Offman H, Riva-Cambrin J, Schmidt J, Smolkin M, Quinn JM, Zumrova A, Marlborough M, McIntyre RS. Psilocybin-assisted psychotherapy for treatment resistant depression: A randomized clinical trial evaluating repeated doses of psilocybin. Med 2024; 5:190-200.e5. [PMID: 38359838 DOI: 10.1016/j.medj.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Psilocybin-assisted psychotherapy (PAP) has been associated with antidepressant effects. Trials to date have typically excluded participants with complex presentations. Our aim was to determine the feasibility of PAP in a complex population, including high levels of treatment resistance in major depressive and bipolar disorder and patients with baseline suicidality and significant comorbidity. We also evaluated flexible repeated doses over a 6-month period. METHODS Adults with treatment-resistant depression as part of major depressive or bipolar II disorder without psychosis or a substance use disorder were eligible to participate. Subjects were randomized to immediate treatment or waitlist control, with all eventually receiving PAP. Participants had one, two, or three psilocybin sessions with a fixed dose of 25 mg. Each dose was accompanied by preparation and integration psychotherapy sessions. Acceptability, safety, tolerability, and efficacy were evaluated (this study was registered at ClinicalTrials.gov: NCT05029466). FINDINGS Participants were randomized to immediate treatment (n = 16) or delayed treatment (n = 14). 29/30 were retained to the week-2 primary endpoint. Adverse events were transient, with no serious adverse events. Greater reductions in depression severity as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) were observed in the immediate treatment arm compared to the waitlist period arm with a large hedge's g effect size of 1.07 (p < 0.01). Repeated doses were associated with further reductions in MADRS scores compared to baseline. CONCLUSIONS PAP was feasible in complex patients with preliminary antidepressant efficacy and adequate safety and tolerability. Repeated doses were associated with greater reductions in depression severity. FUNDING This work was funded by Brain and Cognition Discovery Foundation (BCDF), Usona, and Braxia Scientific.
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Affiliation(s)
- Joshua D Rosenblat
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada.
| | - Shakila Meshkat
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Zoe Doyle
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Erica Kaczmarek
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Ryan M Brudner
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Kevin Kratiuk
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | | | | | | | | | - Shaun Ali
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Jordan Bawks
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Marc G Blainey
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Elisa Brietzke
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; Queens University, Kingston, Ontario, Canada
| | - Victoria Cronin
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Jessica Danilewitz
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Shalini Dhawan
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Anthony Di Fonzo
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Melissa Di Fonzo
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Pawel Drzadzewski
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - William Dunlop
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Hajnalka Fiszter
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Fabiano A Gomes
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - Smrita Grewal
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Marisa Leon-Carlyle
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Marilyn McCallum
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Niki Mofidi
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Hilary Offman
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Jeremy Riva-Cambrin
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Joel Schmidt
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - Mark Smolkin
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Joan M Quinn
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Andrea Zumrova
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Michelle Marlborough
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Roger S McIntyre
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation (BCDF), Toronto, ON, Canada
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Viña SM. Diminished psychedelic returns on distress: Marital status and household size. PLoS One 2024; 19:e0293675. [PMID: 38451885 PMCID: PMC10919602 DOI: 10.1371/journal.pone.0293675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/18/2023] [Indexed: 03/09/2024] Open
Abstract
Although the use of psychedelics to impact health has seen growth, little research has tested the effects of culture conditions on the relationship. More specifically, how does marital status and family size affect the relationship between psychedelics and health? This study tests the relationship between Lifetime Classic Psychedelic Use (LCPU), marital status, and household size (number of people living in a household) on levels of psychological distress in the past 30 days. This project uses pooled data from the National Survey of Drug Use and Health (NSDUH) (2010 to 2018) (N = 674,521). The Final sample size is determined by the dependent variable, psychological distress in the past month (n = 158,633). The analysis includes a series of nested logistic regression models conducted in Stata 17. Results indicate that LCPU is independently associated with better health, but the association between LCPU and health varies across levels of household size. Larger households are associated with higher levels of distress, which are then exacerbated among psychedelics users. Furthermore, three-way interactions reveal that the negative association between household size and distress gets larger among psychedelic users who are married, divorced, and widowed. Overall, results suggest that household size negatively impacts the association between LCPU and health, with those who are married, divorced, and widowed experiencing the worst outcomes.
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Affiliation(s)
- Sean M. Viña
- Department of Sociology, The University of the Incarnate Word, San Antonio, Texas, United States of America
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41
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Capaldi JM, Shabanian J, Finster LB, Asher A, Wertheimer JC, Zebrack BJ, Shirazipour CH. Post-traumatic stress symptoms, post-traumatic stress disorder, and post-traumatic growth among cancer survivors: a systematic scoping review of interventions. Health Psychol Rev 2024; 18:41-74. [PMID: 36632776 DOI: 10.1080/17437199.2022.2162947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
The detrimental effects of Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) and the benefits of Post-Traumatic Growth (PTG) are well established for cancer survivors. Increased cancer survival rates necessitate an understanding of how these two paradoxical outcomes, PTSS/PTSD and PTG, are targeted through interventions. This systematic scoping review aims to (a) examine existing evidence on interventions targeting PTSS/PTSD and/or PTG among cancer survivors and (b) identify knowledge gaps to inform future research. Following the six steps of a scoping review, 76 articles met the inclusion criteria. Quantitative articles were examined using descriptive analysis. Frequency counts of the collated data were tabulated into summary tables. Qualitative articles were reviewed using meta-synthesis. Most articles were quantitative (n = 52) and targeted PTG (n = 68) through promising intervention approaches such as psychotherapy, mindfulness, physical activity, and psilocybin-assisted therapy. Three key implications for future research and practice were synthesized: (1) mechanistic considerations for intervention design that provide a roadmap for rigorous and theoretically-grounded research; (2) the need for improved representation of cancer survivors in trials; and (3) potential facilitators of intervention efficacy. Together, these findings can direct future research to optimize interventions to reduce PTSS/PTSD and promote PTG achievement among cancer survivors.
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Affiliation(s)
- Jessica M Capaldi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julia Shabanian
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Laurel B Finster
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arash Asher
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Celina H Shirazipour
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Kusudo K, Tani H, Yonezawa K, Nakajima S, Nour MM, Carhart‐Harris R, Uchida H. Development of the Japanese version of the Ego-Dissolution Inventory (EDI). Neuropsychopharmacol Rep 2024; 44:292-297. [PMID: 38318991 PMCID: PMC10932788 DOI: 10.1002/npr2.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/05/2024] [Accepted: 01/13/2024] [Indexed: 02/07/2024] Open
Abstract
AIM Psychedelics have recently gained attention as potential therapeutic agents for various psychiatric disorders. Previous research has highlighted that a diminished sense of self, commonly termed "ego-dissolution" is a pivotal feature of the psychedelic-induced state. While the Ego-Dissolution Inventory (EDI) is a widely acknowledged instrument for measuring this phenomenon, no Japanese version has been available. This study aimed to develop a Japanese version of the EDI. METHODS We adhered to the "Guidelines for Best Practices in the Translation and Cultural Modification Process for Patient-Reported Outcomes Instruments: Document from the ISPOR Committee on Translation and Cultural Modification" during our translation approach. Two Japanese psychiatrists independently conducted initial translations, and a consolidated version was achieved via mutual agreement. This version was then back-translated to English and assessed by the original authors for consistency. The repetitive modification process was conducted in continuous dialogues with the original authors until they accepted the concluding back-translated version. RESULTS The finalized, approved back-translated version of the EDI is presented in the accompanying figure. In addition, the authorized Japanese version of the EDI is included in the Appendix. CONCLUSIONS In this study, we successfully developed the Japanese version of the EDI. This instrument will assist in assessing ego-dissolution experiences associated with psychedelic-assisted therapy among Japanese speakers. Additional studies are necessary to evaluate the reliability and validity of this newly translated instrument.
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Affiliation(s)
- Keisuke Kusudo
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Hideaki Tani
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Kengo Yonezawa
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | | | - Matthew M. Nour
- Department of PsychiatryUniversity of OxfordOxfordUK
- University College London, Max Planck UCL Centre for Computational Psychiatry and Ageing ResearchLondonUK
| | - Robin Carhart‐Harris
- University of California San Francisco Sandler Neurosciences CenterSan FranciscoCaliforniaUSA
- Neurology, Psychiatry and Behavioral Sciences, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Hiroyuki Uchida
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
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Barksdale BR, Doss MK, Fonzo GA, Nemeroff CB. The mechanistic divide in psychedelic neuroscience: An unbridgeable gap? Neurotherapeutics 2024; 21:e00322. [PMID: 38278658 DOI: 10.1016/j.neurot.2024.e00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024] Open
Abstract
In recent years, psychedelics have generated considerable excitement and interest as potential novel therapeutics for an array of conditions, with the most advanced evidence base in the treatment of certain severe and/or treatment-resistant psychiatric disorders. An array of clinical and pre-clinical evidence has informed our current understanding of how psychedelics produce profound alterations in consciousness. Mechanisms of psychedelic action include receptor binding and downstream cellular and transcriptional pathways, with long-term impacts on brain structure and function-from the level of single neurons to large-scale circuits. In this perspective, we first briefly review and synthesize separate lines of research on potential mechanistic processes underlying the acute and long-term effects of psychedelic compounds, with a particular emphasis on highlighting current theoretical models of psychedelic drug action and their relationships to therapeutic benefits for psychiatric and brain-based disorders. We then highlight an existing area of ongoing controversy we argue is directly informed by theoretical models originating from disparate levels of inquiry, and we ultimately converge on the notion that bridging the current chasm in explanatory models of psychedelic drug action across levels of inquiry (molecular, cellular, circuit, and psychological/behavioral) through innovative methods and collaborative efforts will ultimately yield the comprehensive understanding needed to fully capitalize on the potential therapeutic properties of these compounds.
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Affiliation(s)
- Bryan R Barksdale
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Manoj K Doss
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Gregory A Fonzo
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Charles B Nemeroff
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
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Tabaac BJ, Shinozuka K, Arenas A, Beutler BD, Cherian K, Evans VD, Fasano C, Muir OS. Psychedelic Therapy: A Primer for Primary Care Clinicians-Psilocybin. Am J Ther 2024; 31:e121-e132. [PMID: 38518269 DOI: 10.1097/mjt.0000000000001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND The primary psychoactive drug in magic mushrooms, psilocybin, induces profound alterations in consciousness through the 5-HT2A receptor. This review consolidates current research findings to elucidate the pharmacology, safety profile, and clinical applications of psilocybin. AREAS OF UNCERTAINTY Despite initial concerns that psilocybin could cause psychosis, contemporary research has demonstrated that psilocybin is generally safe. The most common adverse effects are nausea and headache, yet both tend to be transient. Serious adverse events can generally be avoided in controlled settings such as clinical trials. However, in the largest clinical trial to date, there were a total of 7 reported cases of suicidal ideation, up to 12 weeks after receiving a single 25 mg dose of psilocybin. That being said, all 7 cases did not respond to the treatment. Although selective serotonin reuptake inhibitors may blunt the hallucinogenic qualities of psilocybin, preliminary research suggests that they may enhance its antidepressant effects. THERAPEUTIC ADVANCES In clinical trials, psilocybin has shown promise for treating major depressive disorder and treatment-resistant depression. Initial studies indicated that 42%-57% of patients underwent remission after psilocybin-assisted therapy, which suggests that psilocybin is more effective than existing antidepressant medications. Clinical data have also demonstrated that psilocybin can manage substance use disorders and end-of-life anxiety with clinical outcomes that are sustained for months and sometimes years after 1 or 2 doses. LIMITATIONS However, larger Phase II trials with more than 100 depressed participants have shown a much smaller remission rate of 25%-29%, though these studies still observed that psilocybin causes a significant reduction in depressive symptoms. CONCLUSIONS Aside from ketamine, psilocybin is the most clinically well-researched psychedelic drug, with trials that have enrolled hundreds of participants and multiple therapeutic applications. Phase III trials will determine whether psilocybin lives up to the promise that it showed in previous clinical trials.
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Affiliation(s)
- Burton J Tabaac
- Reno School of Medicine, University of Nevada, Reno, NV
- Department of Neurology, Carson Tahoe Health, Carson City, NV
| | - Kenneth Shinozuka
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Alejandro Arenas
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA
| | - Bryce D Beutler
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kirsten Cherian
- Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Viviana D Evans
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Owen S Muir
- Fermata Health, Brooklyn, NY; and
- Acacia Clinics, Sunnyvale, CA
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Gomonit MM, Skillman B, Swortwood MJ. Quantification of psilocin in human whole blood using liquid chromatography-tandem mass spectrometry (LC-MS/MS). J Forensic Sci 2024; 69:678-687. [PMID: 38140718 DOI: 10.1111/1556-4029.15454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
There has been burgeoning interest in psilocybin-use for the treatment of various neurological and neurodegenerative diseases. Psilocybin is mistakenly perceived as the principal pharmacologically active compound due to its high concentrations found in magic mushrooms; however, it is the prodrug of psilocin. Despite the expanding body of clinical research seeking to understand the pharmacodynamic/pharmacokinetic properties of psilocin, and its role in inducing dramatic changes to cognitive function, there has not been a corresponding increase in the development of sensitive analytical methods that can quantify psilocin in different biological fluids. Existing analytical methods have been developed using plasma, serum, and urine as the matrix of choice, but with the unknown blood-to-plasma ratio of psilocin, any pharmacokinetic conclusions drawn solely on plasma data may be misleading. Thus, the main objective of this study is to develop the first analytical method that utilizes SPE and LC-MS/MS to quantify psilocin in human whole blood. The SPE procedure yielded a high recovery efficiency (≥89%) with minimal matrix effects. The method was validated according to ANSI/ASB 036 guidelines. Linearity was between 0.7-200 ng/mL and encompassed previously reported ranges found in plasma/serum. Bias, within- and between-run precision for all quality controls met ANSI/ASB 036 acceptability criteria. Endogenous/exogenous interferences and carryover were negligible. Psilocin stability was assessed at 4°C over 48 h and was considered stable. Although a proof-of-concept study will need to be performed to characterize the method, this analytical workflow was able to detect and quantify psilocin in human whole blood at low limits of quantification.
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Affiliation(s)
- Munchelou M Gomonit
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, Texas, USA
| | - Britni Skillman
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, Texas, USA
| | - Madeleine J Swortwood
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, Texas, USA
- Robson Forensic, Denver, Colorado, USA
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Yonezawa K, Tani H, Nakajima S, Uchida H. Development of the Japanese version of the 30-item Mystical Experience Questionnaire. Neuropsychopharmacol Rep 2024; 44:280-284. [PMID: 37704433 PMCID: PMC10932800 DOI: 10.1002/npr2.12377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Psychedelics have garnered increased attention as potential therapeutic options for various mental illnesses. Previous studies reported that psychedelics cause psychoactive effects through mystical experiences induced by these substances, including an altered state of consciousness. While this phenomenon is commonly assessed by the Mystical Experiences Questionnaire (MEQ30), a Japanese version of the MEQ30 has not been available. The aim of this study was to develop the Japanese version of the MEQ30. METHODS We adhered to the "Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation" in our translation process. Two Japanese psychiatrists independently performed forward translations, from which a unified version was derived through reconciliation. This version was subsequently back-translated into English and reviewed by the original authors for equivalency. The iterative revision process was carried out through ongoing discussions with the original authors until they approved the final back-translated version. RESULTS The final, approved back-translated version of the MEQ30 is presented in the accompanying figure. Additionally, the authorized Japanese version of the MEQ30 is included in the Appendix A. CONCLUSIONS In this study, we successfully developed a Japanese version of the MEQ30. This scale will facilitate the assessment of mystical experiences associated with psychedelic-assisted therapy among Japanese speakers. Further research is warranted to evaluate the reliability and validity of this newly translated scale.
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Affiliation(s)
- Kengo Yonezawa
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Hideaki Tani
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | | | - Hiroyuki Uchida
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
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Marrocu A, Kettner H, Weiss B, Zeifman RJ, Erritzoe D, Carhart-Harris RL. Psychiatric risks for worsened mental health after psychedelic use. J Psychopharmacol 2024; 38:225-235. [PMID: 38491857 PMCID: PMC10944581 DOI: 10.1177/02698811241232548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Resurgent psychedelic research has largely supported the safety and efficacy of psychedelic therapy for the treatment of various psychiatric disorders. As psychedelic use and therapy increase in prevalence, so does the importance of understanding associated risks. Cases of prolonged negative psychological responses to psychedelic therapy seem to be rare; however, studies are limited by biases and small sample sizes. The current analytical approach was motivated by the question of whether rare but significant adverse effects have been under-sampled in psychedelic research studies. METHODS A "bottom margin analysis" approach was taken to focus on negative responders to psychedelic use in a pool of naturalistic, observational prospective studies (N = 807). We define "negative response" by a clinically meaningful decline in a generic index of mental health, that is, one standard error from the mean decrease in psychological well-being 4 weeks post-psychedelic use (vs pre-use baseline). We then assessed whether a history of diagnosed mental illness can predict negative responses. RESULTS We find that 16% of the cohort falls into the "negative responder" subset. Parsing the sample by self-reported history of psychiatric diagnoses, results revealed a disproportionate prevalence of negative responses among those reporting a prior personality disorder diagnosis (31%). One multivariate regression model indicated a greater than four-fold elevated risk of adverse psychological responses to psychedelics in the personality disorder subsample (b = 1.425, p < 0.05). CONCLUSION We infer that the presence of a personality disorder may represent an elevated risk for psychedelic use and hypothesize that the importance of psychological support and good therapeutic alliance may be increased in this population.
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Affiliation(s)
- Alessia Marrocu
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Hannes Kettner
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Brandon Weiss
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Richard J Zeifman
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Carhart-Harris Lab, Departments of Neurology and Psychiatry, University of California San Francisco, San Francisco, CA, USA
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Tabaac BJ, Shinozuka K, Arenas A, Beutler BD, Cherian K, Evans VD, Fasano C, Muir OS. Psychedelic Therapy: A Primer for Primary Care Clinicians-Historical Perspective and Overview. Am J Ther 2024; 31:e97-e103. [PMID: 38518266 DOI: 10.1097/mjt.0000000000001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Psychedelic drugs have recently emerged as plausibly effective pharmacological agents for the management of depression, anxiety, and other neuropsychiatric conditions, including those that are treatment-resistent. The latter half of the 20th century marked a revolution in the treatment of mental illnesses, exemplified by the introduction of selective serotonin reuptake inhibitors and other pharmacological agents. Nevertheless, mental illness remains a major public health crisis, affecting nearly one billion individuals worldwide. AREAS OF UNCERTAINTY Because of the decades-long status of several psychedelics as Schedule I drugs, there have not been very many large, double-blind, randomized controlled trials of psychedelics. Owing to small sample sizes, there may be rare yet serious adverse events that have not been reported in the clinical trials thus far. THERAPEUTIC ADVANCES Esketamine, a dissociative hallucinogen drug, was approved for the management of major depressive disorder by the Food and Drug Administration in 2019. As of January 2024, two Phase III trials of 3,4-methylenedioxymethamphetamine (MDMA), a synthetic drug that inhibits the serotonin transporter, have been completed; the results indicate that MDMA is superior to existing pharmacological treatments for post-traumatic stress disorder. A phase III trial of psilocybin, a naturally occurring serotonin receptor partial agonist, is currently underway. The following series details the current state of research in psychedelic therapeutics, including lysergic acid diethylamide (LSD), N-N-dimethyltryptamine (DMT) and ayahuasca, psilocybin, ibogaine, MDMA, and ketamine. LIMITATIONS While initial clinical trials of psychedelics for depression were very promising, trials of psilocybin with larger sample sizes (100+ participants) suggest that its remission rate is 25%-29%. This is about the same as the remission rate of antidepressants, which is roughly 30% according to the landmark STAR*D trial. CONCLUSIONS Psychedelic drugs and structural derivatives offer a great deal of promise for the management of a wide range of psychiatric morbidities. It is imperative that clinicians become familiar with these novel agents and learn how to integrate psychedelic therapy with the rest of their care through open communication and referral.
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Affiliation(s)
- Burton J Tabaac
- University of Nevada, Reno School of Medicine, Reno, NV
- Department of Neurology, Carson Tahoe Health, Carson City, NV
| | - Kenneth Shinozuka
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Alejandro Arenas
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Viviana D Evans
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Owen S Muir
- Fermata Health, Brooklyn, NY; and
- Acacia Clinics, Sunnyvale, CA
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Solaja I, Haldane K, Mason N, Weiss B, Xu X, Xu M, Nikolin S, Jayasena T, Millard M, Brett J, Bayes A, Loo CK, Martin DM. Who are you after psychedelics? A systematic review and a meta-analysis of the magnitude of long-term effects of serotonergic psychedelics on cognition/creativity, emotional processing and personality. Neurosci Biobehav Rev 2024; 158:105570. [PMID: 38311046 DOI: 10.1016/j.neubiorev.2024.105570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/06/2024]
Abstract
This systematic review and a meta-analysis synthesised the results from contemporary, randomized and non-randomized controlled studies to assess lasting (one week minimum) changes on cognition/creativity, emotional processing and personality from serotonergic psychedelics. PubMed, Embase and PsycInfo were searched in July 2022. Risk of bias was assessed using Rob 2.0 and ROBINS-I. Ten studies met the eligibility criteria which involved 304 participants. No statistically significant effects were found for the majority outcome measures across the three constructs. A meta-analysis of emotional recognition outcomes found an overall significant effect for faster reaction times in the active treatment groups for disgust (SMD=-0.63, 95% CI=[-1.01 to -0.25], I2 = 65%) and sadness (SMD=-0.45, 95% CI=[-0.85 to -0.06], I2 = 60%). Future research should include larger samples, better control conditions, standardized doses and longer follow-up periods to confirm these preliminary findings.
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Affiliation(s)
- Ivana Solaja
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | | | - Natasha Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Brandon Weiss
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - Xiaomin Xu
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mei Xu
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Stevan Nikolin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Tharusha Jayasena
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | | | - Adam Bayes
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Colleen K Loo
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Donel M Martin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
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50
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Funk D, Araujo J, Slassi M, Lanthier J, Atkinson J, Feng D, Lau W, Lê A, Higgins GA. Effect of a single psilocybin treatment on Fos protein expression in male rat brain. Neuroscience 2024; 539:1-11. [PMID: 38184069 DOI: 10.1016/j.neuroscience.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Psilocybin has received attention as a treatment for depression, stress disorders and drug and alcohol addiction. To help determine the mechanisms underlying its therapeutic effects, here we examined acute effects of a range of behaviourally relevant psilocybin doses (0.1-3 mg/kg SC) on regional expression of Fos, the protein product of the immediate early gene, c-fos in brain areas involved in stress, reward and motivation in male rats. We also determined the cellular phenotypes activated by psilocybin, in a co-labeling analysis with NeuN, a marker of mature neurons, or Olig1, a marker of oligodendrocytes. In adult male Sprague-Dawley rats, psilocybin increased Fos expression dose dependently in several brain regions, including the frontal cortex, nucleus accumbens, central and basolateral amygdala and locus coeruleus. These effects were most marked in the central amygdala. Double labeling experiments showed that Fos was expressed in both neurons and oligodendrocytes. These results extend previous research by determining Fos expression in multiple brain areas at a wider psilocybin dose range, and the cellular phenotypes expressing Fos. The data also highlight the amygdala, especially the central nucleus, a key brain region involved in emotional processing and learning and interconnected with other brain areas involved in stress, reward and addiction, as a potentially important locus for the therapeutic effects of psilocybin. Overall, the present findings suggest that the central amygdala may be an important site through which the initial brain activation induced by psilocybin is translated into neuroplastic changes, locally and in other regions that underlie its extended therapeutic effects.
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Affiliation(s)
- Douglas Funk
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto M5S 2S1, Canada.
| | - Joseph Araujo
- Transpharmation Ltd., Fergus N1M 2W8, Canada; Mindset Pharma, Toronto M5V 0R2, Canada
| | | | | | | | - Daniel Feng
- Transpharmation Ltd., Fergus N1M 2W8, Canada
| | - Winnie Lau
- Transpharmation Ltd., Fergus N1M 2W8, Canada
| | - Anh Lê
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto M5S 2S1, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto M5S 1A8, Canada
| | - Guy A Higgins
- Transpharmation Ltd., Fergus N1M 2W8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto M5S 1A8, Canada
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