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Yao Y, Guo D, Lu TS, Liu FL, Huang SH, Diao MQ, Li SX, Zhang XJ, Kosten TR, Shi J, Bao YP, Lu L, Han Y. Efficacy and safety of psychedelics for the treatment of mental disorders: A systematic review and meta-analysis. Psychiatry Res 2024; 335:115886. [PMID: 38574699 DOI: 10.1016/j.psychres.2024.115886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
We aim to systematically review and meta-analyze the effectiveness and safety of psychedelics [psilocybin, ayahuasca (active component DMT), LSD and MDMA] in treating symptoms of various mental disorders. Web of Science, Embase, EBSCO, and PubMed were searched up to February 2024 and 126 articles were finally included. Results showed that psilocybin has the largest number of articles on treating mood disorders (N = 28), followed by ayahuasca (N = 7) and LSD (N = 6). Overall, psychedelics have therapeutic effects on mental disorders such as depression and anxiety. Specifically, psilocybin (Hedges' g = -1.49, 95% CI [-1.67, -1.30]) showed the strongest therapeutic effect among four psychedelics, followed by ayahuasca (Hedges' g = -1.34, 95% CI [-1.86, -0.82]), MDMA (Hedges' g = -0.83, 95% CI [-1.33, -0.32]), and LSD (Hedges' g = -0.65, 95% CI [-1.03, -0.27]). A small amount of evidence also supports psychedelics improving tobacco addiction, eating disorders, sleep disorders, borderline personality disorder, obsessive-compulsive disorder, and body dysmorphic disorder. The most common adverse event with psychedelics was headache. Nearly a third of the articles reported that no participants reported lasting adverse effects. Our analyses suggest that psychedelics reduce negative mood, and have potential efficacy in other mental disorders, such as substance-use disorders and PTSD.
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Affiliation(s)
- Yuan Yao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Dan Guo
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Tang-Sheng Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Fang-Lin Liu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Shi-Hao Huang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Meng-Qi Diao
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Su-Xia Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China
| | - Xiu-Jun Zhang
- School of Psychology, College of Public Health, North China University of Science and Technology, Tangshan 063210, Hebei Province, China
| | - Thomas R Kosten
- Department of Psychiatry, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China.
| | - Lin Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China; Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China; Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China; Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences (No.2018RU006).
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing 100191, China.
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Sarmanlu M, Kuypers KPC, Vizeli P, Kvamme TL. MDMA-assisted psychotherapy for PTSD: Growing evidence for memory effects mediating treatment efficacy. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110843. [PMID: 37611653 DOI: 10.1016/j.pnpbp.2023.110843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 08/25/2023]
Abstract
The application of MDMA in conjunction with psychotherapy has in recent years seen a resurgence of clinical, scientific, and public interest in the treatment of posttraumatic stress disorder (PTSD). Clinical trials have shown promising safety and efficacy, but the mechanisms underlying this treatment form remain largely unestablished. This article explores recent preclinical and clinical evidence suggesting that the treatment's efficacy may be influenced by the mnemonic effects of MDMA. We review data on the effects of MDMA on fear extinction and fear reconsolidation and the utility of these processes for PTSD treatment. We corroborate our findings by incorporating research from cognitive psychology and psychopharmacology and offer recommendations for future research.
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Affiliation(s)
- Mesud Sarmanlu
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Patrick Vizeli
- Department of Psychiatry, University of California San Diego, San Diego, United States
| | - Timo L Kvamme
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark.
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3
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Burback L, Brémault-Phillips S, Nijdam MJ, McFarlane A, Vermetten E. Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Curr Neuropharmacol 2024; 22:557-635. [PMID: 37132142 PMCID: PMC10845104 DOI: 10.2174/1570159x21666230428091433] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | - Mirjam J. Nijdam
- ARQ National Psychotrauma Center, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, New York University Grossman School of Medicine, New York, USA
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4
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Zaretsky TG, Jagodnik KM, Barsic R, Antonio JH, Bonanno PA, MacLeod C, Pierce C, Carney H, Morrison MT, Saylor C, Danias G, Lepow L, Yehuda R. The Psychedelic Future of Post-Traumatic Stress Disorder Treatment. Curr Neuropharmacol 2024; 22:636-735. [PMID: 38284341 PMCID: PMC10845102 DOI: 10.2174/1570159x22666231027111147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 01/30/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is a mental health condition that can occur following exposure to a traumatic experience. An estimated 12 million U.S. adults are presently affected by this disorder. Current treatments include psychological therapies (e.g., exposure-based interventions) and pharmacological treatments (e.g., selective serotonin reuptake inhibitors (SSRIs)). However, a significant proportion of patients receiving standard-of-care therapies for PTSD remain symptomatic, and new approaches for this and other trauma-related mental health conditions are greatly needed. Psychedelic compounds that alter cognition, perception, and mood are currently being examined for their efficacy in treating PTSD despite their current status as Drug Enforcement Administration (DEA)- scheduled substances. Initial clinical trials have demonstrated the potential value of psychedelicassisted therapy to treat PTSD and other psychiatric disorders. In this comprehensive review, we summarize the state of the science of PTSD clinical care, including current treatments and their shortcomings. We review clinical studies of psychedelic interventions to treat PTSD, trauma-related disorders, and common comorbidities. The classic psychedelics psilocybin, lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT) and DMT-containing ayahuasca, as well as the entactogen 3,4-methylenedioxymethamphetamine (MDMA) and the dissociative anesthetic ketamine, are reviewed. For each drug, we present the history of use, psychological and somatic effects, pharmacology, and safety profile. The rationale and proposed mechanisms for use in treating PTSD and traumarelated disorders are discussed. This review concludes with an in-depth consideration of future directions for the psychiatric applications of psychedelics to maximize therapeutic benefit and minimize risk in individuals and communities impacted by trauma-related conditions.
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Affiliation(s)
- Tamar Glatman Zaretsky
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathleen M. Jagodnik
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Barsic
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josimar Hernandez Antonio
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip A. Bonanno
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carolyn MacLeod
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charlotte Pierce
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hunter Carney
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Morgan T. Morrison
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles Saylor
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Danias
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Lepow
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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5
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Milshteyn Y, Bensimon M. Exploring the subjective experience of rave party participants in Israel who consume psychedelic drugs: a qualitative inquiry. Harm Reduct J 2023; 20:176. [PMID: 38057811 DOI: 10.1186/s12954-023-00908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Rave music parties (RMP) are a world-wide socio-cultural phenomenon, where people listen to rave music while frequently consuming psychedelic drugs. Epidemiological studies have emphasized the hazardous consequences following the consumption of psychedelic drugs at RMP, and qualitative studies have shown social and psycho-spiritual experiences. Yet, phenomenological inquiry into subjective experiences of attendees is scant. This study aimed to examine physical, emotional, perceptual and social experiences of RMP participants in Israel, and their view on Israel's policy toward rave events. In addition, the study aimed to contribute useful information for policymakers and society on rave music and psychedelic drugs experiences at RMP. METHOD Interpretative phenomenological analysis was used to analyze transcriptions of semi-structured interviews with 27 individuals attending RMP regularly and consume psychedelic drugs. RESULTS Analysis revealed four significant themes: the first theme, the impact of Israel's drug policy on participants' sense of safety, relates to participants' sense of insecurity and anxiety at Israeli RMP due to government drug ban policy. The second theme, the stigma on rave culture, relates to participants' perception regarding the stigma on rave culture in law enforcement agencies and in society in general. The third theme, negative experiences, describes short-term experiences after consuming psychedelics at RMP, including hallucinations and disorientation. The fourth theme, positive experiences, describes positive sensory, emotional and self/world attitudinal aspects after consuming psychedelics at RMP. Sensory experiences included intensified auditory, visual and tactile experiences; emotional experiences included positive feelings toward others, reduced stress and ability to vent difficult emotions; self/world attitudinal aspects included self-acceptance, higher appreciation of life and connectedness to nature. CONCLUSIONS The study highlights RMP participants' sense of insecurity due to Israel's strict drug policy and absence of harm reduction strategies at rave scenes. The study also notes participants' experience of stigmatization as drug addicts by society and law enforcement agencies. Reducing police presence and adopting harm reduction policies at rave scenes in Israel may increase participants' sense of security, reduce stigmatization and decrease overdose risk. Hence, the findings may contribute to new knowledge useful for policymakers and society concerning RMP and the use of psychedelics.
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Affiliation(s)
- Yula Milshteyn
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Moshe Bensimon
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel.
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6
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Pires B, Rosendo LM, Brinca AT, Simão AY, Barroso M, Rosado T, Gallardo E. The Therapeutic Potential of Amphetamine-like Psychostimulants. Life (Basel) 2023; 13:2180. [PMID: 38004320 PMCID: PMC10671856 DOI: 10.3390/life13112180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
This review delves into the therapeutic applications of amphetamine-type stimulants such as lisdexamphetamine dimesylate, mixed amphetamine salts, 3,4-methylenedioxymethamphetamine (MDMA), dextroamphetamine, and phentermine. These compounds have been investigated for their potential in treating a range of psychiatric disorders, including attention deficit hyperactivity disorder (ADHD), drug dependence, post-traumatic stress disorder (PTSD), and obesity. Lisdexamphetamine dimesylate has shown promise in effectively treating ADHD symptoms in both children and adults. Additionally, it has been explored as a potential treatment for drug dependency and withdrawal, demonstrating encouraging results. Mixed amphetamine salts have also exhibited efficacy in reducing ADHD symptoms in adults. Future research should explore their potential use in treating bipolar disorder and cocaine dependence, considering the associated risks and benefits. MDMA-assisted psychotherapy has emerged as an innovative approach to treating PTSD, leading to sustained reductions in symptoms and even promoting post-traumatic growth. Furthermore, it has shown promise in managing anxiety related to life-threatening illnesses. Dextroamphetamine and phentermine have demonstrated efficacy in treating cocaine and opioid dependence, ADHD, and obesity. However, careful consideration and monitoring by medical professionals are essential due to the potential risks and benefits associated with them. In conclusion, amphetamine-type stimulants present a promising avenue for therapeutic interventions in various psychiatric conditions. Nevertheless, further research is necessary to comprehensively understand their mechanisms of action, dosage requirements, and long-term effects in different patient populations.
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Affiliation(s)
- Bruno Pires
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), 6201-506 Covilhã, Portugal; (B.P.); (L.M.R.); (A.T.B.); (A.Y.S.)
| | - Luana M. Rosendo
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), 6201-506 Covilhã, Portugal; (B.P.); (L.M.R.); (A.T.B.); (A.Y.S.)
| | - Ana Teresa Brinca
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), 6201-506 Covilhã, Portugal; (B.P.); (L.M.R.); (A.T.B.); (A.Y.S.)
| | - Ana Y. Simão
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), 6201-506 Covilhã, Portugal; (B.P.); (L.M.R.); (A.T.B.); (A.Y.S.)
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, 6200-000 Covilhã, Portugal
| | - Mário Barroso
- Serviço de Química e Toxicologia Forenses, Instituto Nacional de Medicina Legal e Ciências Forenses, Delegação do Sul, 1150-219 Lisboa, Portugal;
| | - Tiago Rosado
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), 6201-506 Covilhã, Portugal; (B.P.); (L.M.R.); (A.T.B.); (A.Y.S.)
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, 6200-000 Covilhã, Portugal
- Centro Académico Clínico das Beiras (CACB)—Missão de Problemas Relacionados com Toxicofilias, 6200-000 Covilhã, Portugal
| | - Eugenia Gallardo
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), 6201-506 Covilhã, Portugal; (B.P.); (L.M.R.); (A.T.B.); (A.Y.S.)
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, 6200-000 Covilhã, Portugal
- Centro Académico Clínico das Beiras (CACB)—Missão de Problemas Relacionados com Toxicofilias, 6200-000 Covilhã, Portugal
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7
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Bouso JC, Révész D, Ona G, Rossi GN, Rocha JM, Dos Santos RG, Hallak JEC, Alcázar-Corcoles MÁ. Longitudinal and transcultural assessment of the relationship between hallucinogens, well-being, and post-traumatic growth during the COVID-19 pandemic. Sci Rep 2023; 13:14052. [PMID: 37696900 PMCID: PMC10495368 DOI: 10.1038/s41598-023-41199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
The COVID-19 pandemic has had a devastating impact on the health and wellbeing of the global population. This paper presents the results of a longitudinal transcultural study that was begun at the peak of the pandemic (in April, 2020). An online survey was used to collect data from English-, Spanish-, and Portuguese-speaking participants. The survey collected information about sociodemographics, lifestyle activities, COVID-19-related circumstances, and drug use (with an emphasis on hallucinogenic drugs), as well as involving psychometric questionnaires. Users of hallucinogenic drugs had higher psychological well-being and lower scores on psychopathology scales, both at baseline and during follow-ups. This difference was larger when users were distinguished by frequency of use, as regular users scored higher on psychological well-being and lower on psychopathology scales. Subjects with more psychological distress had lower scores for all scales of post-traumatic growth, but if they were regular hallucinogens users, they had higher scores for post-traumatic growth. When comparing the results between cultural contexts, heterogeneous results were obtained. There were more English-speaking regular users of hallucinogenic drugs. Further research should analyse the potential role of hallucinogens in large-scale catastrophes, with a special focus on post-traumatic growth.
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Affiliation(s)
- José Carlos Bouso
- ICEERS-International Center for Ethnobotanical Education, Research, and Service, C/ Sepúlveda, 65 Bajos 2, 08015, Barcelona, Catalunya, Spain.
- Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Catalunya, Spain.
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
| | - Dóra Révész
- ICEERS-International Center for Ethnobotanical Education, Research, and Service, C/ Sepúlveda, 65 Bajos 2, 08015, Barcelona, Catalunya, Spain
| | - Genís Ona
- ICEERS-International Center for Ethnobotanical Education, Research, and Service, C/ Sepúlveda, 65 Bajos 2, 08015, Barcelona, Catalunya, Spain
- Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Giordano N Rossi
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana M Rocha
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rafael G Dos Santos
- ICEERS-International Center for Ethnobotanical Education, Research, and Service, C/ Sepúlveda, 65 Bajos 2, 08015, Barcelona, Catalunya, Spain
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute of Science and Technology-Translational Medicine, São Paulo, Brazil
| | - Jaime E C Hallak
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute of Science and Technology-Translational Medicine, São Paulo, Brazil
| | - Miguel Ángel Alcázar-Corcoles
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid (UAM), Madrid, Spain
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8
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Fonseka LN, Woo BKP. Therapeutic role of psilocybin and 3,4-methylenedioxymethamphetamine in trauma: A literature review. World J Psychiatry 2023; 13:182-190. [PMID: 37303932 PMCID: PMC10251361 DOI: 10.5498/wjp.v13.i5.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/28/2023] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
With the Food and Drug Administration designation in 2017 of 3,4-methylenedioxymethamphetamine (MDMA) as a breakthrough therapy in post-traumatic stress disorder and psilocybin in treatment-resistant depression, psychedelic drugs have continued to garner the attention of researchers and clinicians for their promise of unmatched, rapid improvement in a multitude of psychiatric conditions. Classic psychedelic drugs including psilocybin, lysergic acid diethylamide, and ayahuasca, as well as non-classic drugs such as MDMA and ketamine, are currently being investigated for a potential therapeutic role in trauma, depressive disorders, and other psychopathologies. However, psilocybin and MDMA each have a functional profile well-suited for integration with psychotherapy. The present review focuses on psilocybin and MDMA in psychedelic-assisted therapy (PAT), as these studies compose most of the literature pool. In this review, we discuss the current and future uses of psychedelic drugs, with an emphasis on the role of MDMA and psilocybin in PAT in the setting of trauma and related comorbidities on the efficacy of psychedelic drugs across multiple psychiatric disorders. The article concludes with thoughts for future research, such as incorporating wearables and standardization of symptom scales, therapy styles, and assessment of adverse drug reactions.
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Affiliation(s)
- Lakshan N Fonseka
- Harvard South Shore-Psychiatry Residency Program, Veteran Affairs Boston Healthcare System, Brockton, MA 02301, United States
| | - Benjamin KP Woo
- Chinese American Health Promotion Laboratory, University of California, Los Angeles, Los Angeles, CA 90095, United States
- Department of Psychiatry and Biobehavioral Sciences, Olive View - University of California, Los Angeles Medical Center, Sylmar, CA 91342, United States
- Asian American Studies Center, University of California, Los Angeles, Los Angeles, CA 90095, United States
- Podiatric Medicine and Surgery, Western University of Health Sciences, Pomona, CA 91766, United States
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9
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Bedi G, Cotton SM, Guerin AA, Jackson HJ. MDMA-assisted psychotherapy for post-traumatic stress disorder: The devil is in the detail. Aust N Z J Psychiatry 2023; 57:476-481. [PMID: 36165006 DOI: 10.1177/00048674221127186] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent years have seen escalating media, public and scientific interest in psychedelic medicine. Australia and New Zealand have been late to this research; however, in the past 2 years, rapid developments suggest that this is changing. Here, we argue for the need to critically review existing evidence in this field to guide future directions. We focus on (±)3,4-methylenedioxymethamphetamine-assisted psychotherapy for post-traumatic stress disorder, currently the most advanced area of clinical psychedelic research. Food and Drug Administration approval of this approach is likely in 2023, based on a series of promising findings. We provide a detailed overview of Phase 2 and 3 studies published to date. We identify several concerns related to this body of evidence, including methodological/design limitations and broader factors - such as robust involvement of advocacy groups in research and reliance on non-government financing leading to simplistic public messaging - that compound the methodological issues identified. We propose steps for future improvement, including the need for large, high-quality, independent efficacy trials with design enhancements, effectiveness trials and for researchers to consider their own engagement with media and public messaging around these modalities. We argue that, notwithstanding promising findings to date, rigorous and dispassionate science is needed to move the field forward and safeguard the welfare of participants.
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Affiliation(s)
- Gillinder Bedi
- Centre for Youth Mental Health, Research and Translation, The University of Melbourne, Parkvillle, VIC, Australia
- Orygen, Research and Translation, Parkville, VIC, Australia
| | - Susan M Cotton
- Centre for Youth Mental Health, Research and Translation, The University of Melbourne, Parkvillle, VIC, Australia
- Orygen, Research and Translation, Parkville, VIC, Australia
| | - Alexandre A Guerin
- Centre for Youth Mental Health, Research and Translation, The University of Melbourne, Parkvillle, VIC, Australia
- Orygen, Research and Translation, Parkville, VIC, Australia
| | - Henry J Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
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10
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Ching THW, Davis AK, Xin Y, Williams MT. Effects of Psychedelic Use on Racial Trauma Symptoms and Ethnic Identity among Asians in North America. J Psychoactive Drugs 2023; 55:19-29. [PMID: 35012425 DOI: 10.1080/02791072.2022.2025960] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a need to understand ways in which Asians in North America attempt to heal from racial trauma, given their well-documented high risk of exposure and associated adverse mental health outcomes. We conducted a secondary analysis of Asians from a survey of people of color in North America who have consumed psychedelics in response to racial discrimination. Ninety-two Asian participants (Mage = 30.25, SD = 6.83) completed online questions assessing demographics, racial discrimination frequency, characteristics and acute effects of their most meaningful psychedelic experience, change in racial trauma symptoms 30 days before and after their psychedelic experience, and current ethnic identity. Participants reported improvements in racial trauma symptoms (d = 0.52). Bootstrapped mediation analyses controlling for racial discrimination frequency and psychedelic dose and duration indicated complete mediation of the link between higher intensity of insightful experiences and stronger ethnic identity, via improvements in racial trauma symptoms (indirect effect = .08, 95% CI = [.004, .19]). There was partial mediation for the independent variable of lower intensity of challenging experiences (indirect effect = -.08, 95% CI = [-.18, -.005]). This study highlights the central role of higher-intensity insightful experiences and both higher- and lower-intensity challenging experiences in alleviating racial trauma symptoms and promoting ethnic identity among Asians in North America who have experienced racial discrimination. Future research should attune to culturally relevant outcomes of psychedelic use in response to racial discrimination among Asians.
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Affiliation(s)
- Terence H W Ching
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Alan K Davis
- College of Social Work, the Ohio State University, Columbus, OH, USA.,Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yitong Xin
- College of Social Work, the Ohio State University, Columbus, OH, USA
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11
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Zhu P, Wu Q, Liu X, Chen C, Ji Q, Shang X. Effects of Mindfulness-Based Stress Reduction Therapy on Posttraumatic Growth and Quality of Life in Patients With Breast Cancer Under Early Chemotherapy: A Randomized Controlled Trial. Holist Nurs Pract 2022; Publish Ahead of Print:00004650-990000000-00012. [PMID: 36001131 DOI: 10.1097/hnp.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Posttraumatic growth (PTG) in patients with breast cancer has been reported. Mindfulness-based stress reduction (MBSR) has been found to be effective in improving the psychological well-being during cancer care. This study aimed to evaluate the impact of MBSR on the levels of PTG, perceived social support, and quality of life. A sample of 101 participants who experienced early chemotherapy enrolled in an MBSR group (n = 50) and a routine care group (n = 51) for 8 weeks. Their postintervention data were combined with preintervention data through a bundle of questionnaires reporting levels of PTG, perceived social support, and quality of life. MBSR showed the prominent validity in raising the levels of PTG and increasing in perceived social support and quality of life from pre- to posttreatment. MBSR improved the levels of PTG, perceived social support, and quality of life in patients with breast cancer in early chemotherapy. In conclusion, MBSR may help to optimize the positive psychological processes that will be targeted to maximize the efficacy of treatment for future cancer survivors.
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Affiliation(s)
- Pingting Zhu
- School of Nursing, Yangzhou University, Yangzhou, China
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12
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Sarparast A, Thomas K, Malcolm B, Stauffer CS. Drug-drug interactions between psychiatric medications and MDMA or psilocybin: a systematic review. Psychopharmacology (Berl) 2022; 239:1945-1976. [PMID: 35253070 PMCID: PMC9177763 DOI: 10.1007/s00213-022-06083-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/03/2022] [Indexed: 12/13/2022]
Abstract
RATIONALE & OBJECTIVES ± 3,4-Methylenedioxymethamphetamine (MDMA) and psilocybin are currently moving through the US Food and Drug Administration's phased drug development process for psychiatric treatment indications: posttraumatic stress disorder and depression, respectively. The current standard of care for these disorders involves treatment with psychiatric medications (e.g., selective serotonin reuptake inhibitors), so it will be important to understand drug-drug interactions between MDMA or psilocybin and psychiatric medications. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we queried the MEDLINE database via PubMed for publications of human studies in English spanning between the first synthesis of psilocybin (1958) and December 2020. We used 163 search terms containing 22 psychiatric medication classes, 135 specific psychiatric medications, and 6 terms describing MDMA or psilocybin. RESULTS Forty publications were included in our systematic review: 26 reporting outcomes from randomized controlled studies with healthy adults, 3 epidemiologic studies, and 11 case reports. Publications of studies describe interactions between MDMA (N = 24) or psilocybin (N = 5) and medications from several psychiatric drug classes: adrenergic agents, antipsychotics, anxiolytics, mood stabilizers, NMDA antagonists, psychostimulants, and several classes of antidepressants. We focus our results on pharmacodynamic, physiological, and subjective outcomes of drug-drug interactions. CONCLUSIONS As MDMA and psilocybin continue to move through the FDA drug development process, this systematic review offers a compilation of existing research on psychiatric drug-drug interactions with MDMA or psilocybin.
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Affiliation(s)
- Aryan Sarparast
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Kelan Thomas
- College of Pharmacy, Touro University California, Vallejo, CA, 94592, USA
| | | | - Christopher S Stauffer
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, 97239, USA.
- Department of Mental Health, VA Portland Health Care System, Portland, OR, 97239, USA.
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13
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Elsouri KN, Kalhori S, Colunge D, Grabarczyk G, Hanna G, Carrasco C, Aleman Espino A, Francisco A, Borosky B, Bekheit B, Ighanifard M, Astudillo AA, Demory Beckler M. Psychoactive Drugs in the Management of Post Traumatic Stress Disorder: A Promising New Horizon. Cureus 2022; 14:e25235. [PMID: 35747039 PMCID: PMC9214830 DOI: 10.7759/cureus.25235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/22/2022] [Indexed: 11/06/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is an anxiety disorder that often presents after exposure to a traumatic, life-threatening event. Experiencing a traumatic event is not rare, with inciting incidents ranging from being burglarized to politically motivated genocide. While traditional psychopharmacology and psychotherapy are the mainstays of the treatment of PTSD currently, psychoactive drugs (otherwise known as psychedelics) are being explored for their novel role in the treatment of PTSD patients. Psychoactive drugs such as MDMA, ketamine, and psilocybin have been shown to specifically target and decrease fear and anxiety pathways in the brain. These unique properties hold the potential to be utilized in addressing symptoms of trauma in those with refractory or treatment-resistant PTSD. Historically, federal and state laws have restricted research into how psychoactive drugs can be used to treat mental illness due to the widespread belief that these drugs present more harm than benefit. However, the current shift in public opinion on psychedelics has propelled research to look into the benefits of these drugs for patients with mental illness. This article aims to discuss the mechanisms of how MDMA, ketamine, and psilocybin work in the PTSD brain, as well as their beneficial role in treatment.
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14
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Ching THW, Williams MT, Reed SJ, Kisicki MD, Wang JB, Yazar-Klosinski B, Emerson A, Doblin R. MDMA-Assisted Therapy for Posttraumatic Stress Disorder: A Mixed-Methods Case Study of a Participant of Color From an Open-Label Trial. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221076993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
MDMA (±3,4-methylenedioxymethamphetamine)-assisted therapy (MDMA-AT) was shown in previous clinical trials to have promising efficacy and safety for alleviating treatment-resistant posttraumatic stress disorder (PTSD). However, due to low ethnoracial diversity, the question remains as to whether ethnoracial minority participants would benefit similarly. Thus, a mixed-methods case study was conducted on a participant of color from an open-label trial of MDMA-AT for PTSD to provide a culturally informed lens on symptom recovery with this treatment approach. An additional aim was to elucidate mechanisms of change underlying this treatment for the participant. A case profile was provided, documenting quantitative improvement in PTSD symptoms. This was followed by an interpretative phenomenological analysis (IPA) of effects and mechanisms of action for this participant, based on integration session transcripts. Results of IPA indicated recurrent themes related to psychological mechanisms of symptom change, reduced PTSD symptoms, and additional effects (positive and negative) beyond PTSD symptom reduction. These themes were discussed and recommendations for attuning to culturally relevant material during MDMA-AT were provided.
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Affiliation(s)
- Terence H. W. Ching
- University of Connecticut, Storrs, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Yale School of Medicine, New Haven, CT, USA
| | | | - Sara J. Reed
- Minds iHealth Solutions, Inc., Louisville, KY, USA
| | | | | | | | - Amy Emerson
- MAPS Public Benefit Corporation, San Jose, CA, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, USA
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15
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Barone W, Mitsunaga-Whitten M, Blaustein LO, Perl P, Swank M, Swift TC. Facing death, returning to life: A qualitative analysis of MDMA-assisted therapy for anxiety associated with life-threatening illness. Front Psychiatry 2022; 13:944849. [PMID: 36238946 PMCID: PMC9552520 DOI: 10.3389/fpsyt.2022.944849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Anxiety associated with life-threatening illness (LTI) is a pervasive mental health issue with a wide impact. A spectrum of traditional pharmacotherapies and psychotherapies are available, but offer varying success in reducing symptoms and improving quality of life. We explore a novel therapy for this condition by assessing prominent thematic elements from participant narrative accounts of a pilot phase 2 clinical trial of 3,4 Methylenedioxymethamphetamine-Assisted Therapy (MDMA-AT) for treating anxiety associated with LTI. Semi-structured qualitative interviews were conducted with a subset of adult participants 3 months following completion of this trial. This qualitative analysis sought to complement, clarify, and expand upon the quantitative findings obtained from the clinical trial to further understand the process and outcomes of the treatment. Interviews were coded and analyzed using an Interpretative Phenomenological Analysis (IPA) methodological framework. Participants described in detail their experiences from before, during and after the trial, which were analyzed and categorized into thematic clusters. Specifically, participants explored what they felt were important elements of the therapeutic process including processing trauma and grief, exploring mystical and existential experiences, engaging with the present moment with reduced physiological activation, and facing illness and existential fears. Outcomes of the treatment included increased ability to cope with LTI, reduced psychological symptoms, improved vitality and quality of life, and feeling more resourced. Participant narratives also showed a reconnection to life and greater emotional resilience in response to trauma and medical relapse. These findings are compared to similar treatments for the same indication. Limitations and challenges encountered in conducting this study are discussed along with implications for theory and clinical treatment.
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Affiliation(s)
- William Barone
- Lucin Psychology Consultation, Oakland, CA, United States
| | | | | | - Phillip Perl
- MAPS Public Benefit Corporation, San Jose, CA, United States.,University of California, San Francisco, San Francisco, CA, United States
| | - Marisa Swank
- Department of Psychosocial and Psychoanalytic Studies, University of Essex, Colchester, United Kingdom
| | - Thomas Cody Swift
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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16
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La psychothérapie assistée par la MDMA dans la prise en charge du syndrome de stress post-traumatique. PSYCHOLOGIE FRANCAISE 2021. [DOI: 10.1016/j.psfr.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Thal SB, Bright SJ, Sharbanee JM, Wenge T, Skeffington PM. Current Perspective on the Therapeutic Preset for Substance-Assisted Psychotherapy. Front Psychol 2021; 12:617224. [PMID: 34326789 PMCID: PMC8313735 DOI: 10.3389/fpsyg.2021.617224] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/31/2021] [Indexed: 01/07/2023] Open
Abstract
The present narrative review is the first in a series of reviews about the appropriate conduct in substance-assisted psychotherapy (SAPT). It outlines a current perspective onpreconditions and theoretical knowledge that have been identified as valuable in the literaturefor appropriate therapeutic conduct in SAPT. In this context, considerations regarding ethics and the spiritual emphasis of the therapeutic approaches are discussed. Further, current methods, models, and concepts of psychological mechanism of action and therapeutic effects of SAPT are summarized, and similarities between models, approaches, and potential mediators for therapeutic effects are outlined. It is argued that a critical assessment of the literature might indicate that the therapeutic effect of SAPT may be mediated by intra- and interpersonal variables within the therapeutic context rather than specific therapeutic models per se. The review provides a basis for the development and adaptation of future investigations, therapeutic models, training programs for therapists, and those interested in the therapeutic potential of SAPT. Limitations and future directions for research are discussed.
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Affiliation(s)
- Sascha B. Thal
- College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Stephen J. Bright
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Psychedelic Research in Science and Medicine Pty Ltd (PRISM), Balwyn North, VIC, Australia
| | - Jason M. Sharbanee
- Department of Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
| | - Tobias Wenge
- International Society for Bonding Psychotherapy, Friedrichshafen, Germany
| | - Petra M. Skeffington
- College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
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18
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Wagner AC, Liebman RE, Mithoefer AT, Mithoefer MC, Monson CM. Relational and Growth Outcomes Following Couples Therapy With MDMA for PTSD. Front Psychiatry 2021; 12:702838. [PMID: 34262496 PMCID: PMC8273271 DOI: 10.3389/fpsyt.2021.702838] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/02/2021] [Indexed: 11/21/2022] Open
Abstract
Healing from trauma occurs in a relational context, and the impacts of traumatic experiences that result in post-traumatic stress disorder (PTSD) go beyond the diagnosis itself. To fully understand a treatment for PTSD, understanding its impact on interpersonal, relational, and growth outcomes yields a more fulsome picture of the effects of the treatment. The current paper examines these secondary outcomes of a pilot trial of Cognitive Behavioral Conjoint Therapy (CBCT) for PTSD with MDMA. Six romantic dyads, where one partner had PTSD, undertook a course of treatment combining CBCT for PTSD with two MDMA psychotherapy sessions. Outcomes were assessed at mid-treatment, post-treatment, and 3- and 6-month follow-up. Both partners reported improvements in post-traumatic growth, relational support, and social intimacy. Partners reported reduced behavioral accommodation and conflict in the relationship, and patients with PTSD reported improved psychosocial functioning and empathic concern. These improvements were maintained throughout the follow-up period. These findings suggest that CBCT for PTSD with MDMA has significant effect on relational and growth outcomes in this pilot sample. Improvements in these domains is central to a holistic recovery from traumatic experiences, and lends support to the utility of treating PTSD dyadically.
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Affiliation(s)
- Anne C. Wagner
- Remedy, Toronto, ON, Canada
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Rachel E. Liebman
- Department of Psychology, Ryerson University, Toronto, ON, Canada
- Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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19
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Monson CM, Wagner AC, Mithoefer AT, Liebman RE, Feduccia AA, Jerome L, Yazar-Klosinski B, Emerson A, Doblin R, Mithoefer MC. MDMA-facilitated cognitive-behavioural conjoint therapy for posttraumatic stress disorder: an uncontrolled trial. Eur J Psychotraumatol 2020; 11:1840123. [PMID: 33408811 PMCID: PMC7748057 DOI: 10.1080/20008198.2020.1840123] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Cognitive-behavioural conjoint therapy (CBCT) for PTSD has been shown to improve PTSD, relationship adjustment, and the health and well-being of partners. MDMA (3,4-methylenedioxymethamphetamine) has been used to facilitate an individual therapy for PTSD. This study was an initial test of the safety, tolerability, and efficacy of MDMA-facilitated CBCT. Six couples with varying levels of baseline relationship satisfaction in which one partner was diagnosed with PTSD participated in a condensed version of the 15-session CBCT protocol delivered over 7 weeks. There were two sessions in which both members of the couple were administered MDMA. All couples completed the treatment protocol, and there were no serious adverse events in either partner. There were significant improvements in clinician-assessed, patient-rated, and partner-rated PTSD symptoms (pre- to post-treatment/follow-up effect sizes ranged from d = 1.85-3.59), as well as patient depression, sleep, emotion regulation, and trauma-related beliefs. In addition, there were significant improvements in patient and partner-rated relationship adjustment and happiness (d =.64-2.79). These results are contextualized in relation to prior results from individual MDMA-facilitated psychotherapy and CBCT for PTSD alone. MDMA holds promise as a facilitator of CBCT to achieve more robust and broad effects on individual and relational functioning in those with PTSD and their partners.
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Affiliation(s)
- Candice M Monson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Anne C Wagner
- Department of Psychology, Ryerson University, Toronto, ON, Canada.,Remedy, Toronto, ON, Canada
| | | | - Rachel E Liebman
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Allison A Feduccia
- Multidisciplinary Association for Psychedelic Studies and MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | - Lisa Jerome
- Multidisciplinary Association for Psychedelic Studies and MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | - Berra Yazar-Klosinski
- Multidisciplinary Association for Psychedelic Studies and MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | - Amy Emerson
- Multidisciplinary Association for Psychedelic Studies and MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies and MAPS Public Benefit Corporation, Santa Cruz, CA, USA
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20
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Gill H, Gill B, Chen-Li D, El-Halabi S, Rodrigues NB, Cha DS, Lipsitz O, Lee Y, Rosenblat JD, Majeed A, Mansur RB, Nasri F, Ho R, McIntyre RS. The emerging role of psilocybin and MDMA in the treatment of mental illness. Expert Rev Neurother 2020; 20:1263-1273. [DOI: 10.1080/14737175.2020.1826931] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Barjot Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - David Chen-Li
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Sabine El-Halabi
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Nelson B. Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Danielle S. Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Joshua Daniel Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Amna Majeed
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Rodrigo B. Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Flora Nasri
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
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21
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Jerome L, Feduccia AA, Wang JB, Hamilton S, Yazar-Klosinski B, Emerson A, Mithoefer MC, Doblin R. Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials. Psychopharmacology (Berl) 2020; 237:2485-2497. [PMID: 32500209 PMCID: PMC7351848 DOI: 10.1007/s00213-020-05548-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/11/2020] [Indexed: 12/30/2022]
Abstract
RATIONALE Posttraumatic stress disorder (PTSD) is a chronic condition that has wide-ranging negative effects on an individual's health and interpersonal relationships. Treatments with long-term benefits are needed to promote the safety and well-being of those suffering from PTSD. OBJECTIVES To examine long-term change in PTSD symptoms and additional benefits/harms after 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for treatment of PTSD. METHODS Participants received two to three active doses of MDMA (75-125 mg) during blinded or open-label psychotherapy sessions with additional non-drug therapy sessions. PTSD symptoms were assessed using the Clinician-Administered PTSD Scale for DSM IV (CAPS-IV) at baseline, 1 to 2 months after the last active MDMA session (treatment exit), and at least 12 months post final MDMA session (LTFU). A mixed-effect repeated-measures (MMRM) analysis assessed changes in CAPS-IV total severity scores. The number of participants who met PTSD diagnostic criteria was summarized at each time point. Participants completed a long-term follow-up questionnaire. RESULTS There was a significant reduction in CAPS-IV total severity scores from baseline to treatment exit (LS mean (SE) = - 44.8 (2.82), p < .0001), with a Cohen's d effect size of 1.58 (95% CI = 1.24, 1.91). CAPS-IV scores continued to decrease from treatment exit to LTFU (LS mean (SE) = - 5.2 (2.29), p < .05), with a Cohen's d effect size of 0.23 (95% CI = 0.04, 0.43). The number of participants who no longer met PTSD criteria increased from treatment exit (56.0%) to LTFU (67.0%). The majority of participants reported benefits, including improved relationships and well-being, and a minority reported harms from study participation. CONCLUSIONS PTSD symptoms were reduced 1 to 2 months after MDMA-assisted psychotherapy, and symptom improvement continued at least 12 months post-treatment. Phase 3 trials are investigating this novel treatment approach in a larger sample of participants with chronic PTSD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00090064, NCT00353938, NCT01958593, NCT01211405, NCT01689740, NCT01793610.
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Affiliation(s)
- Lisa Jerome
- MAPS Public Benefit Corporations, 1115 Mission St., Santa Cruz, CA, 95060, USA.
| | - Allison A Feduccia
- MAPS Public Benefit Corporations, 1115 Mission St., Santa Cruz, CA, 95060, USA
| | - Julie B Wang
- MAPS Public Benefit Corporations, 1115 Mission St., Santa Cruz, CA, 95060, USA
| | - Scott Hamilton
- Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Amy Emerson
- MAPS Public Benefit Corporations, 1115 Mission St., Santa Cruz, CA, 95060, USA
| | | | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, CA, USA
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