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Parker C, Wood BM. At the Forefront: Social Workers' Role in Psilocybin Treatment for Depression and Substance Misuse. SOCIAL WORK 2024; 69:297-302. [PMID: 38697188 DOI: 10.1093/sw/swae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 05/04/2024]
Abstract
This article underscores the critical role of social workers in harnessing the potential therapeutic benefits of psilocybin for treating major depressive disorder (MDD) and substance use disorder (SUD). Contemporary treatments for MDD often have side effects, and the success rate for SUD treatments remains low. The pervasiveness of MDD, combined with the challenges in treating SUD, highlights a need for innovative treatments. This article provides an overview of the resurgence of literature over the past two decades that illuminates the therapeutic promise of psilocybin for mental health treatment; clinical trials elucidate the efficacy of psilocybin-assisted therapy in mitigating MDD and demonstrate great promise in reducing SUD symptoms. The long-lasting posttreatment effect emphasizes its potential as a novel treatment modality. Furthermore, psilocybin's recognition as a "breakthrough therapy" by the U.S. Food and Drug Administration (FDA) and the accelerating pace of psychedelic reform bills indicate growing acceptance and interest in its therapeutic capacities. Psilocybin-assisted therapy emerges as a potent treatment option, showcasing remarkable effectiveness even after a single dose. Recommendations and pathways for social workers to be involved in psilocybin-assisted therapy investigation, advocacy, and implementation are provided.
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Affiliation(s)
- Claire Parker
- Claire Parker is a social work student, School of Social Work, University of Texas at Arlington, 501 West Mitchell Street, Arlington, TX 76010, USA
| | - Bethany Marie Wood
- Bethany Marie Wood, PhD, CSW, is assistant professor, School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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2
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Floris G, Dabrowski KR, Zanda MT, Daws SE. Psilocybin reduces heroin seeking behavior and modulates inflammatory gene expression in the nucleus accumbens and prefrontal cortex of male rats. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.28.596205. [PMID: 38854027 PMCID: PMC11160682 DOI: 10.1101/2024.05.28.596205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Preclinical and human studies indicate psilocybin may reduce perseverant maladaptive behaviors, including nicotine and alcohol seeking. Such studies in the opioid field are lacking, though opioids are involved in more >50% of overdose deaths. Psilocybin is an agonist at the serotonin 2A receptor (5-HT2AR), a well-documented target for modulation of drug seeking, and evidence suggests 5-HT2AR agonists may dampen motivation for opioids. We sought to investigate the therapeutic efficacy of psilocybin in mediating cessation of opioid use and maintenance of long-lasting abstinence from opioid seeking behavior in a rat model of heroin self-administration (SA). Psilocybin or 5-HT2AR antagonists ketanserin and volinanserin were administered systemically to rats prior to SA of 0.075 mg/kg/infusion of heroin, or relapse following forced abstinence. Psilocybin did not alter heroin taking, but a single exposure to 3.0 mg/kg psilocybin 4-24 hours prior to a relapse test blunted cue-induced heroin seeking. Conversely, 5-HT2AR antagonists exacerbated heroin relapse. To begin to elucidate mechanisms of psilocybin, drug-naïve rats received psilocybin and/or ketanserin, and tissue was collected from the prefrontal cortex (PFC), a region critical for drug seeking and responsive to psilocybin, 24 hours later for RNA-sequencing. 3.0 mg/kg psilocybin regulated ~2-fold more genes in the PFC than 1.0 mg/kg, including genes involved in the cytoskeleton and cytokine signaling. Ketanserin blocked >90% of psilocybin-regulated genes, including the IL-17a cytokine receptor, Il17ra. Psychedelic compounds have reported anti-inflammatory properties, and therefore we performed a gene expression array to measure chemokine/cytokine molecules in the PFC of animals that displayed psilocybin-mediated inhibition of heroin seeking. Psilocybin regulated 4 genes, including Il17a, and a subset of genes correlated with relapse behavior. Selective inhibition of PFC IL-17a was sufficient to reduce heroin relapse. We conclude that psilocybin reduces heroin relapse and highlight IL-17a signaling as a potential downstream pathway of psilocybin that also reduces heroin seeking.
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Affiliation(s)
- Gabriele Floris
- Center for Substance Abuse Research, Temple University, Philadelphia, PA USA
- Department of Neural Sciences, Temple University, Philadelphia, PA USA
| | - Konrad R Dabrowski
- Center for Substance Abuse Research, Temple University, Philadelphia, PA USA
- Department of Biology, Temple University, Philadelphia, PA USA
| | - Mary Tresa Zanda
- Center for Substance Abuse Research, Temple University, Philadelphia, PA USA
- Department of Neural Sciences, Temple University, Philadelphia, PA USA
| | - Stephanie E Daws
- Center for Substance Abuse Research, Temple University, Philadelphia, PA USA
- Department of Neural Sciences, Temple University, Philadelphia, PA USA
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3
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Bahji A, Crockford D, Brasch J, Schutz C, Buckley L, Danilewitz M, Dubreucq S, Mak M, George TP. Training in Substance use Disorders, Part 1: Overview of Clinical Practice Recommendations. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:428-456. [PMID: 38613369 PMCID: PMC11107443 DOI: 10.1177/07067437241231128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Anees Bahji
- Clinical Assistant Professor, Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Crockford
- Clinical Professor, University of Calgary, Cumming School of Medicine, Department of Psychiatry, Calgary, AB, Canada; Hotchkiss Brain Institute & Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, AB, Canada
| | - Jennifer Brasch
- Associate Professor, Department of Psychiatry & Behavioural Neurosciences, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Lead, Addiction Psychiatry, St. Joseph's Healthcare, Hamilton, ON, Canada; Past-President, Canadian Society of Addiction Medicine, Calgary, AB, Canada
| | - Christian Schutz
- Professor, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Research Lead Adult Mental Health and Substance Use, Provincial Health Service Authority, Vancouver, BC, Canada
| | - Leslie Buckley
- Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marlon Danilewitz
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Associate Medical Director, General Psychiatry, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Simon Dubreucq
- Psychiatrist, Department of Addiction Medicine, CHUM, Montreal, QC, Canada; Assistant Professor, Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Michael Mak
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Adjunct Assistant Professor, Department of Medicine, McMaster University, Hamilton, ON, Canada; Adjunct Research Professor, Department of Psychiatry, Western University, London, ON, Canada
| | - Tony P George
- Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Hilal FF, Jeanblanc J, Deschamps C, Naassila M, Pierrefiche O, Ben Hamida S. Epigenetic drugs and psychedelics as emerging therapies for alcohol use disorder: insights from preclinical studies. J Neural Transm (Vienna) 2024; 131:525-561. [PMID: 38554193 DOI: 10.1007/s00702-024-02757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 04/01/2024]
Abstract
Alcohol use disorder (AUD) is a public health issue that affects millions of people worldwide leading to physical, mental and socio-economic consequences. While current treatments for AUD have provided relief to individuals, their effectiveness on the long term is often limited, leaving a number of affected individuals without sustainable solutions. In this review, we aim to explore two emerging approaches for AUD: psychedelics and epigenetic drugs (i.e., epidrugs). By examining preclinical studies, different animal species and procedures, we delve into the potential benefits of each of these treatments in terms of addictive behaviors (alcohol drinking and seeking, motivation to drink alcohol and prevention of relapse). Because psychedelics and epidrugs may share common and complementary mechanisms of action, there is an exciting opportunity for exploring synergies between these approaches and their parallel effectiveness in treating AUD and the diverse associated psychiatric conditions.
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Affiliation(s)
- Fahd François Hilal
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France
| | - Jerome Jeanblanc
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France
| | - Chloé Deschamps
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France
| | - Mickael Naassila
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France.
| | - Olivier Pierrefiche
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France
| | - Sami Ben Hamida
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France.
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Vargas-Perez H, Minauro-Sanmiguel F, Ting-A-Kee R, Grieder TE, Méndez-Díaz M, Prospéro-García O, van der Kooy D. Rewarding Effects of the Hallucinogen 4-AcO-DMT Administration and Withdrawal in Rats: A Challenge to the Opponent-Process Theory. Neurosci Lett 2024; 820:137597. [PMID: 38110146 DOI: 10.1016/j.neulet.2023.137597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
According to the opponent-process theory of drug addiction, the intake of an addictive substance initiates two processes: a rapid primary process that results in the drug's rewarding effects, and a slower opponent process that leads to the aversive motivational state of drug aftereffects. This aversive state is integral in the desire, pursuit, and maintenance of drug use, potentially leading to dependence and addiction. However, current observational and experimental evidence suggests that the administration of a 5-hydroxytryptamine receptors-type 2A (5-HT2A) agonist, while capable of inducing a positive mental state in humans, may not generate the behavioral patterns typically associated with drugs of abuse. In this study, we found that administering the 5-HT2A agonist 4-Acetoxy-N,N-dimethyltryptamine fumarate (4-AcO-DMT) did not result in place preference in male rats compared to control saline administration 24 h later, after the drug has been cleared from the organism. However, in a modified place preference test where only the acute motivational effects of the drug were evaluated (excluding withdrawal), 4-AcO-DMT was found to be rewarding. Furthermore, in another modified place preference test where only the motivational effects of drug withdrawal were evaluated (excluding the acute effects of drug administration), the 24-hour aftereffect of 5-HT2A agonist administration also resulted in a robust place preference. Therefore, while 4-AcO-DMT administration was able to induce place preference, its 24-hour aftereffect also produced a strong reward. In the counterbalanced test, this reward from the aftereffect effectively overshadowed its acute rewarding properties, which could potentially create a false impression that 4-AcO-DMT lacks motivational properties. This suggests that 5-HT2A agonist administration follows a different dynamic than that proposed by the opponent-process theory of motivation and implies that the administration of 5-HT2A agonists may lead to behavioral patterns less typical of drugs associated with addiction.
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Affiliation(s)
- Hector Vargas-Perez
- The Nierika Intercultural Medicine Institute, Ocuilan, Estado de México, 52483, Mexico; Institute of Medical Science and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5S 3E1, Canada; Postgrado En Ciencias Cognitivas, Universidad Autonoma Del Estado de Morelos, Cuernavaca, Mexico.
| | - Fernando Minauro-Sanmiguel
- Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría, Centro Médico Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico
| | - Ryan Ting-A-Kee
- Institute of Medical Science and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5S 3E1, Canada
| | - Taryn Elizabeth Grieder
- Department of Molecular Genetics, the Donnelly Centre, University of Toronto, Toronto, Ontario M5S 3E1, Canada
| | - Mónica Méndez-Díaz
- Laboratorio de Cannabinoides, Departamento de Fisiología, Facultad de Medicina, UNAM, Mexico
| | - Oscar Prospéro-García
- Laboratorio de Cannabinoides, Departamento de Fisiología, Facultad de Medicina, UNAM, Mexico
| | - Derek van der Kooy
- Institute of Medical Science and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5S 3E1, Canada; Department of Molecular Genetics, the Donnelly Centre, University of Toronto, Toronto, Ontario M5S 3E1, Canada
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Sharma R, Batchelor R, Sin J. Psychedelic Treatments for Substance Use Disorder and Substance Misuse: A Mixed Methods Systematic Review. J Psychoactive Drugs 2023; 55:612-630. [PMID: 36933948 DOI: 10.1080/02791072.2023.2190319] [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: 04/16/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 03/20/2023]
Abstract
Renewed interest in psychedelic substances in the 21st century has seen the exploration of psychedelic treatments for various psychiatric disorders including substance use disorder (SUD). This review aimed to assess the effectiveness of psychedelic treatments for people with SUD and those falling below diagnostic thresholds (i.e. substance misuse). We systematically searched 11 databases, trial registries, and psychedelic organization websites for empirical studies examining adults undergoing psychedelic treatment for SUD or substance misuse, published in the English language, between 2000 and 2021. Seven studies investigating treatment using psilocybin, ibogaine, and ayahuasca, alone or adjunct with psychotherapy reported across 10 papers were included. Measures of abstinence, substance use, psychological and psychosocial outcomes, craving, and withdrawal reported positive results, however, this data was scarce among studies examining a wide range of addictions including opioid, nicotine, alcohol, cocaine and unspecified substance. The qualitative synthesis from three studies described subjective experience of psychedelic-assisted treatments enhanced self-awareness, insight, and confidence. At present, there is no sufficient research evidence to suggest effectiveness of any of the psychedelics on any specific substance use disorder or substance misuse. Further research using rigorous effectiveness evaluation methods with larger sample sizes and longer-term follow-up is required.
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Affiliation(s)
| | - Rachel Batchelor
- School of Health and Psychological Sciences, City, University of London, England, London, UK
| | - Jacqueline Sin
- School of Health and Psychological Sciences, City, University of London, England, London, UK
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Salinsky LM, Merritt CR, Zamora JC, Giacomini JL, Anastasio NC, Cunningham KA. μ-opioid receptor agonists and psychedelics: pharmacological opportunities and challenges. Front Pharmacol 2023; 14:1239159. [PMID: 37886127 PMCID: PMC10598667 DOI: 10.3389/fphar.2023.1239159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
Opioid misuse and opioid-involved overdose deaths are a massive public health problem involving the intertwined misuse of prescription opioids for pain management with the emergence of extremely potent fentanyl derivatives, sold as standalone products or adulterants in counterfeit prescription opioids or heroin. The incidence of repeated opioid overdose events indicates a problematic use pattern consistent with the development of the medical condition of opioid use disorder (OUD). Prescription and illicit opioids reduce pain perception by activating µ-opioid receptors (MOR) localized to the central nervous system (CNS). Dysregulation of meso-corticolimbic circuitry that subserves reward and adaptive behaviors is fundamentally involved in the progressive behavioral changes that promote and are consequent to OUD. Although opioid-induced analgesia and the rewarding effects of abused opioids are primarily mediated through MOR activation, serotonin (5-HT) is an important contributor to the pharmacology of opioid abused drugs (including heroin and prescription opioids) and OUD. There is a recent resurgence of interest into psychedelic compounds that act primarily through the 5-HT2A receptor (5-HT 2A R) as a new frontier in combatting such diseases (e.g., depression, anxiety, and substance use disorders). Emerging data suggest that the MOR and 5-HT2AR crosstalk at the cellular level and within key nodes of OUD circuitry, highlighting a major opportunity for novel pharmacological intervention for OUD. There is an important gap in the preclinical profiling of psychedelic 5-HT2AR agonists in OUD models. Further, as these molecules carry risks, additional analyses of the profiles of non-hallucinogenic 5-HT2AR agonists and/or 5-HT2AR positive allosteric modulators may provide a new pathway for 5-HT2AR therapeutics. In this review, we discuss the opportunities and challenges associated with utilizing 5-HT2AR agonists as therapeutics for OUD.
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Affiliation(s)
| | | | | | | | - Noelle C. Anastasio
- Center for Addiction Sciences and Therapeutics and Department of Pharmacology and Toxicology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Kathryn A. Cunningham
- Center for Addiction Sciences and Therapeutics and Department of Pharmacology and Toxicology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, United States
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Valeri J, Gisabella B, Pantazopoulos H. Dynamic regulation of the extracellular matrix in reward memory processes: a question of time. Front Cell Neurosci 2023; 17:1208974. [PMID: 37396928 PMCID: PMC10311570 DOI: 10.3389/fncel.2023.1208974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Substance use disorders are a global health problem with increasing prevalence resulting in significant socioeconomic burden and increased mortality. Converging lines of evidence point to a critical role of brain extracellular matrix (ECM) molecules in the pathophysiology of substance use disorders. An increasing number of preclinical studies highlight the ECM as a promising target for development of novel cessation pharmacotherapies. The brain ECM is dynamically regulated during learning and memory processes, thus the time course of ECM alterations in substance use disorders is a critical factor that may impact interpretation of the current studies and development of pharmacological therapies. This review highlights the evidence for the involvement of ECM molecules in reward learning, including drug reward and natural reward such as food, as well as evidence regarding the pathophysiological state of the brain's ECM in substance use disorders and metabolic disorders. We focus on the information regarding time-course and substance specific changes in ECM molecules and how this information can be leveraged for the development of therapeutic strategies.
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Affiliation(s)
- Jake Valeri
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Barbara Gisabella
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Harry Pantazopoulos
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
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Franco Corso SJ, O'Malley K, Subaiya S, Mayall D, Dakwar E. The role of non-ordinary states of consciousness occasioned by mind-body practices in mental health illness. J Affect Disord 2023; 335:166-176. [PMID: 37150220 DOI: 10.1016/j.jad.2023.04.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/13/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Research with hallucinogens suggests that non-ordinary states of consciousness (NOSCs), particularly mystical-type experiences, predict improvements in various affective disorders and substance use disorders (SUDs). Little is known, however, about the therapeutic potential of NOSCs induced by mind-body practices such as meditation, yoga and breathwork. METHODS We conducted a literature review in online databases (PubMed, Scopus, Google Scholar) and preprint databases (SSRN, bioRxiv) to identify studies of NOSCs induced by mind-body practices and their effects in affective disorders and SUDs. RESULTS A wide variety of mind-body practices involving physical movement (i.e., shamanic drumming, yoga) and hyper-focused immersive mental experiences (i.e., meditation, breathwork) have been reported in the literature. Preliminary evidence, mostly from qualitative studies and open label studies, suggest that mind-body practices produce NOSCs. Such experiences have been associated with short-term reduced levels of anxiety and depression, increased motivation to quit addictive behaviors, and enhanced self-awareness and spiritual well-being. LIMITATIONS Findings are limited by the scarcity of literature in this field. Further rigorous and methodologically sound empirical research is needed, including comparative studies of NOSCs occasioned by different methods. CONCLUSIONS Mind-body practices may represent a promising approach for treating mental health disorders. The NOSCs induced by such practices may lead to beneficial shifts in perceptions, values, beliefs, and behaviors. Given the challenges with hallucinogen-based therapies, mind-body practices may represent a more accessible and acceptable way of eliciting potentially helpful NOSCs in clinical practice.
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Affiliation(s)
- Silvia J Franco Corso
- Department of Psychiatry, Columbia University Vangelos College of Physicians and Surgeons, New York, NY, United States of America; Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America.
| | - Kate O'Malley
- Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America
| | - Saleena Subaiya
- Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America
| | - Danielle Mayall
- Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America
| | - Elias Dakwar
- Department of Psychiatry, Columbia University Vangelos College of Physicians and Surgeons, New York, NY, United States of America; Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America
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Grover C, Monds L, Montebello M. A survey of Australian psychiatrists' and psychiatry trainees' knowledge of and attitudes towards psychedelics in the treatment of psychiatric disorders. Australas Psychiatry 2023:10398562231155125. [PMID: 36753675 DOI: 10.1177/10398562231155125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To assess Australian psychiatrists' and psychiatry trainees' knowledge of and attitudes towards psychedelics as treatment for psychiatric disorders. METHOD Australian members of the Royal Australian and New Zealand College of Psychiatrists were invited to participate in an anonymous survey that ran from October 1 to November 30 2021. Participants were asked about their knowledge of the risks and benefits of, and attitudes towards, psychedelics, including the factors that influence those attitudes. RESULTS Fifty-one doctors responded to the survey, and 38 completed all items. The majority were male, consultants and based primarily in New South Wales. Respondents reported awareness of the evidence demonstrating the benefits of psychedelics for most disorders; however most respondents, particularly females, perceived psychedelics as risky. Most considered themselves open-minded and believed psychedelics deserved further research. CONCLUSIONS The poor response rate was a major limitation of this study. Our sample of Australian psychiatrists and trainees were enthusiastic about psychedelics as psychiatric treatment and were aware of some of the evidence demonstrating their efficacy. Safety continues to be a concern, despite growing evidence of their safety in therapeutic settings. Education about the evidence of their efficacy and the risks associated with their use is needed.
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Affiliation(s)
- Cameron Grover
- Department of Mental Health Services, 2989South Eastern Sydney Local Health District, Kogarah, NSW, Australia
| | - Lauren Monds
- Specialty of Addiction Medicine, Faculty of Medicine and Health, 522555University of Sydney, Sydney, NSW, Australia; Department of Drug and Alcohol Services, 3960Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Mark Montebello
- Drug and Alcohol Services, 3960Northern Sydney Local Health District, St Leonards, NSW, Australia; Specialty of Addiction Medicine, Northern Clinical School, 198092The University of Sydney, St Leonards, NSW, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
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Psychedelic discourses: A qualitative study of discussions in a Danish online forum. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103945. [PMID: 36669238 DOI: 10.1016/j.drugpo.2022.103945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study focuses on user-perspectives related to norms, beliefs and practices concerning psychedelic substances as they are articulated in a Danish online forum. The study combines an interest in online drug research with a focus on discourse analysis to account for the dialectical relationship between individual and shared knowledge regarding the use and meaning of psychedelics. METHODS A total of 1,865 posts from 154 threads of online discussion were coded and analyzed thematically, inspired by a socio-cognitive approach to the study of discourse. All topics were arranged into 54 categories which were further analyzed to map recurring patterns in the construction of meaning resulting in a limited number of dominant discourses. RESULTS Five dominant discourses were identified: the recreational, the therapeutic, the spiritual, the scientific and the performance discourse. We suggest that these discourses can be seen as the available frameworks which forum users draw upon and reproduce when they describe, discuss, and negotiate their understandings and uses of psychedelics. CONCLUSION This study demonstrates the importance of having a nuanced approach to user perceptions. Future drug policy and practice development should take these nuances into account and expect significant variation in the motives and modalities of the use of psychedelics.
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12
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Ko K, Kopra EI, Cleare AJ, Rucker JJ. Psychedelic therapy for depressive symptoms: A systematic review and meta-analysis. J Affect Disord 2023; 322:194-204. [PMID: 36209780 DOI: 10.1016/j.jad.2022.09.168] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Psychedelic therapy shows promise for Major Depressive Disorder, especially when treatment-resistant, as well as life-threatening illness distress. The objective of this systematic review, inclusive of meta-analysis, is to examine recent clinical research on the therapeutic effects of classic psychedelics on depressive symptoms. METHODS Fourteen psychedelic therapy studies, utilising psilocybin, ayahuasca, or LSD, were systematically reviewed. For the meta-analysis, standardised mean differences were calculated for seven randomised controlled trials. RESULTS The systematic review indicated significant short- and long-term reduction of depressive symptoms in all conditions studied after administration of psilocybin, ayahuasca, or LSD, with psychological support. In the meta-analysis, symptom reduction was significantly indicated in three timepoints out of four, including 1-day, 1-week, and 3-5 weeks, supporting the results of the systematic review, with the exception of the 6-8 weeks follow-up point which was less conclusive. LIMITATIONS The absence of required data for 2 studies necessitated the less precise use of graphical extraction and imputation. The small sample size in all but one study negatively affected the statistical power. None of the studies had long-term follow-up without also utilising the cross-over method, which did not allow for long-term results to be included in the meta-review. CONCLUSIONS This review indicates an association between psychedelic therapy and significant reduction of depressive symptoms at several time points. However, the small number of studies, and low sample sizes, calls for careful interpretation of results. This suggests the need for more randomised clinical trials of psychedelic therapy, with larger and more diverse samples.
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Affiliation(s)
- Kwonmok Ko
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Emma I Kopra
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Anthony J Cleare
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham BR3 3BX, UK
| | - James J Rucker
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham BR3 3BX, UK
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Urban MM, Stingl MR, Meinhardt MW. Mini-review: The neurobiology of treating substance use disorders with classical psychedelics. Front Neurosci 2023; 17:1156319. [PMID: 37139521 PMCID: PMC10149865 DOI: 10.3389/fnins.2023.1156319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 05/05/2023] Open
Abstract
The potential of psychedelics to persistently treat substance use disorders is known since the 1960s. However, the biological mechanisms responsible for their therapeutic effects have not yet been fully elucidated. While it is known that serotonergic hallucinogens induce changes in gene expression and neuroplasticity, particularly in prefrontal regions, theories on how specifically this counteracts the alterations that occur in neuronal circuitry throughout the course of addiction are largely unknown. This narrative mini-review endeavors to synthesize well-established knowledge from addiction research with findings and theories regarding the neurobiological effects of psychedelics to give an overview of the potential mechanisms that underlie the treatment of substance use disorders with classical hallucinogenic compounds and point out gaps in the current understanding.
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Affiliation(s)
- Marvin M. Urban
- Interdisciplinary Center for Neurosciences, University of Heidelberg, Heidelberg, Germany
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
- *Correspondence: Marvin M. Urban,
| | - Moritz R. Stingl
- Interdisciplinary Center for Neurosciences, University of Heidelberg, Heidelberg, Germany
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | - Marcus W. Meinhardt
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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14
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Vargas-Perez H, Grieder TE, van der Kooy D. Neural Plasticity in the Ventral Tegmental Area, Aversive Motivation during Drug Withdrawal and Hallucinogenic Therapy. J Psychoactive Drugs 2023; 55:62-72. [PMID: 35114904 DOI: 10.1080/02791072.2022.2033889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aberrant glutamatergic signaling has been closely related to several pathologies of the central nervous system. Glutamatergic activity can induce an increase in neural plasticity mediated by brain-derived neurotrophic factor (BDNF) in the ventral tegmental area (VTA), a nodal point in the mesolimbic dopamine system. Recent studies have related BDNF dependent plasticity in the VTA with the modulation of aversive motivation to deal with noxious environmental stimuli. The disarray of these learning mechanisms would produce an abnormal augmentation in the representation of the emotional information related to aversion, sometimes even in the absence of external environmental trigger, inducing pathologies linked to mood disorders such as depression and drug addiction. Recent studies point out that serotonin (5-hydroxytryptamine, 5-HT) receptors, especially the 2a (5-HT2a) subtype, play an important role in BDNF-related neural plasticity in the VTA. It has been observed that a single administration of a 5HT2a agonist can both revert an animal to a nondependent state from a drug-dependent state (produced by the chronic administration of a substance of abuse). The 5HT2a agonist also reverted the BDNF-induced neural plasticity in the VTA, suggesting that the administration of 5-HT2a agonists could be used as effective therapeutic agents to treat drug addiction. These findings could explain the neurobiological correlate of the therapeutic use of 5HT2a agonists, which can be found in animals, plants and fungi during traditional medicine ceremonies and rituals to treat mood related disorders.
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Affiliation(s)
- Hector Vargas-Perez
- The Nierika Intercultural Medicine Institute, Ocuilan, México.,Postgrado En Ciencias Cognitivas, Universidad Autonoma Del Estado de Morelos, Cuernavaca, Mexico
| | - Taryn Elizabeth Grieder
- Institute of Medical Science and Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Derek van der Kooy
- Institute of Medical Science and Department of Molecular Genetics, University of Toronto, Toronto, Canada
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15
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Maguire DR. Effects of 2,5-Dimethoxy-4-Methylamphetamine (DOM) and 2-Piperazin-1-yl-Quinoline (Quipazine) on Fentanyl Versus Food Choice in Rhesus Monkeys. J Pharmacol Exp Ther 2023; 384:155-162. [PMID: 36272734 PMCID: PMC9827501 DOI: 10.1124/jpet.122.001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/18/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
There has been increasing interest in the potential therapeutic effects of drugs with agonist properties at serotonin 2A subtype (5-HT2A) receptors (e.g., psychedelics), including treatment of substance use disorders. Studying interactions between 5-HT2A receptor agonists and other drugs is important for understanding potential therapeutic effects as well as adverse interactions. Direct-acting 5-HT2A receptor agonists such as 2,5-dimethoxy-4-methylamphetamine (DOM) and 2-piperazin-1-yl-quinoline (quipazine) enhance some (e.g., antinociceptive) effects of opioids; however, it is unclear whether they alter the abuse-related effects of opioids. This study examined whether DOM and quipazine alter the reinforcing effects of fentanyl in rhesus monkeys (n = 6) responding under a food versus drug choice procedure. Responding on one lever delivered sucrose pellets and responding on the other lever delivered intravenous (i.v.) infusions. In one set of experiments, fentanyl (0.1-3.2 µg/kg/infusion) versus food choice sessions were preceded by noncontingent i.v. pretreatments with DOM (0032-0.32 mg/kg), quipazine (0.32-1.0 mg/kg), naltrexone (0.032 mg/kg), or heroin (0.1 mg/kg). In another set of experiments, fentanyl was available during choice sessions in combination with DOM (0.32-100 µg/kg/infusion) or quipazine (3.2-320 µg/kg/infusion) in varying dose ratios. Naltrexone decreased and heroin increased fentanyl choice, demonstrating sensitivity of responding to pharmacological manipulation. However, whether given as a pretreatment or made available in combination with fentanyl as a mixture, neither DOM nor quipazine significantly altered fentanyl choice. These results suggest that 5-HT2A receptor agonists do not enhance the reinforcing effects of opioids and, thus, will not likely enhance abuse potential. SIGNIFICANCE STATEMENT: Serotonin 2A subtype receptor agonists enhance some (e.g., antinociceptive) effects of opioids, suggesting they could be combined with opioids in some therapeutic contexts such as treating pain. However, it is unclear whether they also enhance adverse effects of opioids, including abuse. Results of this study indicate that serotonin 2A subtype receptor agonists do not reliably enhance opioid self-administration and, thus, are unlikely to enhance the abuse potential of opioids.
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Affiliation(s)
- David R Maguire
- Department of Pharmacology and Addiction Research, Treatment & Training Center of Excellence, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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16
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A Critical Appraisal of Evidence on the Efficacy and Safety of Serotonergic Psychedelic Drugs as Emerging Antidepressants: Mind the Evidence Gap. J Clin Psychopharmacol 2022; 42:581-588. [PMID: 36193898 DOI: 10.1097/jcp.0000000000001608] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE/BACKGROUND There has been resurgence of interest in the therapeutic use of serotonergic ("classic") psychedelics in major depressive disorder (MDD) and end-of-life distress. This commentary offers a critical appraisal of current evidence for antidepressant effects of classic psychedelics from contemporary clinical trials and highlights pitfalls that should be addressed before clinical translation. METHODS/PROCEDURES A narrative review was conducted to identify clinical trials of serotonergic psychedelics for the treatment of MDD and end-of-life distress. Trials published between January 1990 and May 2022 were identified on PubMed using combinations of search terms. FINDINGS/RESULTS Psilocybin, lysergic acid diethylamide, and ayahuasca have clinical trials to evaluate antidepressant effects. Two studies showed preliminary positive effects of single-dose ayahuasca for treatment-resistant depression. Similar results were seen in lysergic acid diethylamide for end-of-life distress. Small randomized clinical trials (RCTs) of psilocybin combined with psychotherapy showed superiority to waitlist controls and comparable efficacy and safety to an active comparator in MDD, with additional RCTs showing efficacy in end-of-life distress. Adverse events associated with psychedelics were reported as mild and transient. Small homogenous samples, expectancy bias, functional unblinding, and lack of consensus and standardization of psychotherapy are major limitations of all studies. IMPLICATIONS/CONCLUSIONS Given the methodological limitations of published RCTs, the evidence supporting the efficacy and safety of serotonergic psychedelics for depression is currently of low level. Future research should assess the role of expectancy and psychedelic effects in moderating and mediating treatment response. Innovative trial designs are needed to overcome functional unblinding. For now, psychedelics should remain experimental interventions used within clinical trials.
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Žuljević MF, Buljan I, Leskur M, Kaliterna M, Hren D, Duplančić D. Validation of a new instrument for assessing attitudes on psychedelics in the general population. Sci Rep 2022; 12:18225. [PMID: 36309539 PMCID: PMC9617880 DOI: 10.1038/s41598-022-23056-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/25/2022] [Indexed: 12/31/2022] Open
Abstract
Although there is research interest to assess attitudes on psychedelics, no validated instrument exists for this purpose. We aimed to develop and examine the psychometric properties of the Attitudes on Psychedelics Questionnaire (APQ) in a sample of the Croatian general population. A cross-sectional, web-based survey among the general population was conducted on 1153 participants (62.1% female, 77.7% with a graduate or high school degree, 15.1% health care workers). We assessed participants' ability to recognize psychedelic substances using a short knowledge test. The APQ consists of 20 items with four sub-scales: Legal Use of Psychedelics, Effects of Psychedelics, Risk Assessment of Psychedelics, and Openness to Psychedelics. This model demonstrated best fit in a confirmatory factor analysis. Total scale reliability was excellent (McDonald's ω = 0.949, 95% CI = 0.944-0.953). A strong correlation with a similar unvalidated measure (r = 0.885, P < 0.001) demonstrated convergent validity. We observed an association between attitudes and knowledge on psychedelics (r = 0.494, P < 0.001). Younger age, male gender, and lower educational status were associated with higher APQ scores. The APQ is valid, reliable, and could be applied in assessing educational interventions, patients' treatment outcomes, and the attitudes of different groups of experts. We encourage further validation of the APQ in English.
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Affiliation(s)
- Marija Franka Žuljević
- grid.38603.3e0000 0004 0644 1675Department of Medical Humanities, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
| | - Ivan Buljan
- grid.38603.3e0000 0004 0644 1675Department of Research in Biomedicine and Health, School of Medicine, University of Split, Split, Croatia ,grid.38603.3e0000 0004 0644 1675Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
| | - Mia Leskur
- grid.38603.3e0000 0004 0644 1675School of Medicine, University of Split, Split, Croatia
| | - Mariano Kaliterna
- grid.412721.30000 0004 0366 9017Department of Psychiatry, University Hospital Centre Split, Split, Croatia
| | - Darko Hren
- grid.38603.3e0000 0004 0644 1675Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
| | - Darko Duplančić
- grid.38603.3e0000 0004 0644 1675Department of Medical Humanities, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
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18
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Barnett BS, Weleff J. Psychedelics in the Treatment of Substance Use Disorders. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20220804-01] [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: 11/20/2022]
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Martins B, Rutland W, De Aquino JP, Kazer BL, Funaro M, Potenza MN, Angarita GA. Helpful or Harmful? The Therapeutic Potential of Medications with Varying Degrees of Abuse Liability in the Treatment of Substance Use Disorders. CURRENT ADDICTION REPORTS 2022; 9:647-659. [PMID: 35990796 PMCID: PMC9376579 DOI: 10.1007/s40429-022-00432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review This review summarizes recent clinical trial research on pharmacological treatments for substance use disorders, with a specific focus on agents with potential abuse liability. Recent Findings Pharmacological treatments for substance use disorders may include gabapentinoids, baclofen, modafinil, ketamine, cannabinoids, gamma-hydroxybutyrate, and psychedelics. Gabapentinoids may decrease negative subjective effects of withdrawal in alcohol and cannabis use disorders. Cannabinoids similarly appear to decrease use and withdrawal symptoms in cannabis use disorder, while research shows stimulant medications may reduce cravings and increase abstinence in cocaine use disorder. Ketamine and psychedelics may help treat multiple substance use disorders. Ketamine may reduce withdrawal symptoms, promote abstinence, and diminish cravings in alcohol and cocaine use disorders and psychedelics may promote remission, decrease use, and reduce cravings in alcohol and opioid use disorders. Summary Regardless of current regulatory approval statuses and potentials for abuse, multiple agents should not be dismissed prematurely as possible treatments for substance use disorders. However, further clinical research is needed before effective implementation can begin in practice. Supplementary Information The online version contains supplementary material available at 10.1007/s40429-022-00432-9.
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Affiliation(s)
- Bradford Martins
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
| | - Will Rutland
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
| | - Joao P. De Aquino
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
| | - Benjamin L. Kazer
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT 06510 USA
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Child Study Center, Yale University School of Medicine, New Haven, CT 06510 USA
- Department of Neuroscience, Yale University, New Haven, CT 06510 USA
- Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
- Connecticut Council On Problem Gambling, Wethersfield, CT 06109 USA
- Wu Tsai Institute, Yale University, New Haven, CT 06510 USA
| | - Gustavo A. Angarita
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
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Daldegan-Bueno D, Maia LO, Massarentti CM, Tófoli LF. Ayahuasca and tobacco smoking cessation: results from an online survey in Brazil. Psychopharmacology (Berl) 2022; 239:1767-1782. [PMID: 35179623 DOI: 10.1007/s00213-022-06063-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE Smoking-related disease is a major problem globally. Effective smoking cessation treatments are however limited. Increasing evidence suggests that psychedelics have potential as treatments for substance use disorders and may therefore prove an option in aiding smoking cessation. OBJECTIVES To establish which factors predict smoking cessation in people who reported quitting or reducing smoking following ayahuasca consumption. METHODS A retrospective cross-sectional mixed-method study (quantitative and qualitative design) was undertaken using data from an online survey evaluating peoples' experiences before and after drinking ayahuasca. Multivariate logistic regression was performed with smoking condition (cessation or reduction/relapse) as a dependent variable and demographics, smoking, ayahuasca-related variables and the mystical experience (MEQ30) as predicting factors. RESULTS A total of 441 responses were grouped according to self-reported smoking status: cessation (n = 305) or reduction/relapse (n = 136) smoking. Logistic regression showed that mystical experience (OR: 1.03; 95% CI [1.00-1.05]) and frequency of ayahuasca intake (OR: 2.16[1.00-4.70]) were protective factors, while positive mood (measured by the MEQ30) during the ayahuasca experience was a risk factor (OR: 0.91[0.85-0.97]). Qualitative thematic analysis identified eight themes (e.g. acquired awareness, spiritual experience, increased motivation) related to the ayahuasca experience and the process of smoking cessation/reduction. CONCLUSIONS Our results suggest that ayahuasca could be used as a potential tool for smoking cessation, and that effects may be mediated by mystical experience. Given the current burden of smoking-related disease and the limited treatment options, studies are needed to investigate the efficacy of psychedelics in smoking cessation.
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Affiliation(s)
- Dimitri Daldegan-Bueno
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz Campinas, Rua Tessália Vieira de Camargo 126, Campinas, São Paulo, 13083-887, Brazil
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Lucas Oliveira Maia
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz Campinas, Rua Tessália Vieira de Camargo 126, Campinas, São Paulo, 13083-887, Brazil
| | - Carolina Marcolino Massarentti
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz Campinas, Rua Tessália Vieira de Camargo 126, Campinas, São Paulo, 13083-887, Brazil
| | - Luís Fernando Tófoli
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz Campinas, Rua Tessália Vieira de Camargo 126, Campinas, São Paulo, 13083-887, Brazil.
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Henner RL, Keshavan MS, Hill KP. Review of potential psychedelic treatments for PTSD. J Neurol Sci 2022; 439:120302. [DOI: 10.1016/j.jns.2022.120302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/27/2022] [Accepted: 05/24/2022] [Indexed: 12/20/2022]
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22
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Sekula AD, Downey L, Puspanathan P. Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy. Front Psychol 2022; 13:813746. [PMID: 35310225 PMCID: PMC8931418 DOI: 10.3389/fpsyg.2022.813746] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/11/2022] [Indexed: 12/20/2022] Open
Abstract
Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design that promotes an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation.
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Affiliation(s)
- Agnieszka D. Sekula
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Enosis Therapeutics Pty. Ltd., Melbourne, VIC, Australia
- *Correspondence: Agnieszka D. Sekula,
| | - Luke Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia
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Rabinowitz J, Lev-Ran S, Gross R. The association between naturalistic use of psychedelics and co-occurring substance use disorders. Front Psychiatry 2022; 13:1066369. [PMID: 36704738 PMCID: PMC9871568 DOI: 10.3389/fpsyt.2022.1066369] [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: 10/10/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Classic psychedelics (LSD, psilocybin, and peyote/mescaline) have been used to support addiction treatment in a variety of contexts ranging from ceremonial use to clinical trials. The aim of this study was to test the hypothesis that past naturalistic use of classic psychedelics would be associated with decreased prevalence of substance use disorder, when controlling for known confounders. METHODS This cross-sectional study used 2017 NSDUH survey data to evaluate the association between past use of the classic psychedelics LSD, psilocybin and peyote/mescaline and past year substance dependence or abuse. We calculated adjusted odds ratios by multivariate logistic regression, controlling for a range of sociodemographic variables, use of non-psychedelic illicit drugs and mental health related variables. RESULTS A total of 56,276 participants were included in this study. Past use of LSD and psilocybin were associated with increased odds of substance dependence or abuse compared to those who had never used psychedelics before, and this was more likely for those who had used LSD more recently. However, prior use of peyote or mescaline was associated with lower odds of past year substance dependence or abuse compared to people who had never used psychedelics before (aOR = 0.68, p < 0.001). Past use of classic psychedelics was not associated with nicotine dependence. CONCLUSION Past use of peyote/mescaline was associated with decreased odds of substance use disorder compared to people who had never used psychedelics before, while past use of LSD or psilocybin was not. It remains unclear whether this difference is due to pharmacological differences between these compounds or simply due to the context in which peyote/mescaline are traditionally taken. Future research should investigate why naturalistic use of different psychedelics is associated with different substance use disorder effects.
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Affiliation(s)
- Jonina Rabinowitz
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Shaul Lev-Ran
- Lev Hasharon Medical Center, Netanya, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Israel Center on Addictions, Netanya, Israel
| | - Raz Gross
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
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24
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Rajwani K. Should Adolescents be Included in Emerging Psychedelic Research? CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1089784ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Leger RF, Unterwald EM. Assessing the effects of methodological differences on outcomes in the use of psychedelics in the treatment of anxiety and depressive disorders: A systematic review and meta-analysis. J Psychopharmacol 2022; 36:20-30. [PMID: 34519567 DOI: 10.1177/02698811211044688] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Classical psychedelics are a group of drugs which act as agonists on the serotonin-2A (5-HT2A) receptor. Evidence suggests they may have a uniquely rapid and enduring positive effect on mood. However, marked heterogeneity between methodological designs in this emerging field remains a significant concern. AIMS To determine how differences in the type of psychedelic agent used and the number of dosing sessions administered affect subjects' depression and anxiety outcomes and adverse drug reactions (ADR). METHODS This review collected and screened 1591 records from the MEDLINE and Web of Science databases for clinical trials reporting objective data on mood for subjects with a known anxiety or depression. RESULTS After screening, nine clinical trials met inclusion criteria. Meta-analysis of these studies showed significant, large positive effect sizes for measures of anxiety (Cohen's d = 1.26) and depression (Cohen's d = 1.38) overall. These positive effects were also significant at acute (⩽1 week) and extended (>1 week) time points. No significant differences were observed between trials using different psychedelic agents (psilocybin, ayahuasca or lysergic acid diethylamide (LSD)), however, a significant difference was observed in favour of trials with multiple dosing sessions. No serious ADR were reported. CONCLUSION Psilocybin, ayahuasca and LSD all appear to be effective and relatively safe agents capable of producing rapid and sustained improvements in anxiety and depression. Moreover, the findings of the present analysis suggest that they may show a greater efficacy when given to patients over multiple sessions as compared to the more common single session used in many of the existing trials.
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Affiliation(s)
- Robert F Leger
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ellen M Unterwald
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Kelly JR, Gillan CM, Prenderville J, Kelly C, Harkin A, Clarke G, O'Keane V. Psychedelic Therapy's Transdiagnostic Effects: A Research Domain Criteria (RDoC) Perspective. Front Psychiatry 2021; 12:800072. [PMID: 34975593 PMCID: PMC8718877 DOI: 10.3389/fpsyt.2021.800072] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022] Open
Abstract
Accumulating clinical evidence shows that psychedelic therapy, by synergistically combining psychopharmacology and psychological support, offers a promising transdiagnostic treatment strategy for a range of disorders with restricted and/or maladaptive habitual patterns of emotion, cognition and behavior, notably, depression (MDD), treatment resistant depression (TRD) and addiction disorders, but perhaps also anxiety disorders, obsessive-compulsive disorder (OCD), Post-Traumatic Stress Disorder (PTSD) and eating disorders. Despite the emergent transdiagnostic evidence, the specific clinical dimensions that psychedelics are efficacious for, and associated underlying neurobiological pathways, remain to be well-characterized. To this end, this review focuses on pre-clinical and clinical evidence of the acute and sustained therapeutic potential of psychedelic therapy in the context of a transdiagnostic dimensional systems framework. Focusing on the Research Domain Criteria (RDoC) as a template, we will describe the multimodal mechanisms underlying the transdiagnostic therapeutic effects of psychedelic therapy, traversing molecular, cellular and network levels. These levels will be mapped to the RDoC constructs of negative and positive valence systems, arousal regulation, social processing, cognitive and sensorimotor systems. In summarizing this literature and framing it transdiagnostically, we hope we can assist the field in moving toward a mechanistic understanding of how psychedelics work for patients and eventually toward a precise-personalized psychedelic therapy paradigm.
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Affiliation(s)
- John R. Kelly
- Department of Psychiatry, Trinity College, Dublin, Ireland
- Department of Psychiatry, Tallaght University Hospital, Dublin, Ireland
| | - Claire M. Gillan
- Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
- School of Psychology, Trinity College, Dublin, Ireland
- Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - Jack Prenderville
- Transpharmation Ireland Ltd, Institute of Neuroscience, Trinity College, Dublin, Ireland
- Discipline of Physiology, School of Medicine, Trinity College, Dublin, Ireland
| | - Clare Kelly
- Department of Psychiatry, Trinity College, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
- School of Psychology, Trinity College, Dublin, Ireland
| | - Andrew Harkin
- Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Gerard Clarke
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Veronica O'Keane
- Department of Psychiatry, Trinity College, Dublin, Ireland
- Department of Psychiatry, Tallaght University Hospital, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
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Beating Pain with Psychedelics: Matter over Mind? Neurosci Biobehav Rev 2021; 134:104482. [PMID: 34922987 DOI: 10.1016/j.neubiorev.2021.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 02/08/2023]
Abstract
Basic pain research has shed light on key cellular and molecular mechanisms underlying nociceptive and phenomenological aspects of pain. Despite these advances, [[we still yearn for] the discovery of novel therapeutic strategies to address the unmet needs of about 70% of chronic neuropathic pain patients whose pain fails to respond to opioids as well as to other conventional analgesic agents. Importantly, a substantial body of clinical observations over the past decade cumulatively suggests that the psychedelic class of drugs may possess heuristic value for understanding and treating chronic pain conditions. The present review presents a theoretical framework for hitherto insufficiently understood neuroscience-based mechanisms of psychedelics' potential analgesic effects. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain, analgesia, inflammatory, brain connectivity, ketamine, psilocybin, functional imaging, and dendrites. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) studies employing psychedelics for alleviation of physical and emotional pain; (2) potential neuro-restorative effects of psychedelics to remediate the impaired connectivity underlying the dissociation between pain-related conscious states/cognitions and the subcortical activity/function leading to the eventual chronicity through immediate and long-term effects on dentritic plasticity; (3) anti-neuroinflammatory and pro-immunomodulatory actions of psychedelics as the may pertain to the role of these factors in the pathogenesis of neuropathic pain; (4) safety, legal, and ethical consideration inherent in psychedelics' pharmacotherapy. In addition to direct beneficial effects in terms of reduction of pain and suffering, psychedelics' inclusion in the analgesic armamentarium will contribute to deeper and more sophisticated insights not only into pain syndromes but also into frequently comorbid psychiatric condition associated with emotional pain, e.g., depressive and anxiety disorders. Further inquiry is clearly warranted into the above areas that have potential to evolve into further elucidate the mechanisms of chronic pain and affective disorders, and lead to the development of innovative, safe, and more efficacious neurobiologically-based therapeutic approaches.
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Gutridge AM, Chakraborty S, Varga BR, Rhoda ES, French AR, Blaine AT, Royer QH, Cui H, Yuan J, Cassell RJ, Szabó M, Majumdar S, van Rijn RM. Evaluation of Kratom Opioid Derivatives as Potential Treatment Option for Alcohol Use Disorder. Front Pharmacol 2021; 12:764885. [PMID: 34803709 PMCID: PMC8596301 DOI: 10.3389/fphar.2021.764885] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose:Mitragyna speciosa extract and kratom alkaloids decrease alcohol consumption in mice at least in part through actions at the δ-opioid receptor (δOR). However, the most potent opioidergic kratom alkaloid, 7-hydroxymitragynine, exhibits rewarding properties and hyperlocomotion presumably due to preferred affinity for the mu opioid receptor (µOR). We hypothesized that opioidergic kratom alkaloids like paynantheine and speciogynine with reduced µOR potency could provide a starting point for developing opioids with an improved therapeutic window to treat alcohol use disorder. Experimental Approach: We characterized paynantheine, speciociliatine, and four novel kratom-derived analogs for their ability to bind and activate δOR, µOR, and κOR. Select opioids were assessed in behavioral assays in male C57BL/6N WT and δOR knockout mice. Key Results: Paynantheine (10 mg∙kg−1, i.p.) produced aversion in a limited conditioned place preference (CPP) paradigm but did not produce CPP with additional conditioning sessions. Paynantheine did not produce robust antinociception but did block morphine-induced antinociception and hyperlocomotion. Yet, at 10 and 30 mg∙kg−1 doses (i.p.), paynantheine did not counteract morphine CPP. 7-hydroxypaynantheine and 7-hydroxyspeciogynine displayed potency at δOR but limited µOR potency relative to 7-hydroxymitragynine in vitro, and dose-dependently decreased voluntary alcohol consumption in WT but not δOR in KO mice. 7-hydroxyspeciogynine has a maximally tolerated dose of at least 10 mg∙kg−1 (s.c.) at which it did not produce significant CPP neither alter general locomotion nor induce noticeable seizures. Conclusion and Implications: Derivatizing kratom alkaloids with the goal of enhancing δOR potency and reducing off-target effects could provide a pathway to develop novel lead compounds to treat alcohol use disorder with an improved therapeutic window.
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Affiliation(s)
- Anna M Gutridge
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, United States
| | - Soumen Chakraborty
- Center for Clinical Pharmacology, University of Heath Sciences and Pharmacy at St. Louis and Washington University School of Medicine, St. Louis, MO, United States
| | - Balazs R Varga
- Center for Clinical Pharmacology, University of Heath Sciences and Pharmacy at St. Louis and Washington University School of Medicine, St. Louis, MO, United States
| | - Elizabeth S Rhoda
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, United States
| | - Alexander R French
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, United States.,Purdue Institute for Integrative Neuroscience, West Lafayette, IN, United States
| | - Arryn T Blaine
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, United States
| | - Quinten H Royer
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, United States
| | - Haoyue Cui
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, United States
| | - Jinling Yuan
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, United States
| | - Robert J Cassell
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, United States.,Purdue Institute for Drug Discovery, West Lafayette, IN, United States
| | | | - Susruta Majumdar
- Center for Clinical Pharmacology, University of Heath Sciences and Pharmacy at St. Louis and Washington University School of Medicine, St. Louis, MO, United States
| | - Richard M van Rijn
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, United States.,Purdue Institute for Integrative Neuroscience, West Lafayette, IN, United States.,Purdue Institute for Drug Discovery, West Lafayette, IN, United States
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Deep Network Pharmacology: Targeting Glutamate Systems as Integrative Treatments for Jump-Starting Neural Networks and Recovery Trajectories. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6. [PMID: 34549091 PMCID: PMC8452258 DOI: 10.20900/jpbs.20210008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Significant advances in pharmacological treatments for mental illness and addiction will require abandoning old monoaminergic theories of psychiatric disorders and traditionally narrow approaches to how we conduct treatment research. Reframing our efforts with a view on integrative treatments that target core neural network function and plasticity may provide new approaches for lifting patients out of chronic psychiatric symptom sets and addiction. For example, we discuss new treatments that target brain glutamate systems at key transition points within longitudinal courses of care that integrate several treatment modalities. A reconsideration of what our novel and already available medications are intended to achieve and how and when we deliver them for patients with complex illness trajectories could be the key to unlocking new advances in general and addiction psychiatry.
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Psychedelic perceptions: mental health service user attitudes to psilocybin therapy. Ir J Med Sci 2021; 191:1385-1397. [PMID: 34131812 PMCID: PMC8205319 DOI: 10.1007/s11845-021-02668-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 12/18/2022]
Abstract
Introduction Despite the rapid advance of psychedelic science and possible translation of psychedelic therapy into the psychiatric clinic, very little is known about mental health service user attitudes. Objectives To explore mental health service user attitudes to psychedelics and psilocybin therapy. Methods A questionnaire capturing demographics, diagnoses, previous psychedelic and other drug use, and attitudes to psychedelics and psilocybin therapy was distributed to mental health service users. Results Ninety-nine participants completed the survey (52% female, mean age 42 years). The majority (72%) supported further research, with 59% supporting psilocybin as a medical treatment. A total of 27% previously used recreational psilocybin, with a male preponderance (p = 0.01). Younger age groups, those with previous psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin. A total of 55% of the total sample would accept as a treatment if doctor recommended, whereas 20% would not. Fewer people with depression/anxiety had used recreational psychedelics (p = 0.03) but were more likely to support government funded studies (p = 0.02). A minority (5%) of people with conditions (psychosis and bipolar disorder) that could be exacerbated by psilocybin thought it would be useful for them. One fifth of the total sample viewed psychedelics as addictive and unsafe even under medical supervision. Concerns included fear of adverse effects, lack of knowledge, insufficient research, illegality, and relapse if medications were discontinued. Conclusions The majority supported further research into psilocybin therapy. Younger people, those with previous recreational psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin therapy. Supplementary information The online version contains supplementary material available at 10.1007/s11845-021-02668-2.
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McCoy MT, Jayanthi S, Cadet JL. Potassium Channels and Their Potential Roles in Substance Use Disorders. Int J Mol Sci 2021; 22:1249. [PMID: 33513859 PMCID: PMC7865894 DOI: 10.3390/ijms22031249] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 01/12/2023] Open
Abstract
Substance use disorders (SUDs) are ubiquitous throughout the world. However, much remains to be done to develop pharmacotherapies that are very efficacious because the focus has been mostly on using dopaminergic agents or opioid agonists. Herein we discuss the potential of using potassium channel activators in SUD treatment because evidence has accumulated to support a role of these channels in the effects of rewarding drugs. Potassium channels regulate neuronal action potential via effects on threshold, burst firing, and firing frequency. They are located in brain regions identified as important for the behavioral responses to rewarding drugs. In addition, their expression profiles are influenced by administration of rewarding substances. Genetic studies have also implicated variants in genes that encode potassium channels. Importantly, administration of potassium agonists have been shown to reduce alcohol intake and to augment the behavioral effects of opioid drugs. Potassium channel expression is also increased in animals with reduced intake of methamphetamine. Together, these results support the idea of further investing in studies that focus on elucidating the role of potassium channels as targets for therapeutic interventions against SUDs.
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Affiliation(s)
| | | | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, NIDA Intramural Research Program, Baltimore, MD 21224, USA; (M.T.M.); (S.J.)
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