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Chaudhry S, Weisman AE, Hagen M, Pauli KLS, Tabaac BJ. Examining the influence of team-based learning on medical students' comprehension and attitudes regarding psychedelic therapies. DIALOGUES IN CLINICAL NEUROSCIENCE 2024; 26:56-63. [PMID: 39219339 PMCID: PMC11370688 DOI: 10.1080/19585969.2024.2398456] [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: 06/03/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION This study evaluates the impact of a two-hour team-based learning (TBL) curriculum on medical students' knowledge, comprehension, ethical understanding, and attitudes towards psychedelic therapies. METHODS Sixty-three pre-surveys and fifty post-surveys assessed students' perceived knowledge and attitudes using Likert scales. Forty-eight matched pre/post-knowledge tests with multiple-choice questions quantified changes in comprehension. The TBL approach featured independent learning, team readiness assessments, and application exercises. RESULTS Post-curriculum, students demonstrated significantly improved test scores (mean 41.4% increase, p < 0.0001) and more positive attitudes across 16 of 18 items (p ≤ 0.0495). Overall attitude scores increased 23% (p < 0.0001). Qualitative feedback reflected enhanced comfort discussing psychedelics clinically. While some students expressed support for psychedelic-assisted therapy, others cited reservations. DISCUSSION This innovative curriculum bridged an important education gap given the increasing relevance of psychedelic medicine. Findings suggest TBL enhances medical student preparedness in this emerging field. Continued curricular development is warranted to ensure proper psychedelic education aligns with patient needs and legislative policies. As psychedelic research progresses, maintaining instructional excellence is crucial for future healthcare professionals.
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Affiliation(s)
- Shiven Chaudhry
- Benessair Health, Paradise Valley, AZ, USA
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, USA
| | - Anne E. Weisman
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, USA
| | - Molly Hagen
- Public Health, University of Nevada, Reno, Reno, NV, USA
- School of Medicine, University of Nevada, Reno, Reno, NV, USA
| | | | - Burton J. Tabaac
- School of Medicine, University of Nevada, Reno, Reno, NV, USA
- Department of Neurology, Carson Tahoe Health, Carson City, NV, USA
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Kuiper H, Alley C, Harris Z, Kuiper Rauch C, Robbins M, Rodriguez P, Tomczak P, Urrutia J, Magar V. Psychedelic public health: State of the field and implications for equity. Soc Sci Med 2024; 357:117134. [PMID: 39173415 DOI: 10.1016/j.socscimed.2024.117134] [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: 03/15/2024] [Revised: 05/17/2024] [Accepted: 07/11/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Psychedelic Public Health is an emerging discipline uniting the practices of public health with the potential benefits of psychedelics to reduce harm and promote health, wellness, and equity at community and population levels. Little is known regarding the current state of psychedelic public health despite rising psychedelic usage, evidence of its health efficacy, opening policy environments, and concerns regarding equity and potential harms. METHODS To characterize the current state of psychedelic public health, this survey reviewed relevant webpages from 228 universities housing accredited Schools and Programs in Public Health (SPPHs) and 59 Psychedelic Research Centers (PRCs) in the US and globally. The scan corresponded to the Prisma 2020 checklist, identifying URLs through keyword searches by Beautiful Soup python package and Google search engine web application. Measures were coded through webpage text analysis. FINDINGS Fewer than 10% (9.6%) of SPPHs engaged with psychedelics (2.6% substantially), while half (52.6%) of universities engaged (28.1% substantially). Among PRCs, only 10% indicated a collaboration with SPPHs, and fewer than 3% of PRC personnel held public health degrees. PRCs were preponderantly affiliated with medical schools. Although Indigeneity significantly contributes to Western therapeutic psychedelic protocols, only approximately one-quarter of active universities, SPPHs, or PRCs visibly addressed Indigeneity and only one PRC included Indigenous leadership. 92% of PRCs were led or co-led by people characterized as White-European and 88% by men. Only 20-43% of SPPHs, universities, and PRCs visibly addressed social determinants of health. CONCLUSIONS Public health schools, which train, study, and advise the future of public health, showed limited involvement in the growing psychedelic field, signifying a gap in psychedelic science and practice. The absence of public health's population-level approaches signifies a missed opportunity to maximize benefits and protect against potential harms of psychedelics at community and population levels.
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Affiliation(s)
| | - Chris Alley
- Center for Psychedelic Public Health, USA; New York University, School of Global Public Health, Department of Social and Behavioral Sciences, USA
| | - Zoë Harris
- University of Illinois, Department of Community Health Sciences, Chicago, USA
| | | | - Marlena Robbins
- University of California at Berkeley, School of Public Health, USA; University of California at Berkeley, Center for the Science of Psychedelics, USA
| | | | - Paula Tomczak
- George Washington University, School of Nursing, USA
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Lewis-Healey E, Tagliazucchi E, Canales-Johnson A, Bekinschtein TA. Breathwork-induced psychedelic experiences modulate neural dynamics. Cereb Cortex 2024; 34:bhae347. [PMID: 39191666 DOI: 10.1093/cercor/bhae347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/01/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
Breathwork is an understudied school of practices involving intentional respiratory modulation to induce an altered state of consciousness (ASC). We simultaneously investigate the phenomenological and neural dynamics of breathwork by combining Temporal Experience Tracing, a quantitative methodology that preserves the temporal dynamics of subjective experience, with low-density portable EEG devices. Fourteen novice participants completed a course of up to 28 breathwork sessions-of 20, 40, or 60 min-in 28 days, yielding a neurophenomenological dataset of 301 breathwork sessions. Using hypothesis-driven and data-driven approaches, we found that "psychedelic-like" subjective experiences were associated with increased neural Lempel-Ziv complexity during breathwork. Exploratory analyses showed that the aperiodic exponent of the power spectral density-but not oscillatory alpha power-yielded similar neurophenomenological associations. Non-linear neural features, like complexity and the aperiodic exponent, neurally map both a multidimensional data-driven composite of positive experiences, and hypothesis-driven aspects of psychedelic-like experience states such as high bliss.
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Affiliation(s)
- Evan Lewis-Healey
- Cambridge Consciousness and Cognition Lab, Department of Psychology, Downing Place, University of Cambridge, Cambridge, CB2 3EB, United Kingdom
| | - Enzo Tagliazucchi
- Consciousness, Culture and Complexity Lab, Department of Physics, Pabellón I, University of Buenos Aires, 1428, Buenos Aires, Argentina
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibanez, Santiago, 7910000, Chile
- Cognitive Neuroscience Center, Universidad de San Andrés, Vito Dumas 284, B1644BID Victoria, Provincia de Buenos Aires, Argentina
| | - Andres Canales-Johnson
- Cambridge Consciousness and Cognition Lab, Department of Psychology, Downing Place, University of Cambridge, Cambridge, CB2 3EB, United Kingdom
- The Neuropsychology and Cognitive Neurosciences Research Center, Faculty of Health Sciences, Universidad Católica del Maule, 3460000, Talca, Chile
| | - Tristan A Bekinschtein
- Cambridge Consciousness and Cognition Lab, Department of Psychology, Downing Place, University of Cambridge, Cambridge, CB2 3EB, United Kingdom
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Xie L, Liu X, Yao Y, Tan B, Su R. Serine 3.39 and isoleucine 4.60 are key sites for 5-HT 2AR-mediated G s signaling. FEBS Lett 2024; 598:1783-1791. [PMID: 38757247 DOI: 10.1002/1873-3468.14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/25/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
Certain amino acid sites of 5-HT2AR play crucial roles in interacting with various G proteins. Hallucinogens and non-hallucinogens both act on 5-HT2AR but mediate different pharmacological effects, possibly due to the coupling of different G proteins. Therefore, this study identified the binding sites of hallucinogens and non-hallucinogens with 5-HT2AR through molecular docking. We conducted site mutation to examine the impact of these sites on G proteins, in order to find out the sites that can distinguish the pharmacological effects of hallucinogens and non-hallucinogens. Our results indicate that I4.60A and S3.39A did not affect the ability of hallucinogens to activate Gq signaling, but significantly reduced Gs signaling activation by hallucinogens. These results suggest that S3.39 and I4.60 are important for the activation of Gs signaling by hallucinogens.
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Affiliation(s)
- Lulu Xie
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, China
- Shenyang Pharmaceutical University, China
| | - Xiaoqian Liu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, China
| | - Yishan Yao
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, China
| | - Bo Tan
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, China
| | - Ruibin Su
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, China
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Ramos L, Vicente SG. The effects of psilocybin on cognition and emotional processing in healthy adults and adults with depression: a systematic literature review. J Clin Exp Neuropsychol 2024; 46:393-421. [PMID: 38842300 DOI: 10.1080/13803395.2024.2363343] [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: 10/30/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Psilocybin, a naturally occurring serotonergic agonist in some mushroom species, has shown promise as a novel, fast-acting pharmacotherapy seeking to overcome the limitations of conventional first-line antidepressants. Studying psilocybin effects on cognition and emotional processing may help to clarify the mechanisms underlying the therapeutic potential of psilocybin and may also support studies with people suffering from depression. Thus, this review aims to provide a comprehensive overview of the current literature regarding the effects of psilocybin on these two key areas in both healthy and depressed populations. METHOD A systematic search was performed on 29 January 2024, in the PubMed, EBSCOhost, Web of Science and SCOPUS databases. After duplicates removal, study selection was conducted considering pre-specified criteria. Data extraction was then performed. The quality assessment of the studies was carried out using the Cochrane Collaboration tools for randomized (RoB 2.0) and non-randomized (ROBINS-I) controlled trials. RESULTS Twenty articles were included, with 18 targeting healthy adults and two adults with depression. Results point to impairments within attentional and inhibitory processes, and improvements in the domains of creativity and social cognition in healthy individuals. In the population with depression, only cognitive flexibility and emotional recognition were affected, both being enhanced. The comparison of outcomes from both populations proved limited. CONCLUSIONS Psilocybin acutely alters several cognitive domains, with a localized rather than global focus, in a dose- and time-dependent manner. However, the significant methodological constraints call for further research, in the context of depression and with standardized protocols, with longitudinal studies also imperative.
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Affiliation(s)
- Laura Ramos
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Selene G Vicente
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
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Lasch A, Schweikert T, Dora E, Kolb T, Schurig HL, Walther A. [Psilocybin-Assisted Treatment of Depression, Anxiety and Substance use Disorders: Neurobiological Basis and Clinical Application]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:230-245. [PMID: 37207669 DOI: 10.1055/a-2046-5202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Successful therapy of mental disorders is very important in view of the high level of suffering of those affected. Since established pharmaceutical and psychotherapeutic approaches do not lead to the desired improvement in all cases, complementary or alternative treatment methods are intensively researched. Psilocybin-assisted psychotherapy seems particularly promising, and has been approved in the USA for larger clinical trials. Psilocybin belongs to the group of psychedelics and influences psychological experiences. In assisted therapy, psilocybin is administered in controlled doses under medical supervision to patients with different mental disorders. In the studies conducted so far, longer-term positive effects could be shown after just one or a few doses. In order to provide a better understanding of the potential therapeutic mechanisms, this article will first describe neurobiological and psychological effects of psilocybin. To better assess the potential of psilocybin-assisted psychotherapy for various disorders, clinical studies conducted so far with patients administered psilocybin are reviewed.
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Affiliation(s)
- Anna Lasch
- Biopsychologie, Technische Universität Dresden, Dresden, Germany
| | - Timo Schweikert
- Psychotherapie und Systemneurowissenschaften, Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Eva Dora
- Biopsychologie, Technische Universität Dresden, Dresden, Germany
| | - Theresa Kolb
- Universitätsklinikum Carl Gustav Carus Dresden, Division Psychological and Social Medicine and Developmental Neuroscience, Dresden, Germany
| | - Hanne Lilian Schurig
- Universitätsklinikum Carl Gustav Carus Dresden, Division Psychological and Social Medicine and Developmental Neuroscience, Dresden, Germany
| | - Andreas Walther
- Klinische Psychologie und Psychotherapie, Universität Zürich Psychologisches Institut, Zurich, Switzerland
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Žuljević MF, Breški N, Kaliterna M, Hren D. Attitudes of European psychiatrists on psychedelics: a qualitative study. Front Psychiatry 2024; 15:1411234. [PMID: 38855648 PMCID: PMC11157110 DOI: 10.3389/fpsyt.2024.1411234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction and aim It is important to understand how mental health practitioners view recent findings on psychedelic-assisted psychotherapy (PAP) as there is potential this treatment may be incorporated into clinical practice. The aim of our study was to explore how psychiatrists who are not involved in psychedelic research and who are located in the European region perceive psychedelics and PAP. Methods We conducted online semi-structured interviews with 12 psychiatry specialists and psychiatry trainees from 8 European countries. Data were analyzed using a general inductive approach informed by codebook thematic analysis. Results Based on the interviews, we developed four main themes and 14 sub-themes, including (1) Psychedelics hold potential, (2) Psychedelics are dangerous, (3) Future of psychedelics is uncertain, and (4) Psychiatry is ambivalent toward psychedelics. Discussion Our respondents-psychiatrists acknowledged the potential of PAP but remained cautious and did not yet perceive its evidence base as robust enough. Education on psychedelics is lacking in medical and psychiatric training and should be improved to facilitate the involvement of mental health experts in decision-making on PAP.
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Affiliation(s)
- Marija Franka Žuljević
- Department of Medical Humanities, School of Medicine, University of Split, Split, Croatia
| | - Nando Breški
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
| | - Mariano Kaliterna
- Department of Medical Humanities, School of Medicine, University of Split, Split, Croatia
| | - Darko Hren
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
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Atiq MA, Baker MR, Voort JLV, Vargas MV, Choi DS. Disentangling the acute subjective effects of classic psychedelics from their enduring therapeutic properties. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06599-5. [PMID: 38743110 DOI: 10.1007/s00213-024-06599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Recent research with classic psychedelics suggests significant therapeutic potential, particularly for neuropsychiatric disorders. A mediating influence behind symptom resolution is thought to be the personal insight - at times, bordering on the mystical - one acquires during the acute phase of a psychedelic session. Indeed, current clinical trials have found strong correlations between the acute subjective effects (ASE) under the influence of psychedelics and their enduring therapeutic properties. However, with potential barriers to widespread clinical implementation, including the healthcare resource-intensive nature of psychedelic sessions and the exclusion of certain at-risk patient groups, there is an active search to determine whether ASE elimination can be accompanied by the retention of persisting therapeutic benefits of these class of compounds. Recognizing the aberrant underlying neural circuitry that characterizes a range of neuropsychiatric disorders, and that classic psychedelics promote neuroplastic changes that may correct abnormal circuitry, investigators are rushing to design and discover compounds with psychoplastogenic, but not hallucinogenic (i.e., ASE), therapeutic potential. These efforts have paved the discovery of 'non-psychedelic/subjective psychedelics', or compounds that lack hallucinogenic activity but with therapeutic efficacy in preclinical models. This review aims to distill the current evidence - both clinical and preclinical - surrounding the question: can the ASE of classic psychedelics be dissociated from their sustained therapeutic properties? Several plausible clinical scenarios are then proposed to offer clarity on and potentially answer this question.
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Affiliation(s)
- Mazen A Atiq
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Matthew R Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Maxemiliano V Vargas
- Institute for Psychedelics and Neurotherapeutics, University of California, Davis, Davis, CA, USA
| | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Yu Z, Burback L, Winkler O, Xu L, Dennett L, Vermetten E, Greenshaw A, Li XM, Milne M, Wang F, Cao B, Winship IR, Zhang Y, Chan AW. Alterations in brain network connectivity and subjective experience induced by psychedelics: a scoping review. Front Psychiatry 2024; 15:1386321. [PMID: 38807690 PMCID: PMC11131165 DOI: 10.3389/fpsyt.2024.1386321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/23/2024] [Indexed: 05/30/2024] Open
Abstract
Intense interest surrounds current research on psychedelics, particularly regarding their potential in treating mental health disorders. Various studies suggest a link between the subjective effects produced by psychedelics and their therapeutic efficacy. Neuroimaging evidence indicates an association of changes in brain functional connectivity with the subjective effects of psychedelics. We conducted a review focusing on psychedelics and brain functional connectivity. The review focused on four psychedelic drugs: ayahuasca, psilocybin and LSD, and the entactogen MDMA. We conducted searches in databases of MEDLINE, Embase, APA PsycInfo and Scopus from inception to Jun 2023 by keywords related to functional connectivity and psychedelics. Using the PRISMA framework, we selected 24 articles from an initial pool of 492 for analysis. This scoping review and analysis investigated the effects of psychedelics on subjective experiences and brain functional connectivity in healthy individuals. The studies quantified subjective effects through psychometric scales, revealing significant experiences of altered consciousness, mood elevation, and mystical experiences induced by psychedelics. Neuroimaging results indicated alterations in the functional connectivity of psychedelics, with consistent findings across substances of decreased connectivity within the default mode network and increased sensory and thalamocortical connectivity. Correlations between these neurophysiological changes and subjective experiences were noted, suggesting a brain network basis of the psychedelics' neuropsychological impact. While the result of the review provides a potential neural mechanism of the subjective effects of psychedelics, direct clinical evidence is needed to advance their clinical outcomes. Our research serves as a foundation for further exploration of the therapeutic potential of psychedelics.
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Affiliation(s)
- Zijia Yu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Lujie Xu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Centre, Leiden, Netherlands
| | - Andrew Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Xin-Min Li
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Michaela Milne
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Institute of Human Nutrition at the Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Fei Wang
- Nanjing Medical University Affiliated Brain Hospital, Nanjing, Jiangsu, China
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Ian R. Winship
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Yanbo Zhang
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Allen W. Chan
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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Sjöström DK, Claesdotter-Knutsson E, Kajonius PJ. Personality traits explain the relationship between psychedelic use and less depression in a comparative study. Sci Rep 2024; 14:10195. [PMID: 38702496 PMCID: PMC11068892 DOI: 10.1038/s41598-024-60890-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
Interest in psychedelics is increasing due to the potential for improved mental health and quality of life. However, adverse effects on mental health are still a concern. Personality traits have been suggested to both influence the psychedelic experience and mental health, and even be changed by psychedelic use. The present study describes for the first time a national sample of Swedish psychedelic users (n = 400) compared to a sex and age-matched control-group of non-users (n = 400) regarding mental health variables (depression, insomnia, problematic alcohol and drug use, and dissociation) and personality (Big Five). Data was collected in an online survey including individuals from 16 years of age who had at least one psychedelic experience. The main results reported psychedelic users as less depressed (Patient Health Questionnaire-9; PHQ-9) (d = - 0.29) and having more use of drugs (Drug Use Disorders Identification Test; DUDIT) (d = 1.27). In the Big Five personality traits, openness differed notably (d = 1.72), and the between-group effects in PHQ-9 were explained by lower neuroticism. Our findings reveal that psychedelic users report less depression and higher drug use, and this is partly due to personality traits. These results have implications on how we view psychedelic users and the use of psychedelic drugs.
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Affiliation(s)
- David K Sjöström
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Emma Claesdotter-Knutsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Region Skåne, Child and Adolescent Psychiatry, Regional Outpatient Care, Lund University Hospital, Lund, Sweden
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Wolff M, Evens R, Mertens LJ, Schmidt C, Beck J, Rutrecht H, Cherniak AD, Gründer G, Jungaberle H. Measuring psychotherapeutic processes in the context of psychedelic experiences: Validation of the General Change Mechanisms Questionnaire (GCMQ). J Psychopharmacol 2024; 38:432-457. [PMID: 38742761 PMCID: PMC11102652 DOI: 10.1177/02698811241249698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Therapeutic and salutogenic effects of psychedelic drugs have been attributed to psychotherapeutic or psychotherapy-like processes that can unfold during the acute psychedelic experience and beyond. Currently, there are no psychometric instruments available to comprehensively assess psychotherapeutic processes (as conceptualized by empirical psychotherapy research) in the context of psychedelic experiences. AIMS We report the initial validation of the General Change Mechanisms Questionnaire (GCMQ), a self-report instrument designed to measure five empirically established general change mechanisms (GCMs) of psychotherapy-(1) resource activation, (2) therapeutic relationship, (3) problem actuation, (4) clarification, and (5) mastery-in the context of psychedelic experiences. METHODS An online survey in a sample of 1153 English-speaking and 714 German-speaking psychedelic users was conducted to evaluate simultaneously developed English- and German-language versions of the GCMQ. RESULTS The theory-based factor structure was confirmed. The five GCMQ scales showed good internal consistency. Evidence for convergent validity with external measures was obtained. Significant associations with different settings and with therapeutic, hedonic, and escapist use motives confirmed the hypothesized context dependence of GCM-related psychedelic experiences. Indicating potential therapeutic effects, the association between cumulative stressful life events and well-being was significantly moderated by resource activation, clarification, and mastery. Factor mixture modeling revealed five distinct profiles of GCM-related psychedelic experiences. CONCLUSION Initial testing indicates that the GCMQ is a valid and reliable instrument that can be used in future clinical and nonclinical psychedelic research. The five identified profiles of GCM-related experiences may be relevant to clinical uses of psychedelics and psychedelic harm reduction.
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Affiliation(s)
- Max Wolff
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- MIND Foundation, Berlin, Germany
| | - Ricarda Evens
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lea J Mertens
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Jessica Beck
- MIND Foundation, Berlin, Germany
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | | | - Aaron D Cherniak
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychology, Reichman University, Herzliya, Israel
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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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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Shafiee A, Arabzadeh Bahri R, Rafiei MA, Esmaeilpur Abianeh F, Razmara P, Jafarabady K, Amini MJ. The effect of psychedelics on the level of brain-derived neurotrophic factor: A systematic review and meta-analysis. J Psychopharmacol 2024; 38:425-431. [PMID: 38385351 DOI: 10.1177/02698811241234247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Recent interest in the potential therapeutic effects of psychedelics has led to investigations into their influence on molecular signaling pathways within the brain. AIMS Integrated review and analysis of different studies in this field. METHODS A systematic search was conducted across international databases including Embase, Scopus, Web of Science, and PubMed from inception to 9 July 2023. Eligibility criteria encompassed published and peer-reviewed studies evaluating changes in brain-derived neurotrophic factor (BDNF) levels after psychedelic consumption. OUTCOMES A total of nine studies were included in our study. The meta-analysis demonstrated significantly higher BDNF levels in psychedelic consumers compared to healthy controls, with a pooled standardized mean difference of 0.26 (95% CI: 0.10-0.42, I2 = 38.51%, p < 0.001). Leave-one-out analysis indicated robustness in results upon removal of individual psychedelics. No significant publication bias was observed. The results highlight the potential influence of psychedelics on neuroplasticity by altering BDNF levels. CONCLUSIONS More precisely, the documented rise in BDNF levels indicates a neurobiological mechanism by which psychedelics could enhance synaptic plasticity and foster the growth of neurons. Given the limited data available on this topic, the conclusions remain uncertain. Consequently, we highly recommend additional research with more extensive sample sizes to yield more reliable evidence in this field.
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Affiliation(s)
- Arman Shafiee
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Department of Psychiatry and Mental Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Razman Arabzadeh Bahri
- Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Rafiei
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Parsa Razmara
- University of Southern California, Los Angeles, CA, USA
| | - Kyana Jafarabady
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Javad Amini
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Sloshower J, Zeifman RJ, Guss J, Krause R, Safi-Aghdam H, Pathania S, Pittman B, D'Souza DC. Psychological flexibility as a mechanism of change in psilocybin-assisted therapy for major depression: results from an exploratory placebo-controlled trial. Sci Rep 2024; 14:8833. [PMID: 38632313 PMCID: PMC11024097 DOI: 10.1038/s41598-024-58318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
Several phase II studies have demonstrated that psilocybin-assisted therapy shows therapeutic potential across a spectrum of neuropsychiatric conditions, including major depressive disorder (MDD). However, the mechanisms underlying its often persisting beneficial effects remain unclear. Observational research suggests that improvements in psychological flexibility may mediate therapeutic effects. However, no psychedelic trials to date have substantiated this finding in a clinical sample. In an exploratory placebo-controlled, within-subject, fixed-order study, individuals with moderate to severe MDD were administered placebo (n = 19) followed by psilocybin (0.3 mg/kg) (n = 15) 4 weeks later. Dosing sessions were embedded within a manualized psychotherapy that incorporated principles of Acceptance and Commitment Therapy. Depression severity, psychological flexibility, mindfulness, and values-congruent living were measured over a 16-weeks study period. Psychological flexibility, several facets of mindfulness, and values-congruent living significantly improved following psilocybin and were maintained through week 16. Additionally, improvements in psychological flexibility and experiential acceptance were strongly associated with reductions in depression severity following psilocybin. These findings support the theoretical premise of integrating psilocybin treatment with psychotherapeutic platforms that target psychological flexibility and add to emerging evidence that increasing psychological flexibility may be an important putative mechanism of change in psilocybin-assisted therapy for MDD and potentially, other mental health conditions.
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Affiliation(s)
- Jordan Sloshower
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.
- West Rock Wellness PLLC, New Haven, CT, USA.
| | - Richard J Zeifman
- NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jeffrey Guss
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert Krause
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Nursing, New Haven, CT, USA
- Centered PLLC, New Haven, CT, USA
| | - Hamideh Safi-Aghdam
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Surbhi Pathania
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
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15
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Wilkes R, Roberts DM, Liknaitzky P, Brett J. The psychedelic call: analysis of Australian Poisons Information Centre calls associated with classic psychedelics. Clin Toxicol (Phila) 2024; 62:242-247. [PMID: 38753585 DOI: 10.1080/15563650.2024.2346612] [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: 11/27/2023] [Accepted: 04/18/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The global use of certain classical psychedelics has increased in recent years, but little is known about their spectrum of toxicity within Australia. We aim to describe calls to New South Wales Poisons Information Centre relating to exposures to classical psychedelics including lysergic acid diethylamide, psilocybin, N,N-dimethyltryptamine, ayahuasca, mescaline and ibogaine. METHODS This is a retrospective observational study of calls to New South Wales Poisons Information Centre between January 2014 and December 2022. We identified exposures to classical psychedelics within New South Wales Poisons Information Centre database and measured the annual number of exposures, source of call (hospital, health care worker, member of the public), co-ingested substances, clinical features and advice given. RESULTS There were 737 calls related to relevant psychedelic exposures; 352 (47.8 per cent) to lysergic acid diethylamide, 347 (47.0 per cent) to psilocybin, 28 (3.8 per cent) to N,N-dimethyltryptamine, 4 (0.5 per cent) to ayahuasca, 4 (0.5 per cent) to mescaline and 2 (0.3 per cent) to ibogaine. Cases were predominantly male (77.2 per cent) and aged between 20 and 74 years (65.6 per cent). Psychedelic calls more than doubled from 45 in 2014 to 105 in 2022 and 625 (85 per cent) of all calls were either from or referred to hospital. Co-ingestion of psychedelics with another substance occurred in 249 (33.8 per cent) of calls and the most frequent clinical features related to single substance psychedelic exposures were hallucinations (27.6 per cent), gastrointestinal symptoms (21.7 per cent) and tachycardia (18.1 per cent). Seizures occurred in 2.9 per cent of single substance psychedelic exposures. DISCUSSION Increasing incidence of psychedelic exposure calls, including those reporting significant toxicity, likely reflects increasing community use. This may in part be driven by increasing interest in psychedelic assisted psychotherapy trials subsequently increasing public awareness. CONCLUSION Relatively high poisoning severity contrasts with safety within clinical trials of psychedelic assisted psychotherapy that may relate to the uncontrolled nature of community use which is mitigated within clinical trial environments. Education about safe use may be useful.
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Affiliation(s)
- Rachael Wilkes
- Emergency Department, St. Vincent's Hospital, Sydney, Australia
| | - Darren M Roberts
- Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
- New South Wales Poison's Information Centre, Sydney Children's Hospitals Network, Westmead, Sydney, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Paul Liknaitzky
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jonathan Brett
- New South Wales Poison's Information Centre, Sydney Children's Hospitals Network, Westmead, Sydney, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
- Medicines Intelligence and Health, School of Population Health, University of New South Wales, Australia
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16
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Tolle HM, Farah JC, Mallaroni P, Mason NL, Ramaekers JG, Amico E. The unique neural signature of your trip: Functional connectome fingerprints of subjective psilocybin experience. Netw Neurosci 2024; 8:203-225. [PMID: 38562294 PMCID: PMC10898784 DOI: 10.1162/netn_a_00349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/23/2023] [Indexed: 04/04/2024] Open
Abstract
The emerging neuroscientific frontier of brain fingerprinting has recently established that human functional connectomes (FCs) exhibit fingerprint-like idiosyncratic features, which map onto heterogeneously distributed behavioral traits. Here, we harness brain-fingerprinting tools to extract FC features that predict subjective drug experience induced by the psychedelic psilocybin. Specifically, in neuroimaging data of healthy volunteers under the acute influence of psilocybin or a placebo, we show that, post psilocybin administration, FCs become more idiosyncratic owing to greater intersubject dissimilarity. Moreover, whereas in placebo subjects idiosyncratic features are primarily found in the frontoparietal network, in psilocybin subjects they concentrate in the default mode network (DMN). Crucially, isolating the latter revealed an FC pattern that predicts subjective psilocybin experience and is characterized by reduced within-DMN and DMN-limbic connectivity, as well as increased connectivity between the DMN and attentional systems. Overall, these results contribute to bridging the gap between psilocybin-mediated effects on brain and behavior, while demonstrating the value of a brain-fingerprinting approach to pharmacological neuroimaging.
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Affiliation(s)
- Hanna M. Tolle
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Juan Carlos Farah
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Pablo Mallaroni
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Natasha L. Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Johannes G. Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Enrico Amico
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
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17
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Song-Smith C, Jacobs E, Rucker J, Saint M, Cooke J, Schlosser M. UK medical students' self-reported knowledge and harm assessment of psychedelics and their application in clinical research: a cross-sectional study. BMJ Open 2024; 14:e083595. [PMID: 38485474 PMCID: PMC10941112 DOI: 10.1136/bmjopen-2023-083595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To capture UK medical students' self-reported knowledge and harm assessment of psychedelics and to explore the factors associated with support for changing the legal status of psychedelics to facilitate further clinical research. DESIGN Cross-sectional, anonymous online survey of UK medical students using a non-random sampling method. SETTING UK medical schools recognised by the General Medical Council. PARTICIPANTS 132 medical students who had spent an average of 3.8 years (SD=1.4; range: 1-6) in medical school. RESULTS Most students (83%) reported that they were aware of psychedelic research and only four participants (3%) said that they were not interested in learning more about this type of research. Although medical students' harm assessment of psychedelics closely aligned with that of experts, only 17% of students felt well-educated on psychedelic research. Teachings on psychedelics were only rarely encountered in their curriculum (psilocybin: 14.1 (SD=19.9), scale: 0 (never) to 100 (very often)). Time spent at medical schools was not associated with more knowledge about psychedelics (r=0.12, p=0.129). On average, this sample of medical students showed strong support for changing the legal status of psychedelics to facilitate further research into their potential clinical applications (psilocybin: 80.2 (SD=24.8), scale: 0 (strongly oppose) to 100 (strongly support)). Regression modelling indicated that greater knowledge of psychedelics (p<0.001), lower estimated harm scores (p<0.001), more time spent in medical school (p=0.024) and lower perceived effectiveness of non-pharmacological mental health treatments (p=0.044) were associated with greater support for legal status change. CONCLUSIONS Our findings reveal a significant interest among UK medical students to learn more about psychedelic research and a strong support for further psychedelic research. Future studies are needed to examine how medical education could be refined to adequately prepare medical students for a changing healthcare landscape in which psychedelic-assisted therapy could soon be implemented in clinical practice.
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Affiliation(s)
| | - Edward Jacobs
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - James Rucker
- The Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Kent, UK
| | | | | | - Marco Schlosser
- Division of Psychiatry, UCL, London, UK
- Institut für Psychotherapie Potsdam, Potsdam, Germany
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18
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Barksdale BR, Doss MK, Fonzo GA, Nemeroff CB. The mechanistic divide in psychedelic neuroscience: An unbridgeable gap? Neurotherapeutics 2024; 21:e00322. [PMID: 38278658 DOI: 10.1016/j.neurot.2024.e00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024] Open
Abstract
In recent years, psychedelics have generated considerable excitement and interest as potential novel therapeutics for an array of conditions, with the most advanced evidence base in the treatment of certain severe and/or treatment-resistant psychiatric disorders. An array of clinical and pre-clinical evidence has informed our current understanding of how psychedelics produce profound alterations in consciousness. Mechanisms of psychedelic action include receptor binding and downstream cellular and transcriptional pathways, with long-term impacts on brain structure and function-from the level of single neurons to large-scale circuits. In this perspective, we first briefly review and synthesize separate lines of research on potential mechanistic processes underlying the acute and long-term effects of psychedelic compounds, with a particular emphasis on highlighting current theoretical models of psychedelic drug action and their relationships to therapeutic benefits for psychiatric and brain-based disorders. We then highlight an existing area of ongoing controversy we argue is directly informed by theoretical models originating from disparate levels of inquiry, and we ultimately converge on the notion that bridging the current chasm in explanatory models of psychedelic drug action across levels of inquiry (molecular, cellular, circuit, and psychological/behavioral) through innovative methods and collaborative efforts will ultimately yield the comprehensive understanding needed to fully capitalize on the potential therapeutic properties of these compounds.
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Affiliation(s)
- Bryan R Barksdale
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Manoj K Doss
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Gregory A Fonzo
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Charles B Nemeroff
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
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19
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Pagonabarraga J, Bejr-Kasem H, Martinez-Horta S, Kulisevsky J. Parkinson disease psychosis: from phenomenology to neurobiological mechanisms. Nat Rev Neurol 2024; 20:135-150. [PMID: 38225264 DOI: 10.1038/s41582-023-00918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/17/2024]
Abstract
Parkinson disease (PD) psychosis (PDP) is a spectrum of illusions, hallucinations and delusions that are associated with PD throughout its disease course. Psychotic phenomena can manifest from the earliest stages of PD and might follow a continuum from minor hallucinations to structured hallucinations and delusions. Initially, PDP was considered to be a complication associated with dopaminergic drug use. However, subsequent research has provided evidence that PDP arises from the progression of brain alterations caused by PD itself, coupled with the use of dopaminergic drugs. The combined dysfunction of attentional control systems, sensory processing, limbic structures, the default mode network and thalamocortical connections provides a conceptual framework to explain how new incoming stimuli are incorrectly categorized, and how aberrant hierarchical predictive processing can produce false percepts that intrude into the stream of consciousness. The past decade has seen the publication of new data on the phenomenology and neurobiological basis of PDP from the initial stages of the disease, as well as the neurotransmitter systems involved in PDP initiation and progression. In this Review, we discuss the latest clinical, neuroimaging and neurochemical evidence that could aid early identification of psychotic phenomena in PD and inform the discovery of new therapeutic targets and strategies.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
| | - Helena Bejr-Kasem
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Saul Martinez-Horta
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Jaime Kulisevsky
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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20
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Allen J, Dames SS, Foldi CJ, Shultz SR. Psychedelics for acquired brain injury: a review of molecular mechanisms and therapeutic potential. Mol Psychiatry 2024; 29:671-685. [PMID: 38177350 DOI: 10.1038/s41380-023-02360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024]
Abstract
Acquired brain injury (ABI), such as traumatic brain injury and stroke, is a leading cause of disability worldwide, resulting in debilitating acute and chronic symptoms, as well as an increased risk of developing neurological and neurodegenerative disorders. These symptoms can stem from various neurophysiological insults, including neuroinflammation, oxidative stress, imbalances in neurotransmission, and impaired neuroplasticity. Despite advancements in medical technology and treatment interventions, managing ABI remains a significant challenge. Emerging evidence suggests that psychedelics may rapidly improve neurobehavioral outcomes in patients with various disorders that share physiological similarities with ABI. However, research specifically focussed on psychedelics for ABI is limited. This narrative literature review explores the neurochemical properties of psychedelics as a therapeutic intervention for ABI, with a focus on serotonin receptors, sigma-1 receptors, and neurotrophic signalling associated with neuroprotection, neuroplasticity, and neuroinflammation. The promotion of neuronal growth, cell survival, and anti-inflammatory properties exhibited by psychedelics strongly supports their potential benefit in managing ABI. Further research and translational efforts are required to elucidate their therapeutic mechanisms of action and to evaluate their effectiveness in treating the acute and chronic phases of ABI.
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Affiliation(s)
- Josh Allen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Shannon S Dames
- Psychedelic-Assisted Therapy Post-Graduate Program, Health Sciences and Human Services, Vancouver Island University, Nanaimo, BC, Canada
| | - Claire J Foldi
- Department of Physiology, Monash University, Clayton, VIC, Australia
- Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- Centre for Trauma and Mental Health Research, Health Sciences and Human Services, Vancouver Island University, Nanaimo, BC, Canada.
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21
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Ledesma-Corvi S, Jornet-Plaza J, Gálvez-Melero L, García-Fuster MJ. Novel rapid treatment options for adolescent depression. Pharmacol Res 2024; 201:107085. [PMID: 38309382 DOI: 10.1016/j.phrs.2024.107085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/13/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
There is an urgent need for novel fast-acting antidepressants for adolescent treatment-resistant depression and/or suicidal risk, since the selective serotonin reuptake inhibitors that are clinically approved for that age (i.e., fluoxetine or escitalopram) take weeks to work. In this context, one of the main research lines of our group is to characterize at the preclinical level novel approaches for rapid-acting antidepressants for adolescence. The present review summarizes the potential use in adolescence of non-pharmacological options, such as neuromodulators (electroconvulsive therapy and other innovative types of brain stimulation), as well as pharmacological options, including consciousness-altering drugs (mainly ketamine but also classical psychedelics) and cannabinoids (i.e., cannabidiol), with promising fast-acting responses. Following a brief analytical explanation of adolescent depression, we present a general introduction for each therapeutical approach together with the clinical evidence supporting its potential beneficial use in adolescence (mainly extrapolated from prior successful examples for adults), to then report recent and/or ongoing preclinical studies that will aid in improving the inclusion of these therapies in the clinic, by considering potential sex-, age-, and dose-related differences, and/or other factors that might affect efficacy or long-term safety. Finally, we conclude the review by providing future avenues to maximize treatment response, including the need for more clinical studies and the importance of designing and/or testing novel treatment options that are safe and fast-acting for adolescent depression.
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Affiliation(s)
- Sandra Ledesma-Corvi
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Jordi Jornet-Plaza
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Laura Gálvez-Melero
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - M Julia García-Fuster
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Medicine, University of the Balearic Islands, Palma, Spain.
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22
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Fang S, Yang X, Zhang W. Efficacy and acceptability of psilocybin for primary or secondary depression: A systematic review and meta-analysis of randomized controlled trials. Front Psychiatry 2024; 15:1359088. [PMID: 38426002 PMCID: PMC10902050 DOI: 10.3389/fpsyt.2024.1359088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Psilocybin is a classic psychedelics, which has been shown to have antidepressant effects by many studies in recent years. In this study, we aim to evaluate the efficacy, acceptability and tolerability of psilocybin in the treatment of primary (major depressive disorder) or secondary (experiencing distress related to life-threatening diagnoses and terminal illness) depression. Methods We searched PubMed, EMBASE, Web of Science, Cochrane Library and ClinicalTrials.gov for clinical trials of psilocybin for depression (updated to 4 October, 2023). Effect size Hedges' g was used as an indicator of efficacy, and other outcomes included response rate, drop-out rate, and adverse events. Results A total of 10 studies were finally included in systematic review. 8 studies were included in the meta-analysis, involving a total of 524 adult patients, and produced a large effect size in favor of psilocybin (Hedge's g =-0.89, 95% CI -1.25~-0.53, I² = 70.19%, P<0.01). The therapeutic effects of psilocybin increase with increasing doses. Adverse events caused by psilocybin are generally transient and reversible, but serious adverse events also may occur. Discussion Our study shows that psilocybin has both short-term and long-term antidepressant effects and holds promise as a potential complementary or alternative therapy for depression, probably. Further research may reveal more about its therapeutic potential.
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Affiliation(s)
- Shuping Fang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Xin Yang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
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23
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Spotswood CJ. Psychedelics in Psychiatry, the Nursing Influence, and the Future of Psychedelic Therapies. J Am Psychiatr Nurses Assoc 2024:10783903231222930. [PMID: 38284395 DOI: 10.1177/10783903231222930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Psychedelics and psychedelic-assisted therapies (PATs) are on the cusp of becoming medicalized treatment modalities within the United States, both as potential U.S. Food and Drug Administration (FDA)-approved treatment and therapeutic options outside the medical model, through decriminalization efforts within individual states. Bringing with it a paradigm shift in the delivery of health care for both physical and mental health treatment. A workforce of highly trained facilitators will be needed to meet the anticipated demand for this type of treatment and nurses can play a key role in meeting this demand. This article serves to introduce psychedelic-assisted therapies to psychiatric-mental health nurses as we start to see this new field emerge. METHOD Review of published literature and other media. RESULTS Results based on historical data, modern applications, and future considerations. CONCLUSIONS Nurses have been involved with psychedelic-assisted therapies in the past and are fully capable of providing a wide range of roles upon the anticipated approval as a treatment modality.
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Affiliation(s)
- Carlton J Spotswood
- Carlton J. Spotswood, MSN, APRN, PMHNP-BC, MaineGeneral Medical Center, Augusta, ME, USA
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24
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Vanderijst L, Hever F, Buot A, Dauré C, Benoit J, Hanak C, Veeser J, Morgiève M, Campanella S, Kornreich C, Mallet L, Leys C, Noël X. Psilocybin-assisted therapy for severe alcohol use disorder: protocol for a double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial. BMC Psychiatry 2024; 24:77. [PMID: 38279085 PMCID: PMC10821548 DOI: 10.1186/s12888-024-05502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND A significant number of individuals with alcohol use disorder remain unresponsive to currently available treatments, which calls for the development of new alternatives. In parallel, psilocybin-assisted therapy for alcohol use disorder has recently yielded promising preliminary results. Building on extant findings, the proposed study is set to evaluate the feasibility and preliminary clinical efficacy of psilocybin-assisted therapy when incorporated as an auxiliary intervention during inpatient rehabilitation for severe alcohol use disorder. Moreover, it intends to pinpoint the modifications in the two core neurocognitive systems underscored by dual-process models of addiction. METHODS In this double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial, 62 participants aged 21-64 years will be enrolled to undergo psilocybin-assisted therapy as part of a 4-week inpatient rehabilitation for severe alcohol use disorder. The experimental group will receive a high dose of psilocybin (30 mg), whereas the control group will receive an active placebo dose of psilocybin (5 mg), both within the context of a brief standardized psychotherapeutic intervention drawing from key elements of acceptance and commitment therapy. The primary clinical outcome is the between-group difference regarding the change in percentage of heavy drinking days from baseline to four weeks posthospital discharge, while safety and feasibility metrics will also be reported as primary outcomes. Key secondary assessments include between-group differences in terms of changes in (1) drinking behavior parameters up to six months posthospital discharge, (2) symptoms of depression, anxiety, trauma, and global functioning, (3) neuroplasticity and key neurocognitive mechanisms associated with addiction, and (4) psychological processes and alcohol-related parameters. DISCUSSION The discussion outlines issues that might arise from our design. TRIAL REGISTRATION EudraCT 2022-002369-14 and NCT06160232.
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Affiliation(s)
- Laetitia Vanderijst
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium.
- Research Center for the Promotion of Health, Prosocial Behavior and Wellbeing, Faculty of Psychology, Université libre de Bruxelles, Brussels, Belgium.
| | - Felix Hever
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Anne Buot
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, Paris, France
| | - Charles Dauré
- Université de Paris, INSERM UMRS1144, 4 avenue de l'Observatoire, 75006, Paris, France
| | - Janaïna Benoit
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Catherine Hanak
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Johannes Veeser
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Margot Morgiève
- Université Paris Cité, CNRS, Inserm, Cermes3, F-75006, Paris, France
| | - Salvatore Campanella
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
| | - Charles Kornreich
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Luc Mallet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, Paris, France
- Département Médical-Universitaire de Psychiatrie et d'Addictologie, Univ Paris-Est Créteil, DMU IMPACT, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Christophe Leys
- Research Center for the Promotion of Health, Prosocial Behavior and Wellbeing, Faculty of Psychology, Université libre de Bruxelles, Brussels, Belgium
| | - Xavier Noël
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
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25
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Bradshaw AJ, Ramírez-Cruz V, Awan AR, Furci G, Guzmán-Dávalos L, Dentinger BTM. Phylogenomics of the psychoactive mushroom genus Psilocybe and evolution of the psilocybin biosynthetic gene cluster. Proc Natl Acad Sci U S A 2024; 121:e2311245121. [PMID: 38194448 PMCID: PMC10801892 DOI: 10.1073/pnas.2311245121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
Psychoactive mushrooms in the genus Psilocybe have immense cultural value and have been used for centuries in Mesoamerica. Despite the recent surge of interest in these mushrooms due to the psychotherapeutic potential of their natural alkaloid psilocybin, their phylogeny and taxonomy remain substantially incomplete. Moreover, the recent elucidation of the psilocybin biosynthetic gene cluster is known for only five of ~165 species of Psilocybe, four of which belong to only one of two major clades. We set out to improve the phylogeny of Psilocybe using shotgun sequencing of fungarium specimens, from which we obtained 71 metagenomes including from 23 types, and conducting phylogenomic analysis of 2,983 single-copy gene families to generate a fully supported phylogeny. Molecular clock analysis suggests the stem lineage of Psilocybe arose ~67 mya and diversified ~56 mya. We also show that psilocybin biosynthesis first arose in Psilocybe, with 4 to 5 possible horizontal transfers to other mushrooms between 40 and 9 mya. Moreover, predicted orthologs of the psilocybin biosynthetic genes revealed two distinct gene orders within the biosynthetic gene cluster that corresponds to a deep split within the genus, possibly a signature of two independent acquisitions of the cluster within Psilocybe.
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Affiliation(s)
- Alexander J. Bradshaw
- School of Biological Sciences, University of Utah, Salt Lake City, UT84112
- Natural History Museum of Utah, Collections and Research, University of Utah, Salt Lake City, UT84108
| | - Virginia Ramírez-Cruz
- Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONAHCYT), Departamento de Botánica y Zoología, Universidad de Guadalajara, Zapopan45147, Mexico
| | - Ali R. Awan
- Genomics Innovation Unit, Guy’s and St.Thomas’ NHS Foundation Trust, St Thomas’ Hospital, LondonSE1 7EH, United Kingdom
| | | | - Laura Guzmán-Dávalos
- Departamento de Botánica y Zoología, Universidad de Guadalajara, Zapopan45147, Mexico
| | - Bryn T. M. Dentinger
- School of Biological Sciences, University of Utah, Salt Lake City, UT84112
- Natural History Museum of Utah, Collections and Research, University of Utah, Salt Lake City, UT84108
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26
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Duan W, Cao D, Wang S, Cheng J. Serotonin 2A Receptor (5-HT 2AR) Agonists: Psychedelics and Non-Hallucinogenic Analogues as Emerging Antidepressants. Chem Rev 2024; 124:124-163. [PMID: 38033123 DOI: 10.1021/acs.chemrev.3c00375] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Psychedelics make up a group of psychoactive compounds that induce hallucinogenic effects by activating the serotonin 2A receptor (5-HT2AR). Clinical trials have demonstrated the traditional psychedelic substances like psilocybin as a class of rapid-acting and long-lasting antidepressants. However, there is a pressing need for rationally designed 5-HT2AR agonists that possess optimal pharmacological profiles in order to fully reveal the therapeutic potential of these agonists and identify safer drug candidates devoid of hallucinogenic effects. This Perspective provides an overview of the structure-activity relationships of existing 5-HT2AR agonists based on their chemical classifications and discusses recent advancements in understanding their molecular pharmacology at a structural level. The encouraging clinical outcomes of psychedelics in depression treatment have sparked drug discovery endeavors aimed at developing novel 5-HT2AR agonists with improved subtype selectivity and signaling bias properties, which could serve as safer and potentially nonhallucinogenic antidepressants. These efforts can be significantly expedited through the utilization of structure-based methods and functional selectivity-directed screening.
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Affiliation(s)
- Wenwen Duan
- iHuman Institute, ShanghaiTech University, 393 Middle Huaxia Road, Shanghai 201210, China
| | - Dongmei Cao
- State Key Laboratory of Molecular Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences; University of Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Sheng Wang
- State Key Laboratory of Molecular Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences; University of Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China
| | - Jianjun Cheng
- iHuman Institute, ShanghaiTech University, 393 Middle Huaxia Road, Shanghai 201210, China
- School of Life Science and Technology, ShanghaiTech University, 393 Middle Huaxia Road, Shanghai 201210, China
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27
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Luppi AI, Girn M, Rosas FE, Timmermann C, Roseman L, Erritzoe D, Nutt DJ, Stamatakis EA, Spreng RN, Xing L, Huttner WB, Carhart-Harris RL. A role for the serotonin 2A receptor in the expansion and functioning of human transmodal cortex. Brain 2024; 147:56-80. [PMID: 37703310 DOI: 10.1093/brain/awad311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023] Open
Abstract
Integrating independent but converging lines of research on brain function and neurodevelopment across scales, this article proposes that serotonin 2A receptor (5-HT2AR) signalling is an evolutionary and developmental driver and potent modulator of the macroscale functional organization of the human cerebral cortex. A wealth of evidence indicates that the anatomical and functional organization of the cortex follows a unimodal-to-transmodal gradient. Situated at the apex of this processing hierarchy-where it plays a central role in the integrative processes underpinning complex, human-defining cognition-the transmodal cortex has disproportionately expanded across human development and evolution. Notably, the adult human transmodal cortex is especially rich in 5-HT2AR expression and recent evidence suggests that, during early brain development, 5-HT2AR signalling on neural progenitor cells stimulates their proliferation-a critical process for evolutionarily-relevant cortical expansion. Drawing on multimodal neuroimaging and cross-species investigations, we argue that, by contributing to the expansion of the human cortex and being prevalent at the apex of its hierarchy in the adult brain, 5-HT2AR signalling plays a major role in both human cortical expansion and functioning. Owing to its unique excitatory and downstream cellular effects, neuronal 5-HT2AR agonism promotes neuroplasticity, learning and cognitive and psychological flexibility in a context-(hyper)sensitive manner with therapeutic potential. Overall, we delineate a dual role of 5-HT2ARs in enabling both the expansion and modulation of the human transmodal cortex.
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Affiliation(s)
- Andrea I Luppi
- Department of Clinical Neurosciences and Division of Anaesthesia, University of Cambridge, Cambridge, CB2 0QQ, UK
- Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, CB2 1SB, UK
- The Alan Turing Institute, London, NW1 2DB, UK
| | - Manesh Girn
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, H3A 2B4, Canada
- Psychedelics Division-Neuroscape, Department of Neurology, University of California SanFrancisco, San Francisco, CA 94158, USA
| | - Fernando E Rosas
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
- Data Science Institute, Imperial College London, London, SW7 2AZ, UK
- Centre for Complexity Science, Imperial College London, London, SW7 2AZ, UK
| | - Christopher Timmermann
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Leor Roseman
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - David J Nutt
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Emmanuel A Stamatakis
- Department of Clinical Neurosciences and Division of Anaesthesia, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - R Nathan Spreng
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, H3A 2B4, Canada
| | - Lei Xing
- Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, 01307, Germany
| | - Wieland B Huttner
- Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, 01307, Germany
| | - Robin L Carhart-Harris
- Psychedelics Division-Neuroscape, Department of Neurology, University of California SanFrancisco, San Francisco, CA 94158, USA
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
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28
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Ivan VE, Tomàs-Cuesta DP, Esteves IM, Curic D, Mohajerani M, McNaughton BL, Davidsen J, Gruber AJ. The Nonclassic Psychedelic Ibogaine Disrupts Cognitive Maps. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:275-283. [PMID: 38298796 PMCID: PMC10829624 DOI: 10.1016/j.bpsgos.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 02/02/2024] Open
Abstract
Background The ability of psychedelic compounds to profoundly alter mental function has been long known, but the underlying changes in cellular-level information encoding remain poorly understood. Methods We used two-photon microscopy to record from the retrosplenial cortex in head-fixed mice running on a treadmill before and after injection of the nonclassic psychedelic ibogaine (40 mg/kg intraperitoneally). Results We found that the cognitive map, formed by the representation of position encoded by ensembles of individual neurons in the retrosplenial cortex, was destabilized by ibogaine when mice had to infer position between tactile landmarks. This corresponded with increased neural activity rates, loss of correlation structure, and increased responses to cues. Ibogaine had surprisingly little effect on the size-frequency distribution of network activity events, suggesting that signal propagation within the retrosplenial cortex was largely unaffected. Conclusions Taken together, these data support proposals that compounds with psychedelic properties disrupt representations that are important for constraining neocortical activity, thereby increasing the entropy of neural signaling. Furthermore, the loss of expected position encoding between landmarks recapitulated effects of hippocampal impairment, suggesting that disruption of cognitive maps or other hippocampal processing may be a contributing mechanism of discoordinated neocortical activity in psychedelic states.
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Affiliation(s)
- Victorita E. Ivan
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - David P. Tomàs-Cuesta
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Ingrid M. Esteves
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Davor Curic
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Majid Mohajerani
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Bruce L. McNaughton
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, California
| | - Joern Davidsen
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Aaron J. Gruber
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
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29
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Affiliation(s)
- Eduardo Ekman Schenberg
- Instituto Phaneros, São Paulo, Brazil (Schenberg); Massachusetts General Hospital and Harvard Medical School, Boston (King); Psychotherapist in private practice, Lisbon (Fonseca); Department of Psychology, University of Exeter, Exter, United Kingdom; Centre for Psychedelic Research, Imperial College London, London (Roseman)
| | - Franklin King
- Instituto Phaneros, São Paulo, Brazil (Schenberg); Massachusetts General Hospital and Harvard Medical School, Boston (King); Psychotherapist in private practice, Lisbon (Fonseca); Department of Psychology, University of Exeter, Exter, United Kingdom; Centre for Psychedelic Research, Imperial College London, London (Roseman)
| | - João Eusébio da Fonseca
- Instituto Phaneros, São Paulo, Brazil (Schenberg); Massachusetts General Hospital and Harvard Medical School, Boston (King); Psychotherapist in private practice, Lisbon (Fonseca); Department of Psychology, University of Exeter, Exter, United Kingdom; Centre for Psychedelic Research, Imperial College London, London (Roseman)
| | - Leor Roseman
- Instituto Phaneros, São Paulo, Brazil (Schenberg); Massachusetts General Hospital and Harvard Medical School, Boston (King); Psychotherapist in private practice, Lisbon (Fonseca); Department of Psychology, University of Exeter, Exter, United Kingdom; Centre for Psychedelic Research, Imperial College London, London (Roseman)
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30
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Heifets BD, Olson DE. Therapeutic mechanisms of psychedelics and entactogens. Neuropsychopharmacology 2024; 49:104-118. [PMID: 37488282 PMCID: PMC10700553 DOI: 10.1038/s41386-023-01666-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
Recent clinical and preclinical evidence suggests that psychedelics and entactogens may produce both rapid and sustained therapeutic effects across several indications. Currently, there is a disconnect between how these compounds are used in the clinic and how they are studied in preclinical species, which has led to a gap in our mechanistic understanding of how these compounds might positively impact mental health. Human studies have emphasized extra-pharmacological factors that could modulate psychedelic-induced therapeutic responses including set, setting, and integration-factors that are poorly modelled in current animal experiments. In contrast, animal studies have focused on changes in neuronal activation and structural plasticity-outcomes that are challenging to measure in humans. Here, we describe several hypotheses that might explain how psychedelics rescue neuropsychiatric disease symptoms, and we propose ways to bridge the gap between human and rodent studies. Given the diverse pharmacological profiles of psychedelics and entactogens, we suggest that their rapid and sustained therapeutic mechanisms of action might best be described by the collection of circuits that they modulate rather than their actions at any single molecular target. Thus, approaches focusing on selective circuit modulation of behavioral phenotypes might prove more fruitful than target-based methods for identifying novel compounds with rapid and sustained therapeutic effects similar to psychedelics and entactogens.
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Affiliation(s)
- Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
| | - David E Olson
- Institute for Psychedelics and Neurotherapeutics, University of California, Davis, Davis, CA, 95616, USA.
- Department of Chemistry, University of California, Davis, Davis, CA, 95616, USA.
- Center for Neuroscience, University of California, Davis, Davis, CA, 95618, USA.
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, Sacramento, CA, 95817, USA.
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31
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Gukasyan N, Narayan SK. Menstrual Changes and Reversal of Amenorrhea Induced by Classic Psychedelics: A Case Series. J Psychoactive Drugs 2024; 56:50-55. [PMID: 36682064 DOI: 10.1080/02791072.2022.2157350] [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: 06/02/2022] [Revised: 08/30/2022] [Accepted: 09/23/2022] [Indexed: 01/23/2023]
Abstract
There has been little research on the effects of psychedelics on menstrual and reproductive function, though anecdotal evidence suggests that these compounds may have striking effects on menstrual function in at least a subset of users. Social media and word of mouth were used to seek out individuals who had a history of changes in menstrual function following psychedelic use. Case histories were elicited from three respondents following informed consent. A literature search on the effects of classic psychedelics and related compounds was completed. Three women ranging from 27 to 34 years of age were interviewed and reported three distinct phenomena following the use of classic psychedelics: 1) resumption of menses following amenorrhea, 2) early onset of menses, in particular when psychedelics were used in the mid to late luteal period, and 3) improved menstrual regularity in a woman with irregular cycles who was eventually diagnosed with polycystic ovarian syndrome. The mechanisms behind these effects remain unclear, though they may be mediated via direct or indirect effects of 5-HT2A agonism on the hypothalamic-pituitary-gonadal axis. Although phenomena related to menstrual and reproductive function have been largely overlooked in the psychedelic literature to date, these effects may have therapeutic utility and warrant further study.
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Affiliation(s)
- Natalie Gukasyan
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sasha K Narayan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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32
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Yaden DB, Berghella AP, Hendricks PS, Yaden ME, Levine M, Rohde JS, Nayak S, Johnson MW, Garcia-Romeu A. IUPHAR-review: The integration of classic psychedelics into current substance use disorder treatment models. Pharmacol Res 2024; 199:106998. [PMID: 38029805 DOI: 10.1016/j.phrs.2023.106998] [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: 07/12/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Substance use disorders (SUDs) have an enormous impact on public health. With classic psychedelic-assisted therapies showing initial promise in treating multiple SUDs, it is possible that these treatments will become legally available options for patients with SUDs in the future. This article highlights how classic psychedelic-assisted therapies might be integrated into current clinical practice. We first describe contemporary evidence-based treatments for SUDs and highlight how classic psychedelic-assisted therapies might fit within each treatment. We suggest that classic psychedelic-assisted therapies can be integrated into most mainstream evidence-based SUD treatments that are currently used in clinical settings, indicating broad compatibility of classic psychedelics with contemporary SUD treatment paradigms.
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Affiliation(s)
- David B Yaden
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Andrea P Berghella
- Thomas Jefferson University MD/PhD Program, Sidney Kimmel Medical College and Jefferson College of Life Sciences, Philadelphia, USA
| | - Peter S Hendricks
- School of Public Health, The University of Alabama at Birmingham, Birmingham, USA
| | - Mary E Yaden
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Michael Levine
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julia S Rohde
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sandeep Nayak
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Matthew W Johnson
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Albert Garcia-Romeu
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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Abstract
Cannabis and classic psychedelics are controlled substances with emerging evidence of efficacy in the treatment of a variety of psychiatric illnesses. Cannabis has largely not been regarded as having psychedelic effects in contemporary literature, despite many examples of historical use along with classic psychedelics to attain altered states of consciousness. Research into the "psychedelic" effects of cannabis, and delta-9-tetrahydrocannabinol (THC) in particular, could prove helpful for assessing potential therapeutic indications and elucidating the mechanism of action of both cannabis and classic psychedelics. This review aggregates and evaluates the literature assessing the capacity of cannabis to yield the perceptual changes, aversiveness, and mystical experiences more typically associated with classic psychedelics such as psilocybin. This review also provides a brief contrast of neuroimaging findings associated with the acute effects of cannabis and psychedelics. The available evidence suggests that high-THC cannabis may be able to elicit psychedelic effects, but that these effects may not have been observed in recent controlled research studies due to the doses, set, and settings commonly used. Research is needed to investigate the effects of high doses of THC in the context utilized in therapeutic studies of psychedelics aimed to occasion psychedelic and/or therapeutic experiences. If cannabis can reliably generate psychedelic experiences under these conditions, high-THC dose cannabis treatments should be explored as potential adjunctive treatments for psychiatric disorders and be considered as an active comparator in clinical trials involving traditional psychedelic medications.
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Affiliation(s)
- David Wolinsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Frederick Streeter Barrett
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychological & Brain Sciences, Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Madrid-Gambin F, Fabregat-Safont D, Gomez-Gomez A, Olesti E, Mason NL, Ramaekers JG, Pozo OJ. Present and future of metabolic and metabolomics studies focused on classical psychedelics in humans. Biomed Pharmacother 2023; 169:115775. [PMID: 37944438 DOI: 10.1016/j.biopha.2023.115775] [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: 08/07/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
Psychedelics are classical hallucinogen drugs that induce a marked altered state of consciousness. In recent years, there has been renewed attention to the possible use of classical psychedelics for the treatment of certain mental health disorders. However, further investigation to better understand their biological effects in humans, their mechanism of action, and their metabolism in humans is needed when considering the development of future novel therapeutic approaches. Both metabolic and metabolomics studies may help for these purposes. On one hand, metabolic studies aim to determine the main metabolites of the drug. On the other hand, the application of metabolomics in human psychedelics studies can help to further understand the biological processes underlying the psychedelic state and the mechanisms of action underlying their therapeutic potential. This review presents the state of the art of metabolic and metabolomic studies after lysergic acid diethylamide (LSD), mescaline, N,N-dimethyltryptamine (DMT) and β-carboline alkaloids (ayahuasca brew), 5-methoxy-DMT and psilocybin administrations in humans. We first describe the characteristics of the published research. Afterward, we reviewed the main results obtained by both metabolic and metabolomics (if available) studies in classical psychedelics and we found out that metabolic and metabolomics studies in psychedelics progress at two different speeds. Thus, whereas the main metabolites for classical psychedelics have been robustly established, the main metabolic alterations induced by psychedelics need to be explored. The integration of metabolomics and pharmacokinetics for investigating the molecular interaction between psychedelics and multiple targets may open new avenues in understanding the therapeutic role of psychedelics.
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Affiliation(s)
- Francisco Madrid-Gambin
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, 08003 Barcelona, Spain.
| | - David Fabregat-Safont
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, 08003 Barcelona, Spain; Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, 12071 Castelló, Spain
| | - Alex Gomez-Gomez
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, 08003 Barcelona, Spain; CERBA Internacional, Chromatography Department, 08203 Sabadell, Spain
| | - Eulàlia Olesti
- Department of Clinical Pharmacology, Area Medicament, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; Clinical Pharmacology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Natasha L Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, 6200 MD Maastricht, the Netherlands
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, 6200 MD Maastricht, the Netherlands
| | - Oscar J Pozo
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, 08003 Barcelona, Spain.
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35
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Wallach J, Cao AB, Calkins MM, Heim AJ, Lanham JK, Bonniwell EM, Hennessey JJ, Bock HA, Anderson EI, Sherwood AM, Morris H, de Klein R, Klein AK, Cuccurazzu B, Gamrat J, Fannana T, Zauhar R, Halberstadt AL, McCorvy JD. Identification of 5-HT 2A receptor signaling pathways associated with psychedelic potential. Nat Commun 2023; 14:8221. [PMID: 38102107 PMCID: PMC10724237 DOI: 10.1038/s41467-023-44016-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
Serotonergic psychedelics possess considerable therapeutic potential. Although 5-HT2A receptor activation mediates psychedelic effects, prototypical psychedelics activate both 5-HT2A-Gq/11 and β-arrestin2 transducers, making their respective roles unclear. To elucidate this, we develop a series of 5-HT2A-selective ligands with varying Gq efficacies, including β-arrestin-biased ligands. We show that 5-HT2A-Gq but not 5-HT2A-β-arrestin2 recruitment efficacy predicts psychedelic potential, assessed using head-twitch response (HTR) magnitude in male mice. We further show that disrupting Gq-PLC signaling attenuates the HTR and a threshold level of Gq activation is required to induce psychedelic-like effects, consistent with the fact that certain 5-HT2A partial agonists (e.g., lisuride) are non-psychedelic. Understanding the role of 5-HT2A Gq-efficacy in psychedelic-like psychopharmacology permits rational development of non-psychedelic 5-HT2A agonists. We also demonstrate that β-arrestin-biased 5-HT2A receptor agonists block psychedelic effects and induce receptor downregulation and tachyphylaxis. Overall, 5-HT2A receptor Gq-signaling can be fine-tuned to generate ligands distinct from classical psychedelics.
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Affiliation(s)
- Jason Wallach
- Department of Pharmaceutical Sciences, Saint Joseph's University, Philadelphia, PA, 19104, USA.
| | - Andrew B Cao
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Maggie M Calkins
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Andrew J Heim
- Department of Chemistry, Saint Joseph's University, Philadelphia, PA, 19104, USA
- Chemical Computing Group ULC, 910-1010 Sherbrooke W, Montréal, QC, H3A 2R7, Canada
| | - Janelle K Lanham
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Emma M Bonniwell
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Joseph J Hennessey
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Hailey A Bock
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Emilie I Anderson
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | | | - Hamilton Morris
- Department of Pharmaceutical Sciences, Saint Joseph's University, Philadelphia, PA, 19104, USA
| | - Robbin de Klein
- Research Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Adam K Klein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
- Gilgamesh Pharmaceuticals, New York, NY, 10003, USA
| | - Bruna Cuccurazzu
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - James Gamrat
- Department of Pharmaceutical Sciences, Saint Joseph's University, Philadelphia, PA, 19104, USA
| | - Tilka Fannana
- Department of Pharmaceutical Sciences, Saint Joseph's University, Philadelphia, PA, 19104, USA
| | - Randy Zauhar
- Department of Chemistry, Saint Joseph's University, Philadelphia, PA, 19104, USA
- Artemis Discovery, LLC, Suite 300, 709 N 2nd Street, Philadelphia, PA, 19123, USA
| | - Adam L Halberstadt
- Research Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA.
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
- Center for Psychedelic Research, University of California San Diego, La Jolla, CA, 92093, USA.
| | - John D McCorvy
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
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36
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Wirsching A, Bostoen T, Huizink AC. A Psychometric Evaluation of the Dutch Revised Mystical Experience Questionnaire. J Psychoactive Drugs 2023:1-11. [PMID: 37964603 DOI: 10.1080/02791072.2023.2272832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023]
Abstract
In the Netherlands, scientific interest in psychedelics and their subjective effects has been increasing. The present study examined the reliability, construct and predictive validity of the Dutch 30-item Revised Mystical Experience Questionnaire (MEQ30), a self-report measure that has been used to assess subjective and mystical experiences occasioned by psychedelics. In an online survey, 322 Dutch-speaking adults retrospectively reported on profound experiences with psychedelics. Confirmatory factor analyses demonstrated that both a four-factor structure and the same model extended with the MEQ30-total score as a second-order latent variable fit the data. Factor scores showed good internal reliability (α = between .81 and .94) and were significantly higher in participants that beforehand endorsed having had a mystical experience compared to those that did not, providing evidence for the construct validity of the questionnaire as a measure for self-reported mystical experiences. Additionally, MEQ30 scores significantly predicted the meaningfulness and spiritual significance of the psychedelic experience, as well as self-reported positive changes in well-being, life satisfaction and behavior, providing preliminary evidence for the predictive validity of the Dutch MEQ30. Findings suggest the reliability and validity of the Dutch MEQ30 and support the use of the scale in future studies on the subjective effects of psychedelics.
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Affiliation(s)
- A Wirsching
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
- Psychiatry department, Leiden University Medical Center, Leiden, The Netherlands
- ARQ National Psychotrauma Centre, Centrum '45, Oegstgeest, The Netherlands
| | - T Bostoen
- Psychiatry department, Leiden University Medical Center, Leiden, The Netherlands
- ARQ National Psychotrauma Centre, Centrum '45, Oegstgeest, The Netherlands
| | - A C Huizink
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
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37
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Žuljević MF, Mijatović A, Marušić SL, Kudrjavets G, Buljan I, Hren D. Mystical and Affective Aspects of Psychedelic Use in a Naturalistic Setting: A Linguistic Analysis of Online Experience Reports. J Psychoactive Drugs 2023:1-13. [PMID: 37921118 DOI: 10.1080/02791072.2023.2274382] [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: 05/11/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023]
Abstract
Analyzing online retrospective experience reports of psychedelic use can provide valuable insight into their acute subjective effects. Such reports are unexplored in relation to mystical states, which are thought to be a therapeutic mechanism within psychedelic-assisted psychotherapy. We created a set of words that, when encountered in an experience report, indicate the occurrence of mystical elements within the experience. We used the Shroomery.org website to retrieve 7317 publicly available retrospective psychedelic experience reports of psychedelic use, primarily of psilocybin, and have a designated experience intensity level self-assessed by the text authors during submission of the report. We counted the mystical language words using Linguistic Inquiry and Word Count (LIWC) software and additionally performed sentiment analysis of all reports. We found that the occurrence of mystical language grew with increased self-reported experience intensity. We also found that negative sentiment increased, and positive sentiment decreased as self-reported psychedelic experience intensity increased. These two findings raise the question of whether mystical experiences can co-exist with challenging elements within the psychedelic experience, a consideration for future qualitative studies. We present a new mystical language dictionary measure for further use and expansion, with some suggestions on how it can be used in future studies.
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Affiliation(s)
- Marija Franka Žuljević
- Department of Medical Humanities, School of Medicine, University of Split, Split, Croatia
| | - Antonija Mijatović
- Department of Research in Biomedicine and Health, School of Medicine, Split, Croatia
| | | | - Gunnar Kudrjavets
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - Ivan Buljan
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
| | - Darko Hren
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
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38
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Mendive F, Giovannetti C, García Arce S. Ancient medicine for a modern disease: traditional Amazonian medicine to treat substance use disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:691-704. [PMID: 37948338 DOI: 10.1080/00952990.2023.2264466] [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: 02/18/2023] [Accepted: 09/24/2023] [Indexed: 11/12/2023]
Abstract
Background: There exists an underexploited opportunity to develop innovative therapeutic approaches to SUDs based upon the complementarity between modern and traditional health systems.Objectives: Illustrate the feasibility and potentiality of such an approach through the comprehensive description of Takiwasi Center's treatment model and program, where health concepts and practices from traditional Amazonian medicine work synergistically with modern psychotherapy and medicine in an intercultural dialog to assist in the rehabilitation of people suffering from SUDs.Methods: The description was built from a review of the literature, institutional data, participatory observation and unstructured interviews with staff, researchers and patients during treatment.Results: Since the foundation of the Takiwasi Center in 1992 in the peruvian Amazon, more than a thousand patients with different socio-cultural, ethnic and religious backgrounds have received residential treatment. We present how traditional Amazonian medicine techniques and health concepts cooperate to complement modern psychology in a therapeutic community setting and propose some hypotheses about the neurobiological, psycho-emotional and spiritual healing mechanisms triggered by the program to help people identify and heal the roots of their substance misuse and addictive behavior. We also summarize quantitative outcomes during treatment showing significant improvements in a wide variety of mental health indicators.Conclusion: Takiwasi Center's program is an option for people seeking non-conventional treatment who are sensitive to traditional Amazonian medicine practices and ready to explore the roots of their addiction. From this intercultural approach, some lessons could emerge toward a broader understanding of SUDs that may result in better patient care.
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Affiliation(s)
| | - Cecile Giovannetti
- Institute of Tropical Medicine and International Health, Charite Universitat Medizin Berlin, Berlin, Germany
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39
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Kovacevich A, Weleff J, Claytor B, Barnett BS. Three Cases of Reported Improvement in Microsmia and Anosmia Following Naturalistic Use of Psilocybin and LSD. J Psychoactive Drugs 2023; 55:672-679. [PMID: 37650700 DOI: 10.1080/02791072.2023.2253538] [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: 04/17/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023]
Abstract
Cultural awareness of anosmia and microsmia has recently increased due to their association with COVID-19, though treatment for these conditions is limited. A growing body of online media claims that individuals have noticed improvement in anosmia and microsmia following classic psychedelic use. We report what we believe to be the first three cases recorded in the academic literature of improvement in olfactory impairment after psychedelic use. In the first case, a man who developed microsmia after a respiratory infection experienced improvement in smell after the use of 6 g of psilocybin containing mushrooms. In the second case, a woman with anosmia since childhood reported olfactory improvement after ingestion of 100 µg of lysergic acid diethylamide (LSD). In the third case, a woman with COVID-19-related anosmia reported olfactory improvement after microdosing 0.1 g of psilocybin mushrooms three times. Following a discussion of these cases, we explore potential mechanisms for psychedelic-facilitated improvement in olfactory impairment, including serotonergic effects, increased neuroplasticity, and anti-inflammatory effects. Given the need for novel treatments for olfactory dysfunction, increasing reports describing improvement in these conditions following psychedelic use and potential biological plausibility, we believe that the possible therapeutic benefits of psychedelics for these conditions deserve further investigation.
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Affiliation(s)
| | - Jeremy Weleff
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, USA
- Department of Psychiatry, Yale University School of Medicine, Cleveland, USA
| | | | - Brian S Barnett
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA
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40
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Rijsketic DR, Casey AB, Barbosa DAN, Zhang X, Hietamies TM, Ramirez-Ovalle G, Pomrenze MB, Halpern CH, Williams LM, Malenka RC, Heifets BD. UNRAVELing the synergistic effects of psilocybin and environment on brain-wide immediate early gene expression in mice. Neuropsychopharmacology 2023; 48:1798-1807. [PMID: 37248402 PMCID: PMC10579391 DOI: 10.1038/s41386-023-01613-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
The effects of context on the subjective experience of serotonergic psychedelics have not been fully examined in human neuroimaging studies, partly due to limitations of the imaging environment. Here, we administered saline or psilocybin to mice in their home cage or an enriched environment, immunofluorescently-labeled brain-wide c-Fos, and imaged iDISCO+ cleared tissue with light sheet fluorescence microscopy (LSFM) to examine the impact of environmental context on psilocybin-elicited neural activity at cellular resolution. Voxel-wise analysis of c-Fos-immunofluorescence revealed clusters of neural activity associated with main effects of context and psilocybin-treatment, which were validated with c-Fos+ cell density measurements. Psilocybin increased c-Fos expression in subregions of the neocortex, caudoputamen, central amygdala, and parasubthalamic nucleus while it decreased c-Fos in the hypothalamus, cortical amygdala, striatum, and pallidum in a predominantly context-independent manner. To gauge feasibility of future mechanistic studies on ensembles activated by psilocybin, we confirmed activity- and Cre-dependent genetic labeling in a subset of these neurons using TRAP2+/-;Ai14+ mice. Network analyses treating each psilocybin-sensitive cluster as a node indicated that psilocybin disrupted co-activity between highly correlated regions, reduced brain modularity, and dramatically attenuated intermodular co-activity. Overall, our results indicate that main effects of context and psilocybin were robust, widespread, and reorganized network architecture, whereas context×psilocybin interactions were surprisingly sparse.
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Affiliation(s)
- Daniel Ryskamp Rijsketic
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Austen B Casey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Daniel A N Barbosa
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Xue Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Tuuli M Hietamies
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Grecia Ramirez-Ovalle
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Matthew B Pomrenze
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Nancy Pritzker Laboratory, Stanford University, Stanford, CA, 94305, USA
| | - Casey H Halpern
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Robert C Malenka
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Nancy Pritzker Laboratory, Stanford University, Stanford, CA, 94305, USA
| | - Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
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41
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Gearin AK. Moving beyond a figurative psychedelic literacy: Metaphors of psychiatric symptoms in ayahuasca narratives. Soc Sci Med 2023; 334:116171. [PMID: 37639859 DOI: 10.1016/j.socscimed.2023.116171] [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: 05/30/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
Metaphors, analogies, and similes commonly appear in narratives of drinking the potent psychedelic "ayahuasca", presenting an intriguing transcultural pattern. Based upon survey and field research at an ayahuasca healing center in Pucallpa, Peru, the article investigates conceptual metaphors in narratives of ayahuasca experiences made by the visiting international guests. Bodily metaphors and visionary analogies frequently appear in narrative plots where they can express the reappraisal, overcoming, and sometimes emboldening of symptoms diagnosed by psychiatry. Moving beyond the literal-figurative divide, the article explores the intrinsic "metaphoricity" of psychedelic experiences and advocates for a literacy of conceptual metaphors regarding both clinical and non-clinical psychedelic narratives. Developing this literacy can broaden approaches in psychedelic psychiatry that analyze and treat syndromes and disorders, while also being applicable to social science and humanities research that examine psychoactive drug use beyond medical frameworks.
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Affiliation(s)
- Alex K Gearin
- Medical Ethics and Humanities Unit, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; Centre for Medical Ethics and Law, Faculty of Law and LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
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42
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Wallach J, Cao AB, Calkins MM, Heim AJ, Lanham JK, Bonniwell EM, Hennessey JJ, Bock HA, Anderson EI, Sherwood AM, Morris H, de Klein R, Klein AK, Cuccurazzu B, Gamrat J, Fannana T, Zauhar R, Halberstadt AL, McCorvy JD. Identification of 5-HT 2A Receptor Signaling Pathways Responsible for Psychedelic Potential. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.29.551106. [PMID: 37577474 PMCID: PMC10418054 DOI: 10.1101/2023.07.29.551106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Serotonergic psychedelics possess considerable therapeutic potential. Although 5-HT2A receptor activation mediates psychedelic effects, prototypical psychedelics activate both 5-HT2A-Gq/11 and β-arrestin2 signaling, making their respective roles unclear. To elucidate this, we developed a series of 5-HT2A-selective ligands with varying Gq efficacies, including β-arrestin-biased ligands. We show that 5-HT2A-Gq but not 5-HT2A-β-arrestin2 efficacy predicts psychedelic potential, assessed using head-twitch response (HTR) magnitude in male mice. We further show that disrupting Gq-PLC signaling attenuates the HTR and a threshold level of Gq activation is required to induce psychedelic-like effects, consistent with the fact that certain 5-HT2A partial agonists (e.g., lisuride) are non-psychedelic. Understanding the role of 5-HT2A-Gq efficacy in psychedelic-like psychopharmacology permits rational development of non-psychedelic 5-HT2A agonists. We also demonstrate that β-arrestin-biased 5-HT2A receptor agonists induce receptor downregulation and tachyphylaxis, and have an anti-psychotic-like behavioral profile. Overall, 5-HT2A receptor signaling can be fine-tuned to generate ligands with properties distinct from classical psychedelics.
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Affiliation(s)
- Jason Wallach
- Department of Pharmaceutical Sciences, Saint Joseph’s University, Philadelphia, Pennsylvania 19104, United States
| | - Andrew B. Cao
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Maggie M. Calkins
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Andrew J. Heim
- Department of Chemistry, Saint Joseph’s University, Philadelphia, Pennsylvania 19104, United States
| | - Janelle K. Lanham
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Emma M. Bonniwell
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Joseph J. Hennessey
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Hailey A. Bock
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Emilie I. Anderson
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | | | - Hamilton Morris
- Department of Pharmaceutical Sciences, Saint Joseph’s University, Philadelphia, Pennsylvania 19104, United States
| | - Robbin de Klein
- Research Service, VA San Diego Healthcare System, San Diego, California 92161, United States
| | - Adam K. Klein
- Department of Psychiatry, University of California San Diego, La Jolla, California 92093, United States
| | - Bruna Cuccurazzu
- Department of Psychiatry, University of California San Diego, La Jolla, California 92093, United States
| | - James Gamrat
- Department of Pharmaceutical Sciences, Saint Joseph’s University, Philadelphia, Pennsylvania 19104, United States
| | - Tilka Fannana
- Department of Pharmaceutical Sciences, Saint Joseph’s University, Philadelphia, Pennsylvania 19104, United States
| | - Randy Zauhar
- Department of Chemistry, Saint Joseph’s University, Philadelphia, Pennsylvania 19104, United States
| | - Adam L. Halberstadt
- Department of Psychiatry, University of California San Diego, La Jolla, California 92093, United States
- Research Service, VA San Diego Healthcare System, San Diego, California 92161, United States
| | - John D. McCorvy
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
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Hipólito I, Mago J, Rosas FE, Carhart-Harris R. Pattern breaking: a complex systems approach to psychedelic medicine. Neurosci Conscious 2023; 2023:niad017. [PMID: 37424966 PMCID: PMC10325487 DOI: 10.1093/nc/niad017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/19/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Recent research has demonstrated the potential of psychedelic therapy for mental health care. However, the psychological experience underlying its therapeutic effects remains poorly understood. This paper proposes a framework that suggests psychedelics act as destabilizers, both psychologically and neurophysiologically. Drawing on the 'entropic brain' hypothesis and the 'RElaxed Beliefs Under pSychedelics' model, this paper focuses on the richness of psychological experience. Through a complex systems theory perspective, we suggest that psychedelics destabilize fixed points or attractors, breaking reinforced patterns of thinking and behaving. Our approach explains how psychedelic-induced increases in brain entropy destabilize neurophysiological set points and lead to new conceptualizations of psychedelic psychotherapy. These insights have important implications for risk mitigation and treatment optimization in psychedelic medicine, both during the peak psychedelic experience and during the subacute period of potential recovery.
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Affiliation(s)
- Inês Hipólito
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin 10117, Germany
- Department of Philosophy, Macquarie University, New South Wales 2109, Australia
| | - Jonas Mago
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, United Kingdom
- Integrative Program in Neuroscience, McGill University, Montreal, Quebec QC H3A, Canada
| | - Fernando E Rosas
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London SW7 2BX, United Kingdom
- Centre for Complexity Science, Imperial College London, London SW7 2BX, United Kingdom
- Data Science Institute, Imperial College London, London SW7 2BX, United Kingdom
- Department of Informatics, University of Sussex, Brighton BN1 9RH, United Kingdom
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford OX3 9BX, United Kingdom
| | - Robin Carhart-Harris
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London SW7 2BX, United Kingdom
- Psychedelics Division, University of California San Francisco, San Francisco, CA 92521, United States
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Kozak Z, Johnson MW, Aaronson ST. Assessing potential of psilocybin for depressive disorders. Expert Opin Investig Drugs 2023; 32:887-900. [PMID: 37869790 DOI: 10.1080/13543784.2023.2273493] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION There has been increasing interest in the role psilocybin may play in the treatment of depressive disorders. Several clinical trials have shown psilocybin to have efficacy in reducing symptoms of depression. AREASCOVERED We discuss the current understanding of psilocybin's therapeutic mechanism of action and review existing clinical data investigating psilocybin as a novel therapeutic agent for the treatment of depression. EXPERT OPINION There is still much unknown regarding the risks of psilocybin treatment. When weighing the known risks and benefits of psilocybin treatment against those found in existing standards of care, among patients with depression, patients with treatment-resistant depression (TRD) may be the most suitable candidates for psilocybin treatment at this time.
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Affiliation(s)
- Zofia Kozak
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Scott T Aaronson
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
- The Institute for Advanced Diagnostics and Therapeutics, Sheppard Pratt, Baltimore, MD, USA
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Luppi AI, Hansen JY, Adapa R, Carhart-Harris RL, Roseman L, Timmermann C, Golkowski D, Ranft A, Ilg R, Jordan D, Bonhomme V, Vanhaudenhuyse A, Demertzi A, Jaquet O, Bahri MA, Alnagger NL, Cardone P, Peattie AR, Manktelow AE, de Araujo DB, Sensi SL, Owen AM, Naci L, Menon DK, Misic B, Stamatakis EA. In vivo mapping of pharmacologically induced functional reorganization onto the human brain's neurotransmitter landscape. SCIENCE ADVANCES 2023; 9:eadf8332. [PMID: 37315149 PMCID: PMC10266734 DOI: 10.1126/sciadv.adf8332] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Abstract
To understand how pharmacological interventions can exert their powerful effects on brain function, we need to understand how they engage the brain's rich neurotransmitter landscape. Here, we bridge microscale molecular chemoarchitecture and pharmacologically induced macroscale functional reorganization, by relating the regional distribution of 19 neurotransmitter receptors and transporters obtained from positron emission tomography, and the regional changes in functional magnetic resonance imaging connectivity induced by 10 different mind-altering drugs: propofol, sevoflurane, ketamine, lysergic acid diethylamide (LSD), psilocybin, N,N-Dimethyltryptamine (DMT), ayahuasca, 3,4-methylenedioxymethamphetamine (MDMA), modafinil, and methylphenidate. Our results reveal a many-to-many mapping between psychoactive drugs' effects on brain function and multiple neurotransmitter systems. The effects of both anesthetics and psychedelics on brain function are organized along hierarchical gradients of brain structure and function. Last, we show that regional co-susceptibility to pharmacological interventions recapitulates co-susceptibility to disorder-induced structural alterations. Collectively, these results highlight rich statistical patterns relating molecular chemoarchitecture and drug-induced reorganization of the brain's functional architecture.
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Affiliation(s)
- Andrea I. Luppi
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Justine Y. Hansen
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Ram Adapa
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Robin L. Carhart-Harris
- Psychedelics Division - Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Leor Roseman
- Center for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, UK
| | - Christopher Timmermann
- Center for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, UK
| | - Daniel Golkowski
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, München, Germany
| | - Andreas Ranft
- School of Medicine, Department of Anesthesiology and Intensive Care, Technical University of Munich, Munich, Germany
| | - Rüdiger Ilg
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, München, Germany
- Department of Neurology, Asklepios Clinic, Bad Tölz, Germany
| | - Denis Jordan
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technical University Munich, München, Germany
- University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Audrey Vanhaudenhuyse
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | - Athena Demertzi
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liege, Liege, Belgium
| | - Oceane Jaquet
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liege, Liege, Belgium
| | - Naji L. N. Alnagger
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | - Paolo Cardone
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | - Alexander R. D. Peattie
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | | | - Stefano L. Sensi
- Department of Neuroscience and Imaging and Clinical Science, Center for Advanced Studies and Technology, Institute for Advanced Biomedical Technologies, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
- Institute for Memory Impairments and Neurological Disorders, University of California-Irvine, Irvine, CA, USA
| | - Adrian M. Owen
- Department of Psychology and Department of Physiology and Pharmacology, Western Institute for Neuroscience (WIN), Western University, London, ON, Canada
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - David K. Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Wolfon Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Bratislav Misic
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Emmanuel A. Stamatakis
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Bălăeț M, Trender W, Hellyer PJ, Hampshire A. Associations between the use of psychedelics and other recreational drugs with mental health and resilience during the COVID-19 pandemic. Front Psychiatry 2023; 14:1184681. [PMID: 37398594 PMCID: PMC10307955 DOI: 10.3389/fpsyt.2023.1184681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
The large-scale disruption to peoples' daily lives during the COVID-19 pandemic provides a context for examining whether use of substances such as psychedelics in a naturalistic (outside of a controlled environment) setting, is associated with better mental wellbeing and resilience relative to those who use other drugs, or who do not use drugs at all. We interrogate data from the Great British Intelligence Test and identify that 7.8% out of N = 30,598 unique respondents used recreational drugs inclusive of psychedelics, cannabis, cocaine, and MDMA during the COVID-19 pandemic. Recruitment materials did not mention drug use would be surveyed, thereby enabling us to model the relationship with mood and resilience in people who had not specifically self-selected themselves for a 'drug' study. We report that people form clusters, characterized by different real-world patterns of drug use, and the majority of psychedelics users also use cannabis. However, a subset of cannabis users do not use psychedelics, enabling a subtractive comparison. Those who primarily used psychedelics and cannabis during the COVID-19 pandemic had worse mood self-assessment and resilience scores compared to those who never used drugs or primarily used cannabis. This pattern was also evident for other recreational drug use clusters, except for those who primarily used MDMA and cannabis, who had better mood but were of too low incidence to have confidence in this estimate. These findings cast light on the significant differences in mental wellbeing between users of different drugs and the non-user population during a global-crisis and call for future research to explore the pharmacological, contextual and cultural variables associated with these differences, their generalisability and causal links with greater precision.
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Affiliation(s)
- Maria Bălăeț
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - William Trender
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Engineering and Physical Sciences Research Council CDT Neurotechnology, Imperial College London, London, United Kingdom
| | - Peter J. Hellyer
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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Adamska I, Finc K. Effect of LSD and music on the time-varying brain dynamics. Psychopharmacology (Berl) 2023:10.1007/s00213-023-06394-8. [PMID: 37291360 DOI: 10.1007/s00213-023-06394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
RATIONALE Psychedelics are getting closer to being widely used in clinical treatment. Music is known as a key element of psychedelic-assisted therapy due to its psychological effects, specifically on the emotion, meaning-making, and sensory processing. However, there is still a lack of understanding in how psychedelics influence brain activity in experimental settings involving music listening. OBJECTIVES The main goal of our research was to investigate the effect of music, as a part of "setting," on the brain states dynamics after lysergic acid diethylamide (LSD) intake. METHODS We used an open dataset, where a group of 15 participants underwent two functional MRI scanning sessions under LSD and placebo influence. Every scanning session contained three runs: two resting-state runs separated by one run with music listening. We applied K-Means clustering to identify the repetitive patterns of brain activity, so-called brain states. For further analysis, we calculated states' dwell time, fractional occupancy and transition probability. RESULTS The interaction effect of music and psychedelics led to change in the time-varying brain activity of the task-positive state. LSD, regardless of the music, affected the dynamics of the state of combined activity of DMN, SOM, and VIS networks. Crucially, we observed that the music itself could potentially have a long-term influence on the resting-state, in particular on states involving task-positive networks. CONCLUSIONS This study indicates that music, as a crucial element of "setting," can potentially have an influence on the subject's resting-state during psychedelic experience. Further studies should replicate these results on a larger sample size.
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Affiliation(s)
- Iga Adamska
- Faculty of Philosophy and Social Sciences, Nicolaus Copernicus University, Toruń, Poland.
| | - Karolina Finc
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń, Poland.
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Breeksema JJ, Niemeijer A, Kuin B, Veraart J, Vermetten E, Kamphuis J, van den Brink W, Schoevers R. Phenomenology and therapeutic potential of patient experiences during oral esketamine treatment for treatment-resistant depression: an interpretative phenomenological study. Psychopharmacology (Berl) 2023:10.1007/s00213-023-06388-6. [PMID: 37222753 DOI: 10.1007/s00213-023-06388-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Ketamine and its enantiomers are widely researched and increasingly used to treat mental disorders, especially treatment-resistant depression. The phenomenology of ketamine-induced experiences and their relation to its psychotherapeutic potential have not yet been systematically investigated. AIMS To describe the phenomenology of patient experiences during oral esketamine treatment for treatment-resistant depression (TRD) and to explore the potential therapeutic relevance of these experiences. METHODS In-depth interviews were conducted with 17 patients after a 6-week, twice-weekly 'off label' generic oral esketamine (0.5-3.0mg/kg) treatment program. Interviews explored participants' perspectives, expectations, and experiences with oral esketamine treatment. Audio interviews were transcribed and analyzed using an Interpretative Phenomenological Analysis (IPA) framework. RESULTS The effects of ketamine were highly variable, and psychological distress was common in most patients. Key themes included (a) perceptual effects (auditory, visual, proprioceptive), (b) detachment (from body, self, emotions, and the world), (c) stillness and openness, (d) mystical-type effects (transcendence, relativeness, spirituality), and (e) fear and anxiety. Key themes related to post-session reports included (a) feeling hungover and fatigued, and (b) lifting the blanket: neutralizing mood effects. CONCLUSION Patients reported several esketamine effects with psychotherapeutic potential, such as increased openness, detachment, an interruption of negativity, and mystical-type experiences. These experiences deserve to be explored further to enhance treatment outcomes in patients with TRD. Given the frequency and severity of the perceived distress, we identify a need for additional support in all stages of esketamine treatment.
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Affiliation(s)
- Joost J Breeksema
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands.
| | - Alistair Niemeijer
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Bouwe Kuin
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands
| | - Jolien Veraart
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands
- PsyQ Haaglanden, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanine Kamphuis
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands
| | - Wim van den Brink
- Amsterdam UMC, location Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
- Program Compulsivity, Impulsivity & Attention, Amsterdam Neuroscience Research, Amsterdam, the Netherlands
| | - Robert Schoevers
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands
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Peterson A, Largent EA, Lynch HF, Karlawish J, Sisti D. Journeying to Ixtlan: Ethics of Psychedelic Medicine and Research for Alzheimer's Disease and Related Dementias. AJOB Neurosci 2023; 14:107-123. [PMID: 36476106 DOI: 10.1080/21507740.2022.2148771] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
In this paper, we examine the case of psychedelic medicine for Alzheimer's disease and related dementias (AD/ADRD). These "mind-altering" drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; the impact of "ego dissolution" on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards' orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations.
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Affiliation(s)
| | | | | | | | - Dominic Sisti
- University of Pennsylvania Perelman School of Medicine
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50
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Modlin NL, Miller TM, Rucker JJ, Kirlic N, Lennard-Jones M, Schlosser D, Aaronson ST. Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation. J Affect Disord 2023; 326:18-25. [PMID: 36707036 DOI: 10.1016/j.jad.2023.01.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/11/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
Recent studies have demonstrated the promise of psilocybin therapies in creating positive changes for those with poor mental health across multiple diagnostic categories, including major depressive disorder (MDD), end-of-life anxiety, and obsessive-compulsive disorder (OCD). While there may be a large population that is eligible to participate in psilocybin therapy based on psychiatric diagnosis and medical clearance, little attention has been given to intrapersonal and interpersonal factors that might influence patient's readiness (i.e., eligibility and capacity) for psychedelic interventions. This paper proposes that readiness assessment includes both intrapersonal and interpersonal factors in order to improve safety, patient care, and treatment outcomes. While at the present time a reliable and valid instrument has not been developed, we propose that three specific areas of focus - patient presentation, therapeutic alliance, and patient safety - may be used to establish a patient's readiness for psilocybin therapy, thus increasing therapy optimization and personalization.
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Affiliation(s)
- Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tammy M Miller
- Institute for Advanced Therapeutics and Diagnostics, Sheppard Pratt, Towson, MD, United States of America
| | - James J Rucker
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom; South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | | | | | - Danielle Schlosser
- Compass Pathfinder Ltd, London, United Kingdom; Weill Institute for Neurosciences, University of California, San Francisco, United States of America
| | - Scott T Aaronson
- Institute for Advanced Therapeutics and Diagnostics, Sheppard Pratt, Towson, MD, United States of America; University of Maryland School of Medicine, Department of Psychiatry, 701 West Pratt Street, Baltimore, MD 21201, United States of America.
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