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Abstract
After working in the substance use field for several years and conducting research on substance use, it has come to my attention how deeply ingrained the War on Drugs propaganda is in substance use research. The lines of research demonstrating the potential benefits of substance use (including illicit substances), delineation of harm from stigma, and the societal impact of the War on Drugs is rather weak and lacking, despite numerous recent studies showing the benefits of certain substances and reports of individuals in therapy and online suggesing that illicit substances help them in some respects. There are numerous critical implications of this bias in substance use research. Suppose the field primarily produces studies that show that all substances are harmful in almost any circumstance and that substance use disorders (SUDs) are primarily driven by psychological deficits (e.g., willpower). In that case, we, as researchers, would be feeding into the War on Drugs, which is known for marginalizing individuals, promoting organized crime, exacerbating SUDs, feeding into a police and prison state, and killing individuals due to tainted substances. Substance use researchers and clinicians are among the first to recognize that the War on Drugs has failed. Yet, despite this belief, we seem to have not quite fully noticed how the propaganda has influenced how we conduct our jobs and the research we produce. In the current letter, I inform researchers who study substance use and clinicians who treat SUDs to acknowledge their own learned biases against substances and those who use substances; to be more cautious when interpreting substance use data in the future.
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Affiliation(s)
- Bryant M Stone
- Department of Psychiatry and Behavioral Sciences, 2345Medical University of South Carolina, Charleston, SC, USA
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2
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Wright EC, Scott E, Tian L. Applications of functional neurotransmitter release imaging with genetically encoded sensors in psychiatric research. Neuropsychopharmacology 2024:10.1038/s41386-024-01903-5. [PMID: 38942957 DOI: 10.1038/s41386-024-01903-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/30/2024]
Abstract
Psychiatric research encompasses diverse methodologies to understand the complex interplay between neurochemistry and behavior in mental health disorders. Despite significant advancements in pharmacological interventions, there remains a critical gap in understanding the precise functional changes underlying psychiatric conditions and the mechanisms of action of therapeutic agents. Genetically encoded sensors have emerged as powerful tools to address these challenges by enabling real-time monitoring of neurochemical dynamics in specific neuronal populations. This prospective explores the utility of neurotransmitter binding genetically encoded sensors in uncovering the nature of neuronal dysregulation underpinning mental illness, assessing the impact of pharmaceutical interventions, and facilitating the discovery of novel treatments.
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Affiliation(s)
- Emily C Wright
- Max Planck Florida Institute for Neuroscience, Jupiter, FL, USA.
| | - Erin Scott
- Max Planck Florida Institute for Neuroscience, Jupiter, FL, USA
- Neuroscience Graduate Group, University of California, Davis, CA, USA
| | - Lin Tian
- Max Planck Florida Institute for Neuroscience, Jupiter, FL, USA.
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA.
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Palamar JJ, Fitzgerald ND, Carr TH, Rutherford C, Keyes KM, Cottler LB. National and regional trends in seizures of shrooms (psilocybin) in the United States, 2017-2022. Drug Alcohol Depend 2024; 258:111086. [PMID: 38326175 PMCID: PMC11088526 DOI: 10.1016/j.drugalcdep.2024.111086] [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: 08/29/2023] [Revised: 11/17/2023] [Accepted: 12/23/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Psilocybin, the principle psychoactive component in "shrooms", is regaining acceptance in therapeutic settings, leading to media coverage of medical benefits associated with use. Possession is also becoming increasingly decriminalized throughout the United States. There is a lack of data on prevalence of shroom use, but trends in law enforcement seizure data can provide one indicator of shroom availability in US communities. We determined whether seizures of shrooms have shifted between 2017 and 2022. METHODS This study examined national and regional trends in counts and total weight of shroom seizures reported to High Intensity Drug Trafficking Areas in the US between 2017 and 2022 (N=4526). RESULTS There were 402 seizures in 2017 compared to 1396 in 2022 with the plurality occurring in the Midwest (36.0%), followed by the West (33.5%). Between 2017 Quarter 1 (Q1) and 2022 Quarter 4 (Q4), the number of seizures increased by 368.9% (AQPC=7.0; 95 CI: 5.9-8.1) and there were significant increases in all four regions. In terms of weight, 226.0kg was seized in 2017 vs. 844.0kg in 2022, and the greatest total weight in seizures was in the West (1864.2kg, 42.6%), followed by the South (1831.9kg, 41.8%). Between 2017 Q1 and 2022 Q4, the total weight seized in the US increased by 2749.7% (AQPC=6.2, 95% CI: 0.3-12.4) and there were significant increases in all four regions. CONCLUSIONS Seizures of shrooms have increased, suggesting that availability may be escalating; thus, increases in prevention efforts and harm reduction education are warranted.
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Affiliation(s)
- Joseph J Palamar
- NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA.
| | - Nicole D Fitzgerald
- University of Florida, Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, United States; NDEWS, University of Florida, USA
| | - Thomas H Carr
- Office of National Drug Control Policy, Washington-Baltimore High Intensity Drug Trafficking Areas Program; College of Public Affairs, Center for Drug Policy and Prevention, University of Baltimore, USA
| | - Caroline Rutherford
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Linda B Cottler
- University of Florida, Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, United States; NDEWS, University of Florida, USA
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Coman A, Bondevik H. The ethical imperative of trauma-sensitive care for electroconvulsive therapy (ECT). J Ment Health 2024; 33:177-184. [PMID: 37218175 DOI: 10.1080/09638237.2023.2210650] [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: 06/27/2022] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND The empirical literature on the lived experience of electroconvulsive therapy (ECT) is limited, divergent, and largely focused on the experiences of procedures, (adverse) effects, information provision, or decision-making. AIMS This study aimed to investigate aspects related to the lived experience and meaning-making of people who have had ECT. METHOD In-depth interviews with 21 women (21-65 years old) were analyzed using interpretative phenomenological analysis (IPA). FINDINGS A subgroup of nine participants described more negative experiences with ECT. A common factor for these participants was the experience of trauma that remained under-treated. The superordinate themes identified were a lack of trauma-based and recovery-oriented treatment. The rest of the sample (12) expressed more positive experiences with ECT. CONCLUSIONS This study suggests that exploring more broadly the impacts of ECT at the long term offers insights that can help design more person-centered services aligned to the needs of the treatment recipients. Educational modules for mental health care staff should include, besides knowledge on the methods' effectiveness, additional evidence about treatment recipients' subjective concerns and the relevance of trauma and recovery-oriented care models.
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Affiliation(s)
- Alina Coman
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Hilde Bondevik
- Centre for Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
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Stone BM. When Public Will Meets Legislative Resistance: Five Lessons from Ohio's Issue 2 Cannabis Legalization Controversy. Cannabis Cannabinoid Res 2024. [PMID: 38527180 DOI: 10.1089/can.2024.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
In this paper, I explore the challenges of legalizing cannabis in Ohio, focusing on the passing of the Issue 2 Bill, legislative resistance, and public response. I propose five strategies for effective policy change: persistent advocacy post policy change success, establishing strong coalitions, empowering grassroots movements, promoting rigorous data-driven research, and launching public education campaigns. I offer a detailed analysis of the interaction between public opinion and legislative action in cannabis legalization and its implications for substance-related policy change.
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Affiliation(s)
- Bryant M Stone
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Dharma C, Liu E, Grace D, Logie C, Abramovich A, Mitsakakis N, Baskerville B, Chaiton M. Factors associated with the use of psychedelics, ketamine and MDMA among sexual and gender minority youths in Canada: a machine learning analysis. J Epidemiol Community Health 2024; 78:248-254. [PMID: 38262735 DOI: 10.1136/jech-2023-220748] [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: 04/19/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Substance use is increasing among sexual and gender minority youth (SGMY). This increase may be due to changes in social norms and socialisation, or due to SGMY exploring the potential therapeutic value of drugs such as psychedelics. We identified predictors of psychedelics, MDMA and ketamine use. METHODS Data were obtained from 1414 SGMY participants who completed the ongoing longitudinal 2SLGBTQ+ Tobacco Project in Canada between November 2020 to January 2021. We examined the association between 80 potential features (including sociodemographic factors, mental health-related factors and substance use-related factors) with the use of psychedelics, MDMA and ketamine in the past year. Random forest classifier was used to identify the predictors most associated with reported use of these drugs. RESULTS 18.1% of participants have used psychedelics in the past year; 21.9% used at least one of the three drugs. Cannabis and cocaine use were the predictors most strongly associated with any of these drugs, while cannabis, but not cocaine use, was the one most associated with psychedelic use. Other mental health and 2SLGBTQ+ stigma-related factors were also associated with the use of these drugs. CONCLUSION The use of psychedelics, MDMA and ketamine among 2SLGBTQ+ individuals appeared to be largely driven by those who used them together with other drugs. Depression scores also appeared in the top 10 factors associated with these illicit drugs, suggesting that there were individuals who may benefit from the potential therapeutic value of these drugs. These characteristics should be further investigated in future studies.
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Affiliation(s)
- Christoffer Dharma
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Esther Liu
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Human Biology, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Grace
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- United Nations University Institute for Water Environment and Health, Hamilton, Ontario, Canada
| | - Alex Abramovich
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto Department of Psychiatry, Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Baskerville
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Michael Chaiton
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Medical Science, University of Toronto, Toronto, Ontario, Canada
- Ontario Tobacco Research Unit, University of Toronto, Toronto, Ontario, Canada
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Kusudo K, Tani H, Yonezawa K, Nakajima S, Nour MM, Carhart‐Harris R, Uchida H. Development of the Japanese version of the Ego-Dissolution Inventory (EDI). Neuropsychopharmacol Rep 2024; 44:292-297. [PMID: 38318991 PMCID: PMC10932788 DOI: 10.1002/npr2.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/05/2024] [Accepted: 01/13/2024] [Indexed: 02/07/2024] Open
Abstract
AIM Psychedelics have recently gained attention as potential therapeutic agents for various psychiatric disorders. Previous research has highlighted that a diminished sense of self, commonly termed "ego-dissolution" is a pivotal feature of the psychedelic-induced state. While the Ego-Dissolution Inventory (EDI) is a widely acknowledged instrument for measuring this phenomenon, no Japanese version has been available. This study aimed to develop a Japanese version of the EDI. METHODS We adhered to the "Guidelines for Best Practices in the Translation and Cultural Modification Process for Patient-Reported Outcomes Instruments: Document from the ISPOR Committee on Translation and Cultural Modification" during our translation approach. Two Japanese psychiatrists independently conducted initial translations, and a consolidated version was achieved via mutual agreement. This version was then back-translated to English and assessed by the original authors for consistency. The repetitive modification process was conducted in continuous dialogues with the original authors until they accepted the concluding back-translated version. RESULTS The finalized, approved back-translated version of the EDI is presented in the accompanying figure. In addition, the authorized Japanese version of the EDI is included in the Appendix. CONCLUSIONS In this study, we successfully developed the Japanese version of the EDI. This instrument will assist in assessing ego-dissolution experiences associated with psychedelic-assisted therapy among Japanese speakers. Additional studies are necessary to evaluate the reliability and validity of this newly translated instrument.
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Affiliation(s)
- Keisuke Kusudo
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Hideaki Tani
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Kengo Yonezawa
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | | | - Matthew M. Nour
- Department of PsychiatryUniversity of OxfordOxfordUK
- University College London, Max Planck UCL Centre for Computational Psychiatry and Ageing ResearchLondonUK
| | - Robin Carhart‐Harris
- University of California San Francisco Sandler Neurosciences CenterSan FranciscoCaliforniaUSA
- Neurology, Psychiatry and Behavioral Sciences, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Hiroyuki Uchida
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
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Stone BM. Development of the Enthusiastic Substance Use Attitudes Scale: Preliminary Evidence of a Novel Maintenance Factor. Subst Use Misuse 2024; 59:494-509. [PMID: 38269533 DOI: 10.1080/10826084.2023.2280592] [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: 01/26/2024]
Abstract
Background: Expectancies, motives, and attitudes toward substances are cognitive factors that partially account for substance use; however, existing measures tend to have monotonous phrasing, diverging from the enthusiastic attitude toward the perceived benefits of substance use exhibited by those who use substances regularly in informal settings. Objective: I aimed to characterize a new cognitive maintenance factor that precedes substance use by creating a brief, multidimensional measure to capture this tone nuance, which I called the Enthusiastic Substance Use Attitudes Scale (ESUAS). Method: Undergraduate students (n = 198) between ages 18 and 62 (M = 19.15, SD = 3.65; 66.2% women; 71.71% White) completed the study for course credit. Results: I used exploratory and confirmatory factor analyses to reduce a 90-item item pool based on a comprehensive qualitative thematic analysis of social media, traditional media, and the scientific literature to an 18-item hierarchical bifactor model. This model contained nine specific factors, which are (1) sociability, (2) enjoyment, (3) physical health, (4) mental health, (5) relaxation, (6) personal growth, (7) performance enhancement, (8) boredom, and (9) life processing; two general factors, which are (1) substance-induced emotion regulation and (2) substance-based assistance; and a higher-order single factor above the nine specific factors - resulting in twelve highly internally consistent, empirically supported scales. Further, the ESUAS demonstrated excellent structural, convergent, divergent, incremental, and diagnostic validity. The degree of enthusiasm towards substance use positively related to substance use disorder symptomology, polysubstance use, neuroticism, and difficulty with regulating emotions while negatively relating to one's psychological quality of life and agreeableness. Conclusion: The ESUAS may be an effective tool for professionals to characterize these enthusiastic attitudes further and measure a more ecologically valid view of the perceived benefits of substance use among those who use substances, thereby developing a more compassionate, non-stigmatizing understanding within the general public, advancing medicinal uses of illicit substances, and improving conceptualizations and treatments.
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Affiliation(s)
- Bryant M Stone
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Psychology, Southern Illinois University, Carbondale, Illinois, USA
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9
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Norred MA, Zuschlag ZD, Hamner MB. A Neuroanatomic and Pathophysiologic Framework for Novel Pharmacological Approaches to the Treatment of Post-traumatic Stress Disorder. Drugs 2024; 84:149-164. [PMID: 38413493 DOI: 10.1007/s40265-023-01983-5] [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: 11/28/2023] [Indexed: 02/29/2024]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating disorder inflicting high degrees of symptomatic and socioeconomic burdens. The development of PTSD results from a cascade of events with contributions from multiple processes and the underlying pathophysiology is complex, involving neurotransmitters, neurocircuitry, and neuroanatomical pathways. Presently, only two medications are US FDA-approved for the treatment of PTSD, both selective serotonin reuptake inhibitors (SSRIs). However, the complex underlying pathophysiology suggests a number of alternative pathways and mechanisms that may be targets for potential drug development. Indeed, investigations and drug development are proceeding in a number of these alternative, non-serotonergic pathways in an effort to improve the management of PTSD. In this manuscript, the authors introduce novel and emerging treatments for PTSD, including drugs in various stages of development and clinical testing (BI 1358894, BNC-210, PRAX-114, JZP-150, LU AG06466, NYV-783, PH-94B, SRX246, TNX-102), established agents and known compounds being investigated for their utility in PTSD (brexpiprazole, cannabidiol, doxasoin, ganaxolone, intranasal neuropeptide Y, intranasal oxytocin, tianeptine oxalate, verucerfont), and emerging psychedelic interventions (ketamine, MDMA-assisted psychotherapy, psilocybin-assisted psychotherapy), with an aim to examine and integrate these agents into the underlying pathophysiological frameworks of trauma-related disorders.
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Affiliation(s)
- Michael A Norred
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Zachary D Zuschlag
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Mark B Hamner
- Behavioral Health Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, 29401, USA.
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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Modlin NL, Creed M, Sarang M, Maggio C, Rucker JJ, Williamson V. Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions. Neuropsychiatr Dis Treat 2024; 20:109-135. [PMID: 38268571 PMCID: PMC10807282 DOI: 10.2147/ndt.s432537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/10/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT. Aim To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them. Methods Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified. Results 40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics. Conclusion This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.
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Affiliation(s)
- Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Michael Creed
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Maria Sarang
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Carolina Maggio
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - James J Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Victoria Williamson
- King’s Centre for Military Health Research, King’s College London, London, SE5 9RJ, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, OX2 6 GG, UK
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Du Y, Li Y, Zhao X, Yao Y, Wang B, Zhang L, Wang G. Psilocybin facilitates fear extinction in mice by promoting hippocampal neuroplasticity. Chin Med J (Engl) 2023; 136:2983-2992. [PMID: 37000971 PMCID: PMC10752473 DOI: 10.1097/cm9.0000000000002647] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and depression are highly comorbid. Psilocybin exerts substantial therapeutic effects on depression by promoting neuroplasticity. Fear extinction is a key process in the mechanism of first-line exposure-based therapies for PTSD. We hypothesized that psilocybin would facilitate fear extinction by promoting hippocampal neuroplasticity. METHODS First, we assessed the effects of psilocybin on percentage of freezing time in an auditory cued fear conditioning (FC) and fear extinction paradigm in mice. Psilocybin was administered 30 min before extinction training. Fear extinction testing was performed on the first day; fear extinction retrieval and fear renewal were tested on the sixth and seventh days, respectively. Furthermore, we verified the effect of psilocybin on hippocampal neuroplasticity using Golgi staining for the dendritic complexity and spine density, Western blotting for the protein levels of brain derived neurotrophic factor (BDNF) and mechanistic target of rapamycin (mTOR), and immunofluorescence staining for the numbers of doublecortin (DCX)- and bromodeoxyuridine (BrdU)-positive cells. RESULTS A single dose of psilocybin (2.5 mg/kg, i.p.) reduced the increase in the percentage of freezing time induced by FC at 24 h, 6th day and 7th day after administration. In terms of structural neuroplasticity, psilocybin rescued the decrease in hippocampal dendritic complexity and spine density induced by FC; in terms of neuroplasticity related proteins, psilocybin rescued the decrease in the protein levels of hippocampal BDNF and mTOR induced by FC; in terms of neurogenesis, psilocybin rescued the decrease in the numbers of DCX- and BrdU-positive cells in the hippocampal dentate gyrus induced by FC. CONCLUSIONS A single dose of psilocybin facilitated rapid and sustained fear extinction; this effect might be partially mediated by the promotion of hippocampal neuroplasticity. This study indicates that psilocybin may be a useful adjunct to exposure-based therapies for PTSD and other mental disorders characterized by failure of fear extinction.
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Affiliation(s)
- Yingjie Du
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing 100850, China
| | - Yunfeng Li
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing 100850, China
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Xiangting Zhao
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing 100850, China
- Key Laboratory of Microecology-Immune Regulatory Network and Related Diseases Basic Medical College of Jiamusi University, Jiamusi, Heilongjiang 154000, China
| | - Yishan Yao
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing 100850, China
| | - Bin Wang
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing 100850, China
| | - Liming Zhang
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing 100850, China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Hilal F, Jeanblanc J, Naassila M. [Interest and mechanisms of action of ketamine in alcohol addiction- A review of clinical and preclinical studies]. Biol Aujourdhui 2023; 217:161-182. [PMID: 38018944 DOI: 10.1051/jbio/2023028] [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: 05/19/2023] [Indexed: 11/30/2023]
Abstract
Alcohol Use Disorder (AUD) is a psychiatric condition characterized by chronic and excessive drinking despite negative consequences on overall health and social or occupational functioning. There are currently limited treatment options available for AUD, and the effects size and the response rates to these treatments are often low to moderate. The World Health Organization has identified the development of medications to treat AUD as one of its 24 priorities. This past decade was marked by a renewed interest in psychedelic use in psychiatry. At the centre of this renaissance, ketamine, an atypical psychedelic already used in the treatment of major depression, is an NMDA receptor antagonist that exists as a racemic compound made of two enantiomers, S-ketamine, and R-ketamine. Each form can be metabolized into different metabolites, some of which having antidepressant properties. In this article, we review both clinical and preclinical studies on ketamine and its metabolites in the treatment of AUD. Preclinical as well as clinical studies have revealed that ketamine is effective in reducing withdrawal symptoms and alcohol craving. Convergent data showed that antidepressant properties of ketamine largely contribute to the decreased likelihood of alcohol relapse, especially in patients undergoing ketamine-assisted psychotherapies. Its effectiveness is believed to be linked with its ability to regulate the glutamatergic pathway, enhance neuroplasticity, rewire brain resting state network functional connectivity and decrease depressive-like states. However, it remains to further investigate (i) why strong differences exist between male and female responses in preclinical studies and (ii) the respective roles of each of the metabolites in the ketamine effects in both genders. Interestingly, current studies are also focusing on ketamine addiction and the comorbidity between alcohol addiction and depression occurring more frequently in females.
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Affiliation(s)
- Fahd Hilal
- Groupe de recherche sur l'alcool et les pharmacodépendances, INSERM U1247, CURS, Amiens, France
| | - Jérôme Jeanblanc
- Groupe de recherche sur l'alcool et les pharmacodépendances, INSERM U1247, CURS, Amiens, France
| | - Mickaël Naassila
- Groupe de recherche sur l'alcool et les pharmacodépendances, INSERM U1247, CURS, Amiens, France
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13
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Abstract
In recent years, psychedelic-assisted psychotherapies have reentered the realm of rigorous scientific inquiry, garnering much attention from both the psychiatric community and the broader public. Headlines on major media platforms frequently tout the psychedelic future of psychiatry, and patients increasingly ask about the prospect of using psychedelics during their sessions. Despite this enthusiasm, psychedelics remain in an investigational stage, and more research and regulatory work are required before psychedelics can be deemed appropriate for general clinical use. In this climate, psychiatrists are increasingly curious about the prospects of psychedelic treatments. This review's goal was to help psychiatrists better understand the complexities of the burgeoning field of psychedelic-assisted psychotherapy. The discussion encompasses issues surrounding psychedelics in their current investigational stage and issues for psychiatrists to consider should psychedelics become available for broad clinical use. This review discusses research equipoise in the context of the current enthusiasm for psychedelics, informed consent, patient vulnerability, equity and access, differences between clinical and nonclinical psychedelic uses, and psychedelic self-enhancement. As psychedelics move closer toward regulatory approval beyond research settings, it is vital that these promising treatments be used ethically. The unique features of psychedelic therapies, including the altered states of consciousness they produce and the vulnerability that such states entail for patients, require careful consideration to minimize potential ethical pitfalls. This review seeks to ensure that psychiatrists are equipped to use psychedelic psychotherapy both ethically and effectively.
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Affiliation(s)
- Gregory S Barber
- Private practice, Bethesda (Barber); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Dike)
| | - Charles C Dike
- Private practice, Bethesda (Barber); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Dike)
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14
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Fonseka LN, Woo BKP. Therapeutic role of psilocybin and 3,4-methylenedioxymethamphetamine in trauma: A literature review. World J Psychiatry 2023; 13:182-190. [PMID: 37303932 PMCID: PMC10251361 DOI: 10.5498/wjp.v13.i5.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/28/2023] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
With the Food and Drug Administration designation in 2017 of 3,4-methylenedioxymethamphetamine (MDMA) as a breakthrough therapy in post-traumatic stress disorder and psilocybin in treatment-resistant depression, psychedelic drugs have continued to garner the attention of researchers and clinicians for their promise of unmatched, rapid improvement in a multitude of psychiatric conditions. Classic psychedelic drugs including psilocybin, lysergic acid diethylamide, and ayahuasca, as well as non-classic drugs such as MDMA and ketamine, are currently being investigated for a potential therapeutic role in trauma, depressive disorders, and other psychopathologies. However, psilocybin and MDMA each have a functional profile well-suited for integration with psychotherapy. The present review focuses on psilocybin and MDMA in psychedelic-assisted therapy (PAT), as these studies compose most of the literature pool. In this review, we discuss the current and future uses of psychedelic drugs, with an emphasis on the role of MDMA and psilocybin in PAT in the setting of trauma and related comorbidities on the efficacy of psychedelic drugs across multiple psychiatric disorders. The article concludes with thoughts for future research, such as incorporating wearables and standardization of symptom scales, therapy styles, and assessment of adverse drug reactions.
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Affiliation(s)
- Lakshan N Fonseka
- Harvard South Shore-Psychiatry Residency Program, Veteran Affairs Boston Healthcare System, Brockton, MA 02301, United States
| | - Benjamin KP Woo
- Chinese American Health Promotion Laboratory, University of California, Los Angeles, Los Angeles, CA 90095, United States
- Department of Psychiatry and Biobehavioral Sciences, Olive View - University of California, Los Angeles Medical Center, Sylmar, CA 91342, United States
- Asian American Studies Center, University of California, Los Angeles, Los Angeles, CA 90095, United States
- Podiatric Medicine and Surgery, Western University of Health Sciences, Pomona, CA 91766, United States
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15
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Davis AK, Levin AW, Nagib PB, Armstrong SB, Lancelotta RL. Study protocol of an open-label proof-of-concept trial examining the safety and clinical efficacy of psilocybin-assisted therapy for veterans with PTSD. BMJ Open 2023; 13:e068884. [PMID: 37142308 PMCID: PMC10163450 DOI: 10.1136/bmjopen-2022-068884] [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: 05/06/2023] Open
Abstract
INTRODUCTION Psilocybin-assisted therapy has shown significant promise in treating the cluster of mood and anxiety symptoms that comprise post-traumatic stress disorder (PTSD) but has yet to be tested specifically in this condition. Furthermore, current pharmacological and psychotherapeutic treatments for PTSD are difficult to tolerate and limited in efficacy, especially in the US Military Veteran (USMV) population. This open-label pilot study will examine the safety and efficacy of two psilocybin administration sessions (15 mg and 25 mg), combined with psychotherapy, among USMVs with severe, treatment resistant PTSD. METHODS AND ANALYSIS We will recruit 15 USMVs with severe, treatment resistant PTSD. Participants will receive one low dose (15 mg) and one moderate/high dose (25 mg) of psilocybin in conjunction with preparatory and post-psilocybin therapy sessions. The primary safety outcome will be the type, severity and frequency of adverse events and suicidal ideation/behaviour, as measured by the Columbia Suicide Severity Rating Scale. The primary outcome measure for PTSD will be the Clinician Administered PTSD Scale-5. The primary endpoint will be 1 month following the second psilocybin administration session, and the total follow-up time will be 6 months. ETHICS AND DISSEMINATION All participants will be required to provide written informed consent. The trial has been authorised by the Ohio State University Institutional Review Board (study number: 2022H0280). Dissemination of results will occur via a peer-reviewed publication and other relevant media. TRIAL REGISTRATION NUMBER NCT05554094.
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Affiliation(s)
- Alan K Davis
- Center for Psychedelic Drug Research and Education, The Ohio State University College of Social Work, Columbus, Ohio, USA
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Adam W Levin
- Center for Psychedelic Drug Research and Education, The Ohio State University College of Social Work, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Paul B Nagib
- Center for Psychedelic Drug Research and Education, The Ohio State University College of Social Work, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stacey B Armstrong
- Center for Psychedelic Drug Research and Education, The Ohio State University College of Social Work, Columbus, Ohio, USA
| | - Rafaelle L Lancelotta
- Center for Psychedelic Drug Research and Education, The Ohio State University College of Social Work, Columbus, Ohio, USA
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16
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Kopra EI, Ferris JA, Winstock AR, Kuypers KP, Young AH, Rucker JJ. Investigation of self-treatment with lysergic acid diethylamide and psilocybin mushrooms: Findings from the Global Drug Survey 2020. J Psychopharmacol 2023:2698811231158245. [PMID: 36876583 DOI: 10.1177/02698811231158245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Growing numbers of people are using psychedelics for personal psychotherapy outside clinical settings, but research on such use is scarce. AIMS This study investigated the patterns of use, self-reported outcomes and outcome predictors of psychedelic 'self-treatment' of mental health conditions or specific worries/concerns in life. METHODS We use data from the Global Drug Survey 2020, a large online survey on drug use collected between November 2019 and February 2020. In all, 3364 respondents reported their self-treatment experiences with lysergic acid diethylamide (N = 1996) or psilocybin mushrooms (N = 1368). The primary outcome of interest was the 17-item self-treatment outcome scale, items reflecting aspects of well-being, psychiatric symptoms, social-emotional skills, and health behaviours. RESULTS Positive changes were observed across all 17 outcome items, with the strongest benefits on items related to insight and mood. Negative effects were reported by 22.5% of respondents. High intensity of psychedelic experience, seeking advice before treatment, treating with psilocybin mushrooms and treating post-traumatic stress disorder were associated with higher scores on the self-treatment outcome scale after averaging values across all 17 items. Younger age, high intensity of experience and treating with LSD were associated with increased number of negative outcomes. CONCLUSIONS This study brings important insights into self-treatment practices with psychedelics in a large international sample. Outcomes were generally favourable, but negative effects appeared more frequent than in clinical settings. Our findings can help inform safe practices of psychedelic use in the community, and inspire clinical research. Future research can be improved with utilisation of prospective designs and additional predictive variables.
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Affiliation(s)
- Emma I Kopra
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jason A Ferris
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Adam R Winstock
- Institute of Epidemiology and Health Care, University College London, London, UK.,Global Drug Survey Ltd, London, UK
| | - Kim Pc Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - James J Rucker
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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17
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Psychedelic discourses: A qualitative study of discussions in a Danish online forum. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103945. [PMID: 36669238 DOI: 10.1016/j.drugpo.2022.103945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study focuses on user-perspectives related to norms, beliefs and practices concerning psychedelic substances as they are articulated in a Danish online forum. The study combines an interest in online drug research with a focus on discourse analysis to account for the dialectical relationship between individual and shared knowledge regarding the use and meaning of psychedelics. METHODS A total of 1,865 posts from 154 threads of online discussion were coded and analyzed thematically, inspired by a socio-cognitive approach to the study of discourse. All topics were arranged into 54 categories which were further analyzed to map recurring patterns in the construction of meaning resulting in a limited number of dominant discourses. RESULTS Five dominant discourses were identified: the recreational, the therapeutic, the spiritual, the scientific and the performance discourse. We suggest that these discourses can be seen as the available frameworks which forum users draw upon and reproduce when they describe, discuss, and negotiate their understandings and uses of psychedelics. CONCLUSION This study demonstrates the importance of having a nuanced approach to user perceptions. Future drug policy and practice development should take these nuances into account and expect significant variation in the motives and modalities of the use of psychedelics.
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18
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Herwig U, Mertens L, Rosal SP, Koller G, Jungaberle A, Borgwardt S, Gründer G. [Psychedelics in Psychiatry - Development and Current State in Germany]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023. [PMID: 36599444 DOI: 10.1055/a-1981-3152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Clinical research on the therapeutic efficacy of psychedelics is currently experiencing a renaissance. Available scientific evidence on their efficacy in various psychiatric conditions, as well as their legally approved use in some countries of the world, show the possibility of their future application in clinical practice also in Germany. The field is facing substantial challenges that have to be addressed, such as defining and setting a suitable clinical frame. This manuscript deals with the historical background of the clinical application of psychedelics, as well as the psycho-phenomenology, modes of action, possible indications and aspects of safety. The current research status in Germany and the organization of professional societies are discussed in a historical and international context and attention is drawn to unresolved critical issues in the field.
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Affiliation(s)
- Uwe Herwig
- Zentrum für Psychiatrie Reichenau, Akademisches Lehrkrankenhaus Universität Konstanz, Reichenau, Germany.,Klinik für Psychiatrie und Psychotherapie III, Universität Ulm, Ulm, Germany.,Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| | - Lea Mertens
- Abteilung für Molekulares Neuroimaging, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | | | - Gabriele Koller
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München, Germany
| | - Andrea Jungaberle
- Mind Foundation, Berlin, Germany.,Ovid Health Systems, Berlin, Germany.,Charité Universitätsmedizin Mitte, Berlin, Germany
| | - Stefan Borgwardt
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig Holstein, Universität zu Lübeck, Germany
| | - Gerhard Gründer
- Abteilung für Molekulares Neuroimaging, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.,Ovid Health Systems, Berlin, Germany
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19
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DNA Authentication and Chemical Analysis of Psilocybe Mushrooms Reveal Widespread Misdeterminations in Fungaria and Inconsistencies in Metabolites. Appl Environ Microbiol 2022; 88:e0149822. [PMID: 36445079 PMCID: PMC9764976 DOI: 10.1128/aem.01498-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The mushroom genus Psilocybe is best known as the core group of psychoactive mushrooms, yet basic information on their diversity, taxonomy, chemistry, and general biology is still largely lacking. In this study, we reexamined 94 Psilocybe fungarium specimens, representing 18 species, by DNA barcoding, evaluated the stability of psilocybin, psilocin, and their related tryptamine alkaloids in 25 specimens across the most commonly vouchered species (Psilocybe cubensis, Psilocybe cyanescens, and Psilocybe semilanceata), and explored the metabolome of cultivated P. cubensis. Our data show that, apart from a few well-known species, the taxonomic accuracy of specimen determinations is largely unreliable, even at the genus level. A substantial quantity of poor-quality and mislabeled sequence data in public repositories, as well as a paucity of sequences derived from types, further exacerbates the problem. Our data also support taxon- and time-dependent decay of psilocybin and psilocin, with some specimens having no detectable quantities of them. We also show that the P. cubensis metabolome possibly contains thousands of uncharacterized compounds, at least some of which may be bioactive. Taken together, our study undermines commonly held assumptions about the accuracy of names and presence of controlled substances in fungarium specimens identified as Psilocybe spp. and reveals that our understanding of the chemical diversity of these mushrooms is largely incomplete. These results have broader implications for regulatory policies pertaining to the storage and sharing of fungarium specimens as well as the use of psychoactive mushrooms for recreation and therapy. IMPORTANCE The therapeutic use of psilocybin, the active ingredient in "magic mushrooms," is revolutionizing mental health care for a number of conditions, including depression, posttraumatic stress disorder (PTSD), and end-of-life care. This has spotlighted the current state of knowledge of psilocybin, including the organisms that endogenously produce it. However, because of international regulation of psilocybin as a controlled substance (often included on the same list as cocaine and heroin), basic research has lagged far behind. Our study highlights how the poor state of knowledge of even the most fundamental scientific information can impact the use of psilocybin-containing mushrooms for recreational or therapeutic applications and undermines critical assumptions that underpin their regulation by legal authorities. Our study shows that currently available chemical studies are mainly inaccurate, irreproducible, and inconsistent, that there exists a high rate of misidentification in museum collections and public databases rendering even names unreliable, and that the concentration of psilocybin and its tryptamine derivatives in three of the most commonly collected Psilocybe species (P. cubensis, P. cyanescens, and P. semilanceata) is highly variable and unstable in museum specimens spanning multiple decades, and our study generates the first-ever insight into the highly complex and largely uncharacterized metabolomic profile for the most commonly cultivated magic mushroom, P. cubensis.
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20
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Gonda X, Dome P, Erdelyi-Hamza B, Krause S, Elek LP, Sharma SR, Tarazi FI. Invisible wounds: Suturing the gap between the neurobiology, conventional and emerging therapies for posttraumatic stress disorder. Eur Neuropsychopharmacol 2022; 61:17-29. [PMID: 35716404 DOI: 10.1016/j.euroneuro.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
A sharp increase in the prevalence of neuropsychiatric disorders, including major depression, anxiety, substance use disorders and posttraumatic stress disorder (PTSD) has occurred due to the traumatic nature of the persisting COVID-19 global pandemic. PTSD is estimated to occur in up to 25% of individuals following exposure to acute or chronic trauma, and the pandemic has inflicted both forms of trauma on much of the population through both direct physiological attack as well as an inherent upheaval to our sense of safety. However, despite significant advances in our ability to define and apprehend the effects of traumatic events, the neurobiology and neuroanatomical circuitry of PTSD, one of the most severe consequences of traumatic exposure, remains poorly understood. Furthermore, the current psychotherapies or pharmacological options for treatment have limited efficacy, durability, and low adherence rates. Consequently, there is a great need to better understand the neurobiology and neuroanatomy of PTSD and develop novel therapies that extend beyond the current limited treatments. This review summarizes the neurobiological and neuroanatomical underpinnings of PTSD and discusses the conventional and emerging psychotherapies, pharmacological and combined psychopharmacological therapies, including the use of psychedelic-assisted psychotherapies and neuromodulatory interventions, for the improved treatment of PTSD and the potential for their wider applications in other neuropsychiatric disorders resulting from traumatic exposure.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis University, Hungary; International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Russia.
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; National Institute of Mental Health, Neurology and Neurosurgery - Nyiro Gyula Hospital, Hungary
| | - Berta Erdelyi-Hamza
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; Doctoral School of Mental Health Sciences, Semmelweis University, Hungary
| | - Sandor Krause
- National Institute of Mental Health, Neurology and Neurosurgery - Nyiro Gyula Hospital, Hungary; Doctoral School of Mental Health Sciences, Semmelweis University, Hungary; Department of Pharmacodynamics, Semmelweis University, Hungary
| | - Livia Priyanka Elek
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; Department of Clinical Psychology, Semmelweis University, Hungary
| | - Samata R Sharma
- Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Frank I Tarazi
- Department of Psychiatry and Neuroscience, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA
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21
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Brennan W, Belser AB. Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model. Front Psychol 2022; 13:866018. [PMID: 35719571 PMCID: PMC9201428 DOI: 10.3389/fpsyg.2022.866018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists' prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK's six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists' broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.
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Affiliation(s)
- William Brennan
- Cybin, Inc., Toronto, ON, Canada.,Fordham University, New York City, NY, United States
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22
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Elsouri KN, Kalhori S, Colunge D, Grabarczyk G, Hanna G, Carrasco C, Aleman Espino A, Francisco A, Borosky B, Bekheit B, Ighanifard M, Astudillo AA, Demory Beckler M. Psychoactive Drugs in the Management of Post Traumatic Stress Disorder: A Promising New Horizon. Cureus 2022; 14:e25235. [PMID: 35747039 PMCID: PMC9214830 DOI: 10.7759/cureus.25235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/22/2022] [Indexed: 11/06/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is an anxiety disorder that often presents after exposure to a traumatic, life-threatening event. Experiencing a traumatic event is not rare, with inciting incidents ranging from being burglarized to politically motivated genocide. While traditional psychopharmacology and psychotherapy are the mainstays of the treatment of PTSD currently, psychoactive drugs (otherwise known as psychedelics) are being explored for their novel role in the treatment of PTSD patients. Psychoactive drugs such as MDMA, ketamine, and psilocybin have been shown to specifically target and decrease fear and anxiety pathways in the brain. These unique properties hold the potential to be utilized in addressing symptoms of trauma in those with refractory or treatment-resistant PTSD. Historically, federal and state laws have restricted research into how psychoactive drugs can be used to treat mental illness due to the widespread belief that these drugs present more harm than benefit. However, the current shift in public opinion on psychedelics has propelled research to look into the benefits of these drugs for patients with mental illness. This article aims to discuss the mechanisms of how MDMA, ketamine, and psilocybin work in the PTSD brain, as well as their beneficial role in treatment.
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23
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Pham DNK, Belanger ZS, Chadeayne AR, Golen JA, Manke DR. The crystalline forms of nine hydrochloride salts of substituted tryptamines. ACTA CRYSTALLOGRAPHICA SECTION C-STRUCTURAL CHEMISTRY 2021; 77:615-620. [PMID: 34607984 DOI: 10.1107/s2053229621008950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022]
Abstract
The crystal structures of the hydrochloride salts of nine substituted tryptamines, namely, 1-methyltryptammonium chloride, C11H15N2+·Cl-, (1), 2-methyl-1-phenyltryptammonium chloride, C17H19N2+·Cl-, (2), 5-methoxytryptammonium chloride, C11H15N2O+·Cl-, (3), 5-bromotryptammonium chloride, C10H12BrN2+·Cl-, (4), 5-chlorotryptammonium chloride, C10H12ClN2+·Cl-, (5), 5-fluorotryptammonium chloride, C10H12FN2+·Cl-, (6), 5-methyltryptammonium chloride, C11H15N2+·Cl-, (7), 6-fluorotryptammonium chloride, C10H12FN2+·Cl-, (8), and 7-methyltryptammonium chloride, C11H15N2+·Cl-, (9), are reported. The seven tryptamines with N-H indoles, (3)-(9), show very similar structures, with N-H...Cl hydrogen-bonding networks forming two-dimensional sheets in the crystals. These sheets are combinations of R42(8) and R42(18) rings, and C21(4) and C21(9) chains. Substitution at the indole N atom reduces the dimensionality of the hydrogen-bonding network, with compounds (1) and (2) demonstrating one-dimensional chains that are a combination of different rings and parallel chains.
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Affiliation(s)
- Duyen N K Pham
- University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, MA 02747, USA
| | - Zachary S Belanger
- University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, MA 02747, USA
| | | | - James A Golen
- University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, MA 02747, USA
| | - David R Manke
- University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, MA 02747, USA
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