1
|
Marrocu A, Kettner H, Weiss B, Zeifman RJ, Erritzoe D, Carhart-Harris RL. Psychiatric risks for worsened mental health after psychedelic use. J Psychopharmacol 2024; 38:225-235. [PMID: 38491857 PMCID: PMC10944581 DOI: 10.1177/02698811241232548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Resurgent psychedelic research has largely supported the safety and efficacy of psychedelic therapy for the treatment of various psychiatric disorders. As psychedelic use and therapy increase in prevalence, so does the importance of understanding associated risks. Cases of prolonged negative psychological responses to psychedelic therapy seem to be rare; however, studies are limited by biases and small sample sizes. The current analytical approach was motivated by the question of whether rare but significant adverse effects have been under-sampled in psychedelic research studies. METHODS A "bottom margin analysis" approach was taken to focus on negative responders to psychedelic use in a pool of naturalistic, observational prospective studies (N = 807). We define "negative response" by a clinically meaningful decline in a generic index of mental health, that is, one standard error from the mean decrease in psychological well-being 4 weeks post-psychedelic use (vs pre-use baseline). We then assessed whether a history of diagnosed mental illness can predict negative responses. RESULTS We find that 16% of the cohort falls into the "negative responder" subset. Parsing the sample by self-reported history of psychiatric diagnoses, results revealed a disproportionate prevalence of negative responses among those reporting a prior personality disorder diagnosis (31%). One multivariate regression model indicated a greater than four-fold elevated risk of adverse psychological responses to psychedelics in the personality disorder subsample (b = 1.425, p < 0.05). CONCLUSION We infer that the presence of a personality disorder may represent an elevated risk for psychedelic use and hypothesize that the importance of psychological support and good therapeutic alliance may be increased in this population.
Collapse
Affiliation(s)
- Alessia Marrocu
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Hannes Kettner
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Brandon Weiss
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Richard J Zeifman
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Carhart-Harris Lab, Departments of Neurology and Psychiatry, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
2
|
Haeny AM, Lopez JA, Colón Grigas PA, Crouch MC, Davis AK, Williams M. Investigating the associations of acute psychedelic experiences and changes in racial trauma symptoms, psychological flexibility, and substance use among People with Racial and Ethnic Minoritized Identities in the United States and Canada. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209035. [PMID: 37019336 PMCID: PMC11134567 DOI: 10.1016/j.josat.2023.209035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/03/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Evidence suggests that psychedelics may serve as a therapeutic approach to reduce substance use; however, people with racial and ethnic minoritized (REM) identities are often excluded from this research. We investigated whether psychedelic use affects other substance use among REM people and whether perceived changes in psychological flexibility and racial trauma mediates this association. METHODS REM people in the United States and Canada (N = 211; 32 % Black, 29 % Asian, 18 % American Indian/Indigenous Canadian, 21 % Native Hawaiian/Pacific Islander; 57 % female; mean age = 33.1, SD = 11.2) completed an online survey retrospectively reporting their substance use, psychological flexibility, and racial trauma symptoms 30 days before and after their most memorable psychedelic experience. RESULTS Analyses showed a significant perceived reduction in alcohol (p < .0001, d = 0.54) and drug use (p = .0001, d = 0.23) from before to after the psychedelic experience. Preliminary associations found perceived reductions in racial trauma symptoms were associated with perceived reductions in alcohol use and this association varied by race, dose, ethnic identity, and change in depressive symptoms. Specifically, Indigenous participants experienced greater perceived reductions in alcohol use relative to participants who identified as Asian, Black, or other. Those who took a high dose of psychedelics experienced greater perceived reductions in alcohol use relative to those who took a low dose. Participants with a stronger ethnic identity and those with a perceived reduction in depressive symptoms experienced a perceived reduction in alcohol use. Serial mediation indicated a perceived increase in psychological flexibility and reduction in racial trauma symptoms mediated the association between acute psychedelic effects and perceived reductions in alcohol and drug use. CONCLUSION These findings suggest that psychedelic experiences may contribute to an increase in psychological flexibility and reduction in racial trauma symptoms and alcohol and drug use among REM people. REM people have been largely excluded from psychedelic treatment research even though psychedelic use is considered a traditional healing practice in many communities of color. Longitudinal studies of REM people should replicate our findings.
Collapse
Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, 34 Park St, New Haven, CT 06519, USA.
| | - Joel A Lopez
- University of Connecticut, Department of Psychological Sciences, 406 Unit 1020, Babbidge Rd., Storrs, CT 06269, USA
| | - Pamela A Colón Grigas
- University of Connecticut, Department of Psychological Sciences, 406 Unit 1020, Babbidge Rd., Storrs, CT 06269, USA
| | - Maria C Crouch
- Yale School of Medicine, 34 Park St, New Haven, CT 06519, USA
| | - Alan K Davis
- Center for Psychedelic Drug Research and Education, The Ohio State University, College of Social Work, 1947 College Rd N., Columbus, OH 43210, USA; The Ohio State University, Department of Psychiatry, 370 W. 9th Avenue, Columbus, OH 43210, USA; Center for Psychedelic and Consciousness Research, Johns Hopkins University, 5510 Nathan Shock Rd., Baltimore, MD, USA
| | - Monnica Williams
- University of Ottawa, Faculty of Social Sciences, 120 University Private Social Sciences Building, Ottawa, Ontario K1N 6N5, Canada
| |
Collapse
|
3
|
Nikolaidis A, Lancelotta R, Gukasyan N, Griffiths RR, Barrett FS, Davis AK. Subtypes of the psychedelic experience have reproducible and predictable effects on depression and anxiety symptoms. J Affect Disord 2023; 324:239-249. [PMID: 36584715 PMCID: PMC9887654 DOI: 10.1016/j.jad.2022.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/24/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Subjective experiences seem to play an important role in the enduring effects of psychedelic experiences. Although the importance of the subjective experience on the impact of psychedelics is frequently discussed, a more detailed understanding of the subtypes of psychedelic experiences and their associated impacts on mental health has not been well documented. METHODS In the current study, machine learning cluster analysis was used to derive three subtypes of psychedelic experience in a large (n = 985) cross sectional sample. RESULTS These subtypes are not only associated with reductions in anxiety and depression symptoms and other markers of psychological wellbeing, but the structure of these subtypes and their subsequent impact on mental health are highly reproducible across multiple psychedelic substances. LIMITATIONS Data were obtained via retrospective self-report, which does not allow for definitive conclusions about the direction of causation between baseline characteristics of respondents, qualities of subjective experience, and outcomes. CONCLUSIONS The present analysis suggests that psychedelic experiences, in particular those that are associated with enduring improvements in mental health, may be characterized by reproducible and predictable subtypes of the subjective psychedelic effects. These subtypes appear to be significantly different with respect to the baseline demographic characteristics, baseline measures of mental health, and drug type and dose. These findings also suggest that efforts to increase psychedelic associated personal and mystical insight experiences may be key to maximizing beneficial impact of clinical approaches using this treatment in their patients.
Collapse
Affiliation(s)
- Aki Nikolaidis
- Child Mind Institute, Center for the Developing Brain, United States of America
| | - Rafaelle Lancelotta
- College of Social Work, The Ohio State University, Columbus, United States of America
| | - Natalie Gukasyan
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Roland R Griffiths
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Frederick S Barrett
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Alan K Davis
- College of Social Work, The Ohio State University, Columbus, United States of America; Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
| |
Collapse
|
4
|
Jones GM. Race and ethnicity moderate the associations between lifetime psychedelic use (MDMA/ecstasy and psilocybin) and major depressive episodes. J Psychopharmacol 2023; 37:61-69. [PMID: 36314881 DOI: 10.1177/02698811221127304] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychedelics are receiving renewed attention within Western medicine as they represent potential treatments for many difficult-to-treat mental health disorders. However, psychedelic science is limited in its focus and inclusion of racial and ethnic minorities. Hence, this study examines whether race and ethnicity moderate the associations that naturalistic 3,4-methylenedioxymethamphetamine (MDMA)/ecstasy use and psilocybin use share with major depressive episodes (MDEs). METHOD Data for this project are from The National Survey on Drug Use and Health (2005-2019). Participants were adults aged 18 years and older (unweighted N = 596,187). This study used multivariable logistic regression to test the interaction between race and ethnicity and MDMA/ecstasy use and psilocybin use for predicting lifetime, past year, and past year severe MDEs. RESULTS Race and ethnicity significantly moderated the associations between MDMA/ecstasy use and psilocybin use and MDEs. For White participants, MDMA/ecstasy use and psilocybin use each were associated with lowered odds of all three MDE outcomes (adjusted odds ratio (aOR) range: 0.82-0.92). For Hispanic participants, MDMA/ecstasy use and psilocybin use each conferred lowered odds of only a past year MDE (MDMA/ecstasy aOR: 0.82; psilocybin aOR: 0.79). For Non-Hispanic Racial Minority participants, MDMA/ecstasy and psilocybin use did not confer lowered odds of any MDE outcomes. CONCLUSION Race and ethnicity have an impact on the associations that psychedelics share with mental health outcomes. Future research should explore the impact of identity and discrimination on the effects of psychedelics and should explore whether these substances can serve as effective treatments for minorities when used in culturally informed contexts.
Collapse
Affiliation(s)
- Grant M Jones
- Department of Psychology, Harvard University, Cambridge, MA, USA
| |
Collapse
|
5
|
Race and ethnicity moderate the associations between lifetime psychedelic use (MDMA and psilocybin) and psychological distress and suicidality. Sci Rep 2022; 12:16976. [PMID: 36216840 PMCID: PMC9551032 DOI: 10.1038/s41598-022-18645-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/17/2022] [Indexed: 12/29/2022] Open
Abstract
Psychedelic compounds have been linked to salutary mental health outcomes in both naturalistic and clinical settings; however, current research on psychedelics suffers from a lack of inclusion and focus on racial and ethnic minorities. Thus, the goal of our study was to assess whether race and ethnicity moderate the associations that naturalistic lifetime MDMA (3,4-Methylenedioxymethamphetamine) use and psilocybin use share with past month psychological distress and past year suicidality (ideation and planning). Using data from the National Survey on Drug Use and Health (NSDUH) (2008-2019) (N = 484,732), we conducted survey-weighted multivariable logistic regression to conduct interaction tests and to assess the associations that MDMA use and psilocybin use share with the aforementioned outcomes for each racial and ethnic group. Race and ethnicity significantly moderated the associations between MDMA and psilocybin use and psychological distress and suicidality. For White participants, MDMA and psilocybin use conferred lowered odds of all distress and suicidality outcomes. For racial and ethnic minority participants, the associations between psychedelic use and suicidality were far fewer. These findings invite further research into the impact of race, ethnicity, and other identity factors (e.g., socioeconomic status, sexual/gender minority status) on the effects of psychedelic substances.
Collapse
|
6
|
Gobbi G, Inserra A, Greenway KT, Lifshitz M, Kirmayer LJ. Psychedelic medicine at a crossroads: Advancing an integrative approach to research and practice. Transcult Psychiatry 2022; 59:718-724. [PMID: 36263521 PMCID: PMC9663823 DOI: 10.1177/13634615221119388] [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: 11/16/2022]
Abstract
Psychedelics have been already used by human societies for more than 3000 years, mostly in religious and healing context. The renewed interest in the potential application of psychedelic compounds as novel therapeutics has led to promising preliminary evidence of clinical benefit in some psychiatric disorders. Despite these promising results, the potential for large-scale clinical application of these profoundly consciousness-altering substances, in isolation from the sociocultural contexts in which they were traditionally used, raises important concerns. These concerns stem from the recognition that the mechanisms of therapeutic action of psychedelics are not entirely dependent on neurobiology, but also on the psychological, social and spiritual processes for their efficacy. For these reasons, physicians or psychotherapists involved in psychedelic-assisted psychotherapy need training in ways to accompany patients through this experience to promote positive outcomes and address potential side effects. Psychedelic therapies may foster the emergence of a novel paradigm in psychiatry that integrates psychopharmacological, psychotherapeutic, and cultural interventions for patients with mental health issues.
Collapse
Affiliation(s)
- Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, 5620McGill University, Montreal, QC, Canada
| | - Antonio Inserra
- Neurobiological Psychiatry Unit, Department of Psychiatry, 5620McGill University, Montreal, QC, Canada
| | - Kyle T Greenway
- Geri-PARTy Research Group, 113635Lady Davis Institute for Medical Research, Jewish General Hospital, 5620McGill University, Montreal, QC, Canada
| | - Michael Lifshitz
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, 5620McGill University, Montreal, QC, Canada.,Culture and Mental Health Research Unit, Institute of Community & Family Psychiatry and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, 5620McGill University, Montreal, QC, Canada.,Culture and Mental Health Research Unit, Institute of Community & Family Psychiatry and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| |
Collapse
|
7
|
Abstract
Experiences of psychedelics and psychosis were deeply entangled in scientific practices in the mid-20th century, from uses of psychedelic drugs that could model psychosis, to detailed phenomenological comparisons of endogenous and drug-induced madness. After the moral panic of the 1960s shut down psychedelic research, however, these two phenomena became disentangled. In the decades following, the science of psychosis transformed, shedding the language of psychoanalysis, and adopting the new scientific veneer of psychiatry. Today, as psychedelic science re-emerges, the research programs surrounding psychosis and psychedelics now stand in stark contrast. Here, I look closely at how these research programs respond to questions related to what is worth measuring, what is worth investigating, and how we ought to respond to these experiences. This comparison reveals radically different assumptions and values that guide each research paradigm and shape clinical practice. While psychedelic research often includes scales that seek to capture experiences of mysticism, meaningfulness, and ego dissolution, research related to psychosis focuses on the measurement of pathological symptoms and functioning. Research into psychosis primarily seeks universal and reductionist causal explanations and interventions, while psychedelic research embraces the importance of set and setting in shaping unique experiences. Responses to psychedelic crisis involve warmth, compassion, and support, while responses to psychotic experiences often involve restraint, seclusion, and weapons. I argue that these differences contain important lessons for psychiatry. However, as psychedelic research struggles to meet regulatory requirements and fit within the paradigm of evidence-based medicine, these differences may quickly dissolve.
Collapse
Affiliation(s)
- Phoebe Friesen
- Biomedical Ethics Unit, Department of Social Studies of Medicine, 5620McGill University, Montreal, QC, Canada
| |
Collapse
|
8
|
Pharmacological Strategies for Suicide Prevention Based on the Social Pain Model: A Scoping Review. PSYCH 2022. [DOI: 10.3390/psych4030038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Suicidal behaviour is a public health problem whose magnitude is both substantial and increasing. Since many individuals seek medical treatment following a suicide attempt, strategies aimed at reducing further attempts in this population are a valid and feasible secondary prevention approach. An evaluation of the available evidence suggests that existing treatment approaches have a limited efficacy in this setting, highlighting the need for innovative approaches to suicide prevention. Existing research on the neurobiology of social pain has highlighted the importance of this phenomenon as a risk factor for suicide, and has also yielded several attractive targets for pharmacological strategies that could reduce suicidality in patients with suicidal ideation or a recent attempt. In this paper, the evidence related to these targets is synthesized and critically evaluated. The way in which social pain is related to the “anti-suicidal” properties of recently approved treatments, such as ketamine and psilocybin, is examined. Such strategies may be effective for the short-term reduction in suicidal ideation and behaviour, particularly in cases where social pain is identified as a contributory factor. These pharmacological approaches may be effective regardless of the presence or absence of a specific psychiatric diagnosis, but they require careful evaluation.
Collapse
|
9
|
Argento E, Goldenberg S, Deering K, Lavalley J, Braschel M, Bingham B, Shannon K. Interest in receiving psychedelic-assisted therapy among marginalized women: Implications and findings from a community-based study in Canada. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100044. [PMID: 36845985 PMCID: PMC9948919 DOI: 10.1016/j.dadr.2022.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Background Psychedelic-assisted therapies are receiving mounting attention for their therapeutic potential. However, little is known about interest among women who experience elevated risk of mental health and substance use disorders. This study examined interest in receiving psychedelic-assisted therapy and socio-structural factors associated with interest among marginalized women. Methods Data (2016-2017) were drawn from two community-based, prospective open cohorts of >1000 marginalized women in Metro Vancouver, Canada. Bivariate and multivariable logistic regression examined associations with interest in receiving psychedelic-assisted therapy. Among women who used psychedelics, additional data were collected to describe ratings of personal meaningfulness, sense of wellbeing, and spiritual significance. Results Of 486 eligible participants (aged 20-67 years), 43% (n = 211) were interested in receiving psychedelic-assisted therapy. Over half identified as Indigenous (First Nations, Métis or Inuit). Factors independently associated with interest in psychedelic-assisted therapy in multivariable analysis included: daily crystal methamphetamine use in the last six months (Adjusted Odds Ratio [AOR] 3.02; 95%Confidence Interval (CI) 1.37-6.65), lifetime mental health conditions (depression, anxiety, post-traumatic stress disorder) (AOR 2.13; 95%CI 1.27-3.59), childhood abuse (AOR 1.99; 95%CI 1.02-3.88), lifetime psychedelic use (AOR 1.97; 95%CI 1.14-3.38), and younger age (AOR 0.97 per year older; 95%CI 0.95-0.99). Conclusions Several mental health and substance use-related variables that have been demonstrated to be amenable to psychedelic-assisted therapy were associated with interest in receiving psychedelic-assisted therapy among women in this setting. As access to psychedelic-assisted therapies continues to expand, any future approaches to extend psychedelic medicine to marginalized women should integrate trauma-informed care and broader socio-structural supports.
Collapse
Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver V6T 1Z3 BC, Canada
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
- BC Centre on Substance Use, 1045 Howe Street, Vancouver V6Z 1Y6, BC, Canada
| | - Shira Goldenberg
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada
| | - Kathleen Deering
- Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver V6T 1Z3 BC, Canada
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
| | - Jennifer Lavalley
- BC Centre on Substance Use, 1045 Howe Street, Vancouver V6Z 1Y6, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver V6T 1Z4, BC, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
| | - Brittany Bingham
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
- Vancouver Coastal Health, Aboriginal Health, 2750 East Hastings Street, Vancouver V5K 1Z9, BC, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver V6T 1Z3 BC, Canada
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
| |
Collapse
|
10
|
Hearn BG, Brubaker MD, Richardson G. Counselors’ attitudes toward psychedelics and their use in therapy. JOURNAL OF COUNSELING AND DEVELOPMENT 2022. [DOI: 10.1002/jcad.12429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Benjamin G. Hearn
- College of Education, Criminal Justice, and Human Services University of Cincinnati Cincinnati Ohio USA
| | - Michael D. Brubaker
- College of Education, Criminal Justice, and Human Services University of Cincinnati Cincinnati Ohio USA
| | - George Richardson
- College of Education, Criminal Justice, and Human Services University of Cincinnati Cincinnati Ohio USA
| |
Collapse
|
11
|
Psychedelic use is associated with reduced daily opioid use among people who use illicit drugs in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103518. [PMID: 34758431 PMCID: PMC8890776 DOI: 10.1016/j.drugpo.2021.103518] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Research into the therapeutic and naturalistic uses of psychedelics for improving outcomes related to mental health disorders has generated increasing interest in recent years. While controlled clinical trials of psychedelics have signaled benefits for treating substance use disorders, this area has not been well studied in the context of naturalistic psychedelic use. This study sought to investigate the possible relationship between recent naturalistic psychedelic use and subsequent daily illicit opioid use among people who use drugs (PWUD). METHODS Data (2006-2018) were drawn from three harmonized prospective cohorts of community-recruited PWUD in Vancouver, Canada. We used multivariable generalized linear mixed-effects modeling (GLMM) to estimate the independent association between psychedelic use and subsequent daily illicit opioid use. RESULTS Among 3813 PWUD at baseline, 1093 (29%) reported daily use of illicit opioids and 229 (6%) reported psychedelic use in the past six months. Over study follow-up after adjusting for a range of potential confounders, psychedelic use remained independently associated with a significantly reduced odds of subsequent daily opioid use (Adjusted Odds Ratio: 0.45; 95% Confidence Interval: 0.29 to 0.70). CONCLUSION While confirmation in other settings is required, these findings align with growing evidence that psychedelic use may be associated with detectable reductions in subsequent substance use including illicit opioid use.
Collapse
|
12
|
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating, chronic disorder and efficacy rates of current PTSD treatments are underwhelming. There is a critical need for innovative approaches. We provide an overview of trauma and PTSD and cite literature providing converging evidence of the therapeutic potential of psilocybin for PTSD. No study to date has investigated psilocybin or psilocybin-assisted psychotherapy (PAP) as treatments for PTSD. An open-label study in traumatized AIDS survivors found that PAP reduced PTSD symptoms, attachment anxiety, and demoralization. Several PAP trials show preliminary efficacy in facilitating confronting traumatic memories, decreasing emotional avoidance, depression, anxiety, pessimism, and disconnection from others, and increasing acceptance, self-compassion, and forgiveness of abusers, all of which are relevant to PTSD recovery. There is also early evidence that other classic psychedelics may produce large reductions in PTSD symptoms in combat veterans. However, this body of literature is small, mechanisms are not yet well understood, and the risks of using psychedelic compounds for trauma-related disorders need further study. In sum, evidence supports further investigation of PAP as a radically new approach for treating PTSD.
Collapse
Affiliation(s)
- Amanda J Khan
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Ellen Bradley
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Aoife O'Donovan
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Joshua Woolley
- Department of Psychiatry, University of California, San Francisco, CA, USA.
| |
Collapse
|
13
|
Hearn B. Psychedelics, Mystical Experiences, and Meaning Making: A Renegotiation Process With the Challenges of Existence. THE JOURNAL OF HUMANISTIC COUNSELING 2021. [DOI: 10.1002/johc.12164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Benjamin Hearn
- Department of Counselor Education and Human Services University of Cincinnati
| |
Collapse
|
14
|
Forstmann M, Sagioglou C. New Insights Into the Clinical and Nonclinical Effects of Psychedelic Substances. EUROPEAN PSYCHOLOGIST 2021. [DOI: 10.1027/1016-9040/a000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. After decades of stagnation, research on psychedelic substances (such as lysergic acid diethylamide [LSD], psilocybin, or N,N-dimethyltryptamine [DMT]) has experienced a renaissance over the last 10 years, with various major research programs being conducted across Europe and the United States. This research primarily investigates the potential of psychedelics in the treatment of mental health disorders, their short- and long-term effects on recreational users, and the neurological and cognitive processes responsible for their effects. The present review provides a concise summary of the most recent insights gained from this research. We briefly outline the history of psychedelic research, the objective and subjective effects caused by these substances, the prevalence and socio-psychological correlates of their use, as well as their potential for harm. Subsequently, we review empirical research on the beneficial effects of psychedelics in clinical samples, focusing on their efficacy in the treatment of major depression, anxiety, and substance use disorders, and discuss research on the proposed neural and cognitive mechanisms behind these effects. We then review research on their effects on healthy subjects, focusing on psychological well-being as well as changes in personality, nature-relatedness, and creativity. Finally, we review empirical evidence regarding the long-term effects of single experiences with psychedelics and conclude with a summary and outlook.
Collapse
|
15
|
Ross S, Agin-Liebes G, Lo S, Zeifman RJ, Ghazal L, Benville J, Franco Corso S, Bjerre Real C, Guss J, Bossis A, Mennenga SE. Acute and Sustained Reductions in Loss of Meaning and Suicidal Ideation Following Psilocybin-Assisted Psychotherapy for Psychiatric and Existential Distress in Life-Threatening Cancer. ACS Pharmacol Transl Sci 2021; 4:553-562. [PMID: 33860185 PMCID: PMC8033770 DOI: 10.1021/acsptsci.1c00020] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 12/13/2022]
Abstract
People with advanced cancer are at heightened risk of desire for hastened death (DHD), suicidal ideation (SI), and completed suicide. Loss of Meaning (LoM), a component of demoralization, can be elevated by a cancer diagnosis and predicts DHD and SI in this population. We completed a randomized controlled trial in which psilocybin-assisted psychotherapy (PAP) produced rapid and sustained improvements in depression, demoralization, and hopelessness in people with cancer. Converging epidemiologic and clinical trial findings suggests a potential antisuicidal effect of this treatment. To probe our hypothesis that PAP relieves SI through its beneficial impacts on depression and demoralization (LoM in particular), we performed secondary analyses assessing within- and between-group differences with regard to LoM and an SI composite score. Among participants with elevated SI at baseline, PAP was associated with within-group reductions in SI that were apparent as early as 8 h and persisted for 6.5 months postdosing. PAP also produced large reductions in LoM from baseline that were apparent 2 weeks after treatment and remained significant and robust at the 6.5 month and 3.2 and 4.5 year follow-ups. Exploratory analyses support our hypothesis and suggest that PAP may be an effective antisuicidal intervention following a cancer diagnosis due to its positive impact on hopelessness and demoralization and its effects on meaning-making in particular. These preliminary results implicate psilocybin treatment as a potentially effective alternative to existing antidepressant medications in patients with cancer that are also suicidal, and warrant further investigation in participants with elevated levels of depression and suicidality.
Collapse
Affiliation(s)
- Stephen Ross
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States.,Bellevue Hospital Center, New York, New York, 10016, United States
| | - Gabrielle Agin-Liebes
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, San Francisco, California, 94110, United States.,Zuckerberg San Francisco General Hospital, San Francisco, California, 94110, United States
| | - Sharon Lo
- Pacific University College of Health Professions, Hillsboro, Oregon 97123-4218, United States
| | | | - Leila Ghazal
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States
| | - Julia Benville
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States
| | - Silvia Franco Corso
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, New York, 10032-3784, United States
| | - Christian Bjerre Real
- Memorial Sloan Kettering Cancer Center, New York, New York, 10065-6007, United States
| | - Jeffrey Guss
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States.,Bellevue Hospital Center, New York, New York, 10016, United States
| | - Anthony Bossis
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States.,Bellevue Hospital Center, New York, New York, 10016, United States
| | - Sarah E Mennenga
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States
| |
Collapse
|
16
|
Zeifman R, Singhal N, Breslow L, Weissman CR. On the Relationship between Classic Psychedelics and Suicidality: A Systematic Review. ACS Pharmacol Transl Sci 2021; 4:436-451. [PMID: 33860173 PMCID: PMC8033757 DOI: 10.1021/acsptsci.1c00024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Indexed: 12/13/2022]
Abstract
Use of classic psychedelics (e.g., psilocybin, ayahuasca, and lysergic acid diethylamide) is increasing, and psychedelic therapy is receiving growing attention as a novel mental health intervention. Suicidality remains a potential safety concern associated with classic psychedelics and is, concurrently, a mental health concern that psychedelic therapy may show promise in targeting. Accordingly, further understanding of the relationship between classic psychedelics and suicidality is needed. Therefore, we conducted a systematic review of the relationship between classic psychedelics (both non-clinical psychedelic use and psychedelic therapy) and suicidality. We identified a total of 64 articles, including 41 articles on the association between non-clinical classic psychedelic use and suicidality and 23 articles on the effects of psychedelic therapy on suicidality. Findings on the association between lifetime classic psychedelic use and suicidality were mixed, with studies finding positive, negative, and no significant association. A small number of reports of suicide and decreased suicidality following non-clinical classic psychedelic use were identified. Several cases of suicide in early psychedelic therapy were identified; however, it was unclear whether this was due to psychedelic therapy itself. In recent psychedelic therapy clinical trials, we found no reports of increased suicidality and preliminary evidence for acute and sustained decreases in suicidality following treatment. We identify some remaining questions and provide suggestions for future research on the association between classic psychedelics and suicidality.
Collapse
Affiliation(s)
- Richard
J. Zeifman
- Department
of Psychology, Ryerson University, Toronto, Ontario M5B 2K3, Canada
| | - Nikhita Singhal
- Department
of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Leah Breslow
- Independent
Researcher, Toronto, Ontario, Canada
| | - Cory R. Weissman
- Department
of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| |
Collapse
|
17
|
Abstract
This paper introduces a new construct, the 'pivotal mental state', which is defined as a hyper-plastic state aiding rapid and deep learning that can mediate psychological transformation. We believe this new construct bears relevance to a broad range of psychological and psychiatric phenomena. We argue that pivotal mental states serve an important evolutionary function, that is, to aid psychological transformation when actual or perceived environmental pressures demand this. We cite evidence that chronic stress and neurotic traits are primers for a pivotal mental state, whereas acute stress can be a trigger. Inspired by research with serotonin 2A receptor agonist psychedelics, we highlight how activity at this particular receptor can robustly and reliably induce pivotal mental states, but we argue that the capacity for pivotal mental states is an inherent property of the human brain itself. Moreover, we hypothesize that serotonergic psychedelics hijack a system that has evolved to mediate rapid and deep learning when its need is sensed. We cite a breadth of evidences linking stress via a variety of inducers, with an upregulated serotonin 2A receptor system (e.g. upregulated availability of and/or binding to the receptor) and acute stress with 5-HT release, which we argue can activate this primed system to induce a pivotal mental state. The pivotal mental state model is multi-level, linking a specific molecular gateway (increased serotonin 2A receptor signaling) with the inception of a hyper-plastic brain and mind state, enhanced rate of associative learning and the potential mediation of a psychological transformation.
Collapse
Affiliation(s)
- Ari Brouwer
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | | |
Collapse
|
18
|
Zeifman RJ, Singhal N, Dos Santos RG, Sanches RF, de Lima Osório F, Hallak JEC, Weissman CR. Rapid and sustained decreases in suicidality following a single dose of ayahuasca among individuals with recurrent major depressive disorder: results from an open-label trial. Psychopharmacology (Berl) 2021; 238:453-459. [PMID: 33118052 DOI: 10.1007/s00213-020-05692-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/23/2020] [Indexed: 01/14/2023]
Abstract
RATIONALE Suicidality is a major public health concern with limited treatment options. Accordingly, there is a need for innovative interventions for suicidality. Preliminary evidence indicates that treatment with the psychedelic ayahuasca may lead to decreases in depressive symptoms among individuals with major depressive disorder (MDD). However, there remains limited understanding of whether ayahuasca also leads to reductions in suicidality. OBJECTIVE To examine the acute and post-acute effect of ayahuasca on suicidality among individuals with MDD. METHODS We conducted a secondary analysis of an open-label trial in which individuals with recurrent MDD received a single dose of ayahuasca (N = 17). Suicidality was assessed at baseline; during the intervention; and 1, 7, 14, and 21 days after the intervention. RESULTS Among individuals with suicidality at baseline (n = 15), there were significant acute (i.e., 40, 80, 140, and 180 min after administration) and post-acute (1, 7, 14, and 21 days after administration) decreases in suicidality following administration of ayahuasca. Post-acute effect sizes for decreases in suicidality were large (Hedges' g = 1.31-1.75), with the largest effect size 21 days after the intervention (g = 1.75). CONCLUSIONS When administered in the appropriate context, ayahuasca may lead to rapid and sustained reductions in suicidality among individuals with MDD. Randomized, double-blind studies with larger sample sizes are needed to confirm this early finding.
Collapse
Affiliation(s)
- Richard J Zeifman
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, Canada.
| | - Nikhita Singhal
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rafael G Dos Santos
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, SP, Brazil
| | - Rafael F Sanches
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, SP, Brazil
| | - Flávia de Lima Osório
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, SP, Brazil
| | - Jaime E C Hallak
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, SP, Brazil
| | - Cory R Weissman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
19
|
Barnett BS, Greer GR. Psychedelic Psychiatry and the Consult-Liaison Psychiatrist: A Primer. J Acad Consult Liaison Psychiatry 2021; 62:460-471. [PMID: 34210406 DOI: 10.1016/j.jaclp.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Psychedelic compounds such as lysergic acid diethylamide (LSD), psilocybin, and 3,4-Methylenedioxymethamphetamine (MDMA) share a long and complex history with psychiatry. A half century ago, psychedelics were widely employed by psychiatrists in investigational and clinical settings, with studies demonstrating promising findings for their use in the treatment of mental illness and substance use disorders. However, concerns were also raised about their abuse potential and other adverse effects. Owing to these worries and psychedelics' association with the counterculture movement, psychedelics were largely outlawed in the United States in 1970, bringing research on their therapeutic potential to a halt. However, in recent years, a resurgence of psychedelic research has revealed compelling, though early, evidence for the use of psychedelic-assisted therapy in treating alcohol use disorder, nicotine use disorder, posttraumatic stress disorder, and depression. OBJECTIVE Here we provide an overview of psychiatry's complicated relationship with psychedelics, while reviewing contemporary findings on psychedelic-assisted therapy, safety of psychedelic-assisted therapy, and risks of nonmedical use. We also make the case that psychiatry should consider preparing now for the possibility of Food and Drug Administration approval of psychedelic-assisted therapies in the near future. We conclude by discussing how growing societal interest in psychedelics could impact the work of consult-liaison psychiatrists, while also exploring how consult-liaison psychiatrists might contribute to future delivery of psychedelic treatments. METHODS We reviewed literature on psychedelic-assisted therapies and adverse events resulting from nonmedical psychedelic use. RESULTS We found a small, but rapidly growing literature indicating that psychedelic-assisted therapies may have treatment potential for mental illness and addiction. Our search also revealed a variety of rare adverse events stemming from nonmedical psychedelic use. CONCLUSIONS Despite past concerns about psychedelics, current data indicate psychedelic-assisted therapy may potentially reduce suffering owing to mental illness and addiction if administered thoughtfully and cautiously by trained professionals in medical settings.
Collapse
Affiliation(s)
- Brian S Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH.
| | | |
Collapse
|
20
|
Kočárová R, Horáček J, Carhart-Harris R. Does Psychedelic Therapy Have a Transdiagnostic Action and Prophylactic Potential? Front Psychiatry 2021; 12:661233. [PMID: 34349678 PMCID: PMC8327748 DOI: 10.3389/fpsyt.2021.661233] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022] Open
Abstract
Addressing global mental health is a major 21st-century challenge. Current treatments have recognized limitations; in this context, new ones that are prophylactic and effective across diagnostic boundaries would represent a major advance. The view that there exists a core of transdiagnostic overlap between psychiatric disorders has re-emerged in recent years, and evidence that psychedelic therapy holds promise for a range of psychiatric disorders supports the position that it may be transdiagnostically effective. Here, we propose that psychedelic therapy's core, transdiagnostically relevant action lies in its ability to increase neuronal and mental plasticity, thus enhancing the potential for change, which we consider to be a key to its therapeutic benefits. Moreover, we suggest that enhanced plasticity via psychedelics, combined with a psychotherapeutic approach, can aid healthy adaptability and resilience, which are protective factors for long-term well-being. We present candidate neurological and psychological markers of this plasticity and link them with a predictive processing model of the action of psychedelics. We propose that a model of psychedelic-induced plasticity combined with an adequate therapeutic context has prophylactic and transdiagnostic potential, implying that it could have a broad, positive impact on public health.
Collapse
Affiliation(s)
- Rita Kočárová
- Department of Translational Neuroscience, National Institute of Mental Health, Klecany, Czechia.,Department of Psychology, Faculty of Arts, Charles University, Prague, Czechia.,Beyond Psychedelics, Prague, Czechia
| | - Jiří Horáček
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Robin Carhart-Harris
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| |
Collapse
|
21
|
Inserra A, De Gregorio D, Gobbi G. Psychedelics in Psychiatry: Neuroplastic, Immunomodulatory, and Neurotransmitter Mechanisms. Pharmacol Rev 2020; 73:202-277. [PMID: 33328244 DOI: 10.1124/pharmrev.120.000056] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mounting evidence suggests safety and efficacy of psychedelic compounds as potential novel therapeutics in psychiatry. Ketamine has been approved by the Food and Drug Administration in a new class of antidepressants, and 3,4-methylenedioxymethamphetamine (MDMA) is undergoing phase III clinical trials for post-traumatic stress disorder. Psilocybin and lysergic acid diethylamide (LSD) are being investigated in several phase II and phase I clinical trials. Hence, the concept of psychedelics as therapeutics may be incorporated into modern society. Here, we discuss the main known neurobiological therapeutic mechanisms of psychedelics, which are thought to be mediated by the effects of these compounds on the serotonergic (via 5-HT2A and 5-HT1A receptors) and glutamatergic [via N-methyl-d-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors] systems. We focus on 1) neuroplasticity mediated by the modulation of mammalian target of rapamycin-, brain-derived neurotrophic factor-, and early growth response-related pathways; 2) immunomodulation via effects on the hypothalamic-pituitary-adrenal axis, nuclear factor ĸB, and cytokines such as tumor necrosis factor-α and interleukin 1, 6, and 10 production and release; and 3) modulation of serotonergic, dopaminergic, glutamatergic, GABAergic, and norepinephrinergic receptors, transporters, and turnover systems. We discuss arising concerns and ways to assess potential neurobiological changes, dependence, and immunosuppression. Although larger cohorts are required to corroborate preliminary findings, the results obtained so far are promising and represent a critical opportunity for improvement of pharmacotherapies in psychiatry, an area that has seen limited therapeutic advancement in the last 20 years. Studies are underway that are trying to decouple the psychedelic effects from the therapeutic effects of these compounds. SIGNIFICANCE STATEMENT: Psychedelic compounds are emerging as potential novel therapeutics in psychiatry. However, understanding of molecular mechanisms mediating improvement remains limited. This paper reviews the available evidence concerning the effects of psychedelic compounds on pathways that modulate neuroplasticity, immunity, and neurotransmitter systems. This work aims to be a reference for psychiatrists who may soon be faced with the possibility of prescribing psychedelic compounds as medications, helping them assess which compound(s) and regimen could be most useful for decreasing specific psychiatric symptoms.
Collapse
Affiliation(s)
- Antonio Inserra
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Danilo De Gregorio
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
22
|
Johnson S, Black QC. Classic Psychedelics as a Psychotherapeutic Aid in the Treatment of Stimulant Use Disorder: a Case Report. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
23
|
Kuitunen-Paul S, Roessner V, Basedow LA, Golub Y. Beyond the tip of the iceberg: A narrative review to identify research gaps on comorbid psychiatric disorders in adolescents with methamphetamine use disorder or chronic methamphetamine use. Subst Abus 2020; 42:13-32. [PMID: 32870121 DOI: 10.1080/08897077.2020.1806183] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Methamphetamine use disorder (MUD) frequently begins in adolescence, often accompanied by other psychiatric or mental disorders. Up to now, no comprehensive review about MUD and comorbid disorders in adolescents is available. We thus aimed to review the literature on comorbid mental disorders and MUD in adolescents in order to identify future research topics. Method: A PubMed search was conducted in July 2019. Relevant comorbidities were defined as attention-deficit disorder with/without hyperactivity, anxiety disorders, depression, eating disorders, post-traumatic stress disorder, psychosis, borderline personality disorder, conduct disorder and antisocial personality disorder, as well as other substance use disorders. For each comorbidity, we summarized prevalence rates, findings on comorbidity mechanisms, and recommended treatment options, if applicable. Results: Few articles focused on MUD in adolescents. Prevalence rates differed largely between comorbid disorders, with tobacco use disorder, conduct disorder, post-traumatic stress disorder, anxiety disorders, and attention-deficit disorders being the most prevalent comorbidities while eating disorders were rare. Examined onset patterns and comorbidity mechanisms indicated three groups of comorbidities: preexisting disorders self-medicated with methamphetamine, disorders induced by chronic methamphetamine use, and disorders arising due to risk factors shared with MUD. Reviewed comorbidities were frequently associated with worse treatment outcomes. Conclusions: The limited evidence is in stark contrast to the presumably high prevalence and relevance of comorbid mental disorders in adolescents with MUD. Suggestions for future research topics, informed by adult findings, include genetic vulnerabilities, biological changes, and consequences of different use patterns. Surprisingly few MUD treatment programs explicitly integrate comorbid mental disorder modules.
Collapse
Affiliation(s)
- Sören Kuitunen-Paul
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lukas A Basedow
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yulia Golub
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
24
|
Johnson S, Black QC. Can Psychedelics Alleviate Symptoms of Cluster Headache and Accompanying Mental Health Problems? A Case Report Involving Hawaiian Baby Woodrose. J Psychoactive Drugs 2020; 52:319-323. [PMID: 32375602 DOI: 10.1080/02791072.2020.1762023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Preliminary evidence supports the efficacy of psychedelics in the alleviation of cluster headache and mental health problems. We describe a case of an individual with cluster headache and mood disorder who claims to have benefited from her use of psychedelics. A forty-eight-year-old woman was referred to a private Australian mental health clinic for the management of chronic pain and depression. She reported using Hawaiian baby woodrose to successfully alleviate symptoms of cluster headache and the accompanying mental health problems. Incidental observation also highlighted the potential therapeutic benefits of antiviral therapy. This is the first case report to concurrently examine the analgesic and psycho-spiritual effects of Hawaiian baby woodrose, with results in support of nascent research in this field. The results of this case report highlight the need for further research into the use of psychedelics in the management of cluster headache and mental illness.
Collapse
Affiliation(s)
- Shevaugn Johnson
- The Department of Psychiatry, School of Medicine, Adelaide University and the Department of Psychology, School of Psychology, Social Work, and Social Policy, University of South Australia, Adelaide, South Australia.,Wellbeing and Recovery Research Institute , Adelaide, South Australia
| | - Quentin C Black
- The Department of Psychiatry, School of Medicine, Adelaide University and the Department of Psychology, School of Psychology, Social Work, and Social Policy, University of South Australia, Adelaide, South Australia.,Wellbeing and Recovery Research Institute , Adelaide, South Australia
| |
Collapse
|
25
|
Fuentes JJ, Fonseca F, Elices M, Farré M, Torrens M. Therapeutic Use of LSD in Psychiatry: A Systematic Review of Randomized-Controlled Clinical Trials. Front Psychiatry 2020; 10:943. [PMID: 32038315 PMCID: PMC6985449 DOI: 10.3389/fpsyt.2019.00943] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/28/2019] [Indexed: 12/15/2022] Open
Abstract
Lysergic acid diethylamide (LSD) was studied from the 1950s to the 1970s to evaluate behavioral and personality changes, as well as remission of psychiatric symptoms in various disorders. LSD was used in the treatment of anxiety, depression, psychosomatic diseases and addiction. However, most of the studies were not performed under contemporary standards, and it has taken several decades for a resurgence of interest in LSD research and its therapeutic potential for psychiatry. The aim of this review is to identify controlled and randomized clinical trials that assess the potential use of LSD in psychiatry. PRISMA guidelines for systematic review were followed. A literature search of PubMed and Psychedelic bibliography from Multidisciplinary Association for Psychedelic Studies (MAPS) databases was performed as well as a manual search of references from evaluated studies. Only randomized-controlled clinical trials were included. Study quality was systematically calculated by using the Cochrane Collaboration Tool for assessing risk of bias. A final selection of 11 articles was made after considering inclusion and exclusion criteria. LSD was administered to 567 patients in a dose ranging from 20 to 800 mcg. Despite the design heterogeneity of clinical trials, positive results were observed, thus revealing the therapeutic potential of LSD to reduce psychiatric symptomatology, mainly in alcoholism. The vast majority of authors describe significant and positive short-term changes in patients, despite the fact that in some studies an important homogenization was observed between the LSD treatment group and control group at long-term follow-up. Multiple variables regarding LSD treatment therapeutic approach and quality of experience were revealed and related to therapeutic outcomes. LSD is revealed as a potential therapeutic agent in psychiatry; the evidence to date is strongest for the use of LSD in the treatment of alcoholism. Despite the difficulty of designing proper double blind clinical trials with this substance, new studies that conform to modern standards are necessary in order to strengthen our knowledge on its use and open new doors in the future.
Collapse
Affiliation(s)
- Juan José Fuentes
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Francina Fonseca
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
- Addiction Research Group (GRAd), Neuroscience Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Psychiatry Department, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Matilde Elices
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Magí Farré
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol (IGTP), Badalona, Spain
- Pharmacology Department, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Marta Torrens
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
- Addiction Research Group (GRAd), Neuroscience Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Psychiatry Department, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
| |
Collapse
|
26
|
Lengvenyte A, Olié E, Courtet P. Suicide Has Many Faces, So Does Ketamine: a Narrative Review on Ketamine's Antisuicidal Actions. Curr Psychiatry Rep 2019; 21:132. [PMID: 31797066 DOI: 10.1007/s11920-019-1108-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Suicidal behaviours are a challenge for a medical system and public health, partly due to the current lack of evidence-based, effective, rapid tools for suicidal crisis management. Ketamine and its enantiomer esketamine have raised hopes regarding this issue in the recent years. However, their efficacy in suicidal behaviours and mechanisms for it remain a topic of debate. RECENT FINDINGS Subanesthetic ketamine doses rapidly, albeit transiently decrease suicidal ideation, with effects emerging within an hour and persisting up to a week. Current evidence points to various and not necessarily exclusive mechanisms for ketamine's antisuicidal action, including effects on neuroplasticity, inflammation, reward system and pain processing. Ketamine rapidly decreases suicidal ideation, but whether it leads to meaningful clinical outcomes past 1 week is unclear. Multiple putative mechanisms drive ketamine's antisuicidal action. Future studies will have to show long-term ketamine treatment outcomes and further elucidate its mechanisms of action.
Collapse
Affiliation(s)
- Aiste Lengvenyte
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Emilie Olié
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France. .,Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France.
| |
Collapse
|
27
|
Zeifman RJ, Palhano-Fontes F, Hallak J, Arcoverde E, Maia-Oliveira JP, Araujo DB. The Impact of Ayahuasca on Suicidality: Results From a Randomized Controlled Trial. Front Pharmacol 2019; 10:1325. [PMID: 31798447 PMCID: PMC6878725 DOI: 10.3389/fphar.2019.01325] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023] Open
Abstract
Suicide is a major public health problem. Given increasing suicide rates and limitations surrounding current interventions, there is an urgent need for innovative interventions for suicidality. Although ayahuasca has been shown to target mental health concerns associated with suicidality (i.e., depression and hopelessness), research has not yet explored the impact of ayahuasca on suicidality. Therefore, we conducted secondary analyses of a randomized placebo-controlled trial in which individuals with treatment-resistant depression were administered one dose of ayahuasca (n = 14) or placebo (n = 15). Suicidality was assessed by a trained psychiatrist at baseline, as well as 1 day, 2 days, and 7 days after the intervention. A fixed-effects linear mixed model, as well as between and within-groups Cohen's d effect sizes were used to examine changes in suicidality. Controlling for baseline suicidality, we found a significant effect for time (p < .05). The effect of the intervention (i.e., ayahuasca vs. placebo) trended toward significance (p = .088). At all time points, we found medium between-group effect sizes (i.e., ayahuasca vs. placebo; day 1 Cohen’s d = 0.58; day 2 d = 0.56; day 7 d = 0.67), as well as large within-group (ayahuasca; day 1 Cohen's d = 1.33; day 2 d = 1.42; day 7 d = 1.19) effect sizes, for decreases in suicidality. Conclusions: This research is the first to explore the impact of ayahuasca on suicidality. The findings suggest that ayahuasca may show potential as an intervention for suicidality. We highlight important limitations of the study, potential mechanisms, and future directions for research on ayahuasca as an intervention for suicidality. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02914769.
Collapse
Affiliation(s)
- Richard J Zeifman
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Fernanda Palhano-Fontes
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.,Onofre Lopes University Hospital, UFRN, Natal, Brazil
| | - Jaime Hallak
- Department of Neurosciences and Behaviour, University of Sa~o Paulo (USP), Ribeira~o Preto, Brazil
| | | | | | - Draulio B Araujo
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.,Onofre Lopes University Hospital, UFRN, Natal, Brazil
| |
Collapse
|
28
|
O’Donnell KC, Mennenga SE, Bogenschutz MP. Psilocybin for depression: Considerations for clinical trial design. JOURNAL OF PSYCHEDELIC STUDIES 2019. [DOI: 10.1556/2054.2019.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background and aims
Given the enormous global burden of depressive illness, there is an urgent need to develop novel and more effective treatments for major depressive disorder (MDD). Recent findings have suggested that psychedelic drugs may have a role in the treatment of depressive symptoms, and a number of groups are in the process of developing protocols to study this question systematically. Given the subjective quality of both the psychedelic experience and depressive symptomatology, great care must be taken when designing a protocol to study the clinical efficacy of psychedelic drugs. This study will discuss many factors to consider when designing a clinical trial of psilocybin for MDD.
Methods
We provide a thorough review of pertinent research into antidepressant clinical trial methodology and review practical considerations that are relevant to the study of psychedelic-assisted treatment for depression.
Results
We discuss participant selection (including diagnostic accuracy, exclusion criteria, characteristics of the depressive episode, and the use of concurrent medications), study interventions (including dosing regimens, placebo selection, non-pharmacological components of treatment, and the importance of blinding), trial duration, outcome measures, and safety considerations.
Conclusions
Careful and transparent study design and data analysis will maximize the likelihood of generating meaningful, reproducible results, and identifying a treatment-specific effect. Meeting the highest standards for contemporary trial design may also broaden the acceptance of psychedelic research in the scientific community at large.
Collapse
Affiliation(s)
- Kelley C. O’Donnell
- 1 Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- 2 Department of Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Sarah E. Mennenga
- 1 Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- 2 Department of Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Michael P. Bogenschutz
- 1 Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- 2 Department of Psychiatry, Bellevue Hospital Center, New York, NY, USA
| |
Collapse
|
29
|
Carhart-Harris RL, Friston KJ. REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics. Pharmacol Rev 2019; 71:316-344. [PMID: 31221820 PMCID: PMC6588209 DOI: 10.1124/pr.118.017160] [Citation(s) in RCA: 363] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This paper formulates the action of psychedelics by integrating the free-energy principle and entropic brain hypothesis. We call this formulation relaxed beliefs under psychedelics (REBUS) and the anarchic brain, founded on the principle that-via their entropic effect on spontaneous cortical activity-psychedelics work to relax the precision of high-level priors or beliefs, thereby liberating bottom-up information flow, particularly via intrinsic sources such as the limbic system. We assemble evidence for this model and show how it can explain a broad range of phenomena associated with the psychedelic experience. With regard to their potential therapeutic use, we propose that psychedelics work to relax the precision weighting of pathologically overweighted priors underpinning various expressions of mental illness. We propose that this process entails an increased sensitization of high-level priors to bottom-up signaling (stemming from intrinsic sources), and that this heightened sensitivity enables the potential revision and deweighting of overweighted priors. We end by discussing further implications of the model, such as that psychedelics can bring about the revision of other heavily weighted high-level priors, not directly related to mental health, such as those underlying partisan and/or overly-confident political, religious, and/or philosophical perspectives. SIGNIFICANCE STATEMENT: Psychedelics are capturing interest, with efforts underway to bring psilocybin therapy to marketing authorisation and legal access within a decade, spearheaded by the findings of a series of phase 2 trials. In this climate, a compelling unified model of how psychedelics alter brain function to alter consciousness would have appeal. Towards this end, we have sought to integrate a leading model of global brain function, hierarchical predictive coding, with an often-cited model of the acute action of psychedelics, the entropic brain hypothesis. The resulting synthesis states that psychedelics work to relax high-level priors, sensitising them to liberated bottom-up information flow, which, with the right intention, care provision and context, can help guide and cultivate the revision of entrenched pathological priors.
Collapse
Affiliation(s)
- R L Carhart-Harris
- Centre for Psychedelic Research, Division of Brain Sciences, Imperial College London, London, United Kingdom (R.L.C.-H.); and Institute of Neurology, Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom (K.J.F.)
| | - K J Friston
- Centre for Psychedelic Research, Division of Brain Sciences, Imperial College London, London, United Kingdom (R.L.C.-H.); and Institute of Neurology, Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom (K.J.F.)
| |
Collapse
|
30
|
Johnson MW, Hendricks PS, Barrett FS, Griffiths RR. Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. Pharmacol Ther 2019; 197:83-102. [DOI: 10.1016/j.pharmthera.2018.11.010] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
31
|
Polito V, Stevenson RJ. A systematic study of microdosing psychedelics. PLoS One 2019; 14:e0211023. [PMID: 30726251 PMCID: PMC6364961 DOI: 10.1371/journal.pone.0211023] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 12/10/2018] [Indexed: 12/20/2022] Open
Abstract
The phenomenon of 'microdosing', that is, regular ingestion of very small quantities of psychedelic substances, has seen a rapid explosion of popularity in recent years. Individuals who microdose report minimal acute effects from these substances yet claim a range of long-term general health and wellbeing benefits. There have been no published empirical studies of microdosing and the current legal and bureaucratic climate makes direct empirical investigation of the effects of psychedelics difficult. In Study One we conducted a systematic, observational investigation of individuals who microdose. We tracked the experiences of 98 microdosing participants, who provided daily ratings of psychological functioning over a six week period. 63 of these additionally completed a battery of psychometric measures tapping mood, attention, wellbeing, mystical experiences, personality, creativity, and sense of agency, at baseline and at completion of the study. Analyses of daily ratings revealed a general increase in reported psychological functioning across all measures on dosing days but limited evidence of residual effects on following days. Analyses of pre and post study measures revealed reductions in reported levels of depression and stress; lower levels of distractibility; increased absorption; and increased neuroticism. To better understand these findings, in Study Two we investigated pre-existing beliefs and expectations about the effects of microdosing in a sample of 263 naïve and experienced microdosers, so as to gauge expectancy bias. All participants believed that microdosing would have large and wide-ranging benefits in contrast to the limited outcomes reported by actual microdosers. Notably, the effects believed most likely to change were unrelated to the observed pattern of reported outcomes. The current results suggest that dose controlled empirical research on the impacts of microdosing on mental health and attentional capabilities are needed.
Collapse
Affiliation(s)
- Vince Polito
- Department of Cognitive Science, Macquarie University, Sydney, Australia
| | | |
Collapse
|
32
|
Argento E, Braschel M, Walsh Z, Socias ME, Shannon K. The moderating effect of psychedelics on the prospective relationship between prescription opioid use and suicide risk among marginalized women. J Psychopharmacol 2018; 32:1385-1391. [PMID: 30255717 PMCID: PMC6355147 DOI: 10.1177/0269881118798610] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Given high rates of depression and suicide among marginalized women, and increasing calls to integrate trauma-informed biomedical and community-led structural interventions, this study longitudinally examines the potential moderating effect of psychedelic use on the relationship between other illicit drug use and suicide risk. METHODS Data (2010-2017) were drawn from a community-based, prospective open cohort of marginalized women in Vancouver, Canada. Extended Cox regression analyses examined the moderating effect of psychedelic use on the association between other illicit drug use and incidence of suicidal ideation or attempt over follow-up. RESULTS Of 340 women without suicidal ideation or attempt at baseline, 16% ( n=53) reported a first suicidal episode during follow-up, with an incidence density of 4.63 per 100 person-years (95% confidence interval 3.53-6.07). In unadjusted analysis, psychedelic use moderated the relationship between prescription opioid use and suicide risk: among women who did not use psychedelics, prescription opioid use increased the hazard of suicide (hazard ratio 2.91; 95% confidence interval 1.40-6.03) whereas prescription opioid use was not associated with increased suicidal ideation or attempt among those who used psychedelics (hazard ratio 0.69; 95% confidence interval 0.27-1.73) (interaction term p-value: 0.016). The moderating effect of psychedelics remained significant when adjusted for confounders (interaction term p-value: 0.036). CONCLUSIONS Psychedelic use had a protective moderating effect on the relationship between prescription opioid use and suicide risk. In the context of a severe public health crisis around prescription opioids and lack of addiction services tailored to marginalized women, this study supports calls for innovative, evidence-based and trauma-informed interventions, including further research on the potential benefits of psychedelics.
Collapse
Affiliation(s)
- Elena Argento
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - M. Eugenia Socias
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,BC Centre on Substance Use, Vancouver, BC, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
33
|
Haijen ECHM, Kaelen M, Roseman L, Timmermann C, Kettner H, Russ S, Nutt D, Daws RE, Hampshire ADG, Lorenz R, Carhart-Harris RL. Predicting Responses to Psychedelics: A Prospective Study. Front Pharmacol 2018; 9:897. [PMID: 30450045 PMCID: PMC6225734 DOI: 10.3389/fphar.2018.00897] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/23/2018] [Indexed: 01/14/2023] Open
Abstract
Responses to psychedelics are notoriously difficult to predict, yet significant work is currently underway to assess their therapeutic potential and the level of interest in psychedelics among the general public appears to be increasing. We aimed to collect prospective data in order to improve our ability to predict acute- and longer-term responses to psychedelics. Individuals who planned to take a psychedelic through their own initiative participated in an online survey (www.psychedelicsurvey.com). Traits and variables relating to set, setting and the acute psychedelic experience were measured at five different time points before and after the experience. Principle component and regression methods were used to analyse the data. Sample sizes for the five time points were N = 654, N = 535, N = 379, N = 315, and N = 212 respectively. Psychological well-being was increased 2 weeks after a psychedelic experience and remained at this level after 4 weeks. Higher ratings of a “mystical-type experience” had a positive effect on the change in well-being after a psychedelic experience, whereas the other acute psychedelic experience measures, i.e., “challenging experience” and “visual effects”, did not influence the change in well-being after the psychedelic experience. Having “clear intentions” for the experience was conducive to mystical-type experiences. Having a positive “set” as well as having the experience with intentions related to “recreation” were both found to decrease the likelihood of having a challenging experience. The baseline trait “absorption” and higher drug doses promoted all aspects of the acute experience, i.e., mystical-type and challenging experiences, as well as visual effects. When comparing the relative contribution of different types of variables in explaining the variance in the change in well-being, it seemed that baseline trait variables had the strongest effect on the change in well-being after a psychedelic experience. These results confirm the importance of extra-pharmacological factors in determining responses to a psychedelic. We view this study as an early step towards the development of empirical guidelines that can evolve and improve iteratively with the ultimate purpose of guiding crucial clinical decisions about whether, when, where and how to dose with a psychedelic, thus helping to mitigate risks while maximizing potential benefits in an evidence-based manner.
Collapse
Affiliation(s)
- Eline C H M Haijen
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Mendel Kaelen
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Leor Roseman
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom.,The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), Department of Medicine, Imperial College London, London, United Kingdom
| | - Christopher Timmermann
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom.,The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), Department of Medicine, Imperial College London, London, United Kingdom
| | - Hannes Kettner
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Suzanne Russ
- Psychology Program, Department of Social Sciences, Dickinson State University, Dickinson, ND, United States
| | - David Nutt
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Richard E Daws
- The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), Department of Medicine, Imperial College London, London, United Kingdom
| | - Adam D G Hampshire
- The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), Department of Medicine, Imperial College London, London, United Kingdom
| | - Romy Lorenz
- The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), Department of Medicine, Imperial College London, London, United Kingdom
| | - Robin L Carhart-Harris
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| |
Collapse
|
34
|
Hendricks PS. Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy. Int Rev Psychiatry 2018; 30:331-342. [PMID: 30260256 DOI: 10.1080/09540261.2018.1474185] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A psychological model of classic psychedelic-assisted psychotherapy informed by contemporary scientific data is presented in this paper. It is suggested that classic psychedelic-occasioned mystical experience is characterized by profound awe, a discrete emotion experienced in the presence of a vast stimulus requiring accommodation of mental structures. Awe, in turn, promotes the small self, a construct that, in the extreme, is analogous to those of unitive experience and ego dissolution. The small self is conceptualized as key to understanding the downstream effects of mystical experience occasioned in the context of classic psychedelic-assisted psychotherapy. With this novel theoretical framework in mind, a number of clinical implications and recommendations are provided so as to advance this incipient field of study.
Collapse
Affiliation(s)
- Peter S Hendricks
- a Department of Health Behavior, School of Public Health , University of Alabama at Birmingham , Birmingham , AL , USA
| |
Collapse
|
35
|
Mason NL, Kuypers KPC. Mental health of a self-selected sample of psychedelic users and self-medication practices with psychedelics. JOURNAL OF PSYCHEDELIC STUDIES 2018. [DOI: 10.1556/2054.2018.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Natasha L. Mason
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Kim P. C. Kuypers
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
36
|
Abstract
How do psychedelic drugs produce their characteristic range of acute effects in perception, emotion, cognition, and sense of self? How do these effects relate to the clinical efficacy of psychedelic-assisted therapies? Efforts to understand psychedelic phenomena date back more than a century in Western science. In this article I review theories of psychedelic drug effects and highlight key concepts which have endured over the last 125 years of psychedelic science. First, I describe the subjective phenomenology of acute psychedelic effects using the best available data. Next, I review late 19th-century and early 20th-century theories-model psychoses theory, filtration theory, and psychoanalytic theory-and highlight their shared features. I then briefly review recent findings on the neuropharmacology and neurophysiology of psychedelic drugs in humans. Finally, I describe recent theories of psychedelic drug effects which leverage 21st-century cognitive neuroscience frameworks-entropic brain theory, integrated information theory, and predictive processing-and point out key shared features that link back to earlier theories. I identify an abstract principle which cuts across many theories past and present: psychedelic drugs perturb universal brain processes that normally serve to constrain neural systems central to perception, emotion, cognition, and sense of self. I conclude that making an explicit effort to investigate the principles and mechanisms of psychedelic drug effects is a uniquely powerful way to iteratively develop and test unifying theories of brain function.
Collapse
Affiliation(s)
- Link R. Swanson
- Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN, United States
- Department of Philosophy, University of Minnesota, Minneapolis, MN, United States
- Minnesota Center for Philosophy of Science, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|