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Yang J, Wang N, Luo W, Gao J. The efficacy and safety of MDMA-assisted psychotherapy for treatment of posttraumatic stress disorder: A systematic review and meta-analysis from randomized controlled trials. Psychiatry Res 2024; 339:116043. [PMID: 38896930 DOI: 10.1016/j.psychres.2024.116043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024]
Abstract
3,4-methylenedioxymethamphetamine (MDMA), commonly known as ecstasy, is one of the most widely used illicit substances worldwide. MDMA-assisted psychotherapy has become a novel treatment for posttraumatic stress disorder (PTSD), and many randomized controlled trials (RCTs) have been performed over the past decade. Therefore, this study aimed to systematically review and demonstrate the efficacy and safety of MDMA-assisted psychotherapy for the treatment of PTSD. We conducted a systematic search of PubMed, Embase, and Web of Science databases up to October 27, 2023, selected RCTs assessing the efficacy and safety of MDMA-assisted psychotherapy for the treatment of PTSD, and evaluated their quality using the Cochrane risk of bias tool. Seven RCTs were selected from the retrieved references. The results revealed that MDMA-assisted psychotherapy effectively reduced the change from baseline score in the Clinician-Administered PTSD Scale in patients with PTSD compared with either placebo or active controls. However, MDMA causes a series of adverse events, including muscle tightness, nausea, and decreased appetite. To a certain extent, MDMA-assisted psychotherapy may improve symptoms in patients with PTSD. However, side effects and abuse issues still seriously hinder clinical application of MDMA.
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Affiliation(s)
- Jianhua Yang
- Department of Intensive Care Medicine, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing 400016, China
| | - Ni Wang
- Nursing Office of General Hospital of Xinjiang Military Region, Wulumuqi 830013, China
| | - Wulin Luo
- Department of Medical Psychology and Neurology, The 947th Hospital of Army, Kashi, China
| | - Junwei Gao
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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2
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de la Salle S, Kettner H, Thibault Lévesque J, Garel N, Dames S, Patchett-Marble R, Rej S, Gloeckler S, Erritzoe D, Carhart-Harris R, Greenway KT. Longitudinal experiences of Canadians receiving compassionate access to psilocybin-assisted psychotherapy. Sci Rep 2024; 14:16524. [PMID: 39019922 PMCID: PMC11254907 DOI: 10.1038/s41598-024-66817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024] Open
Abstract
Recent clinical trials have found that the serotonergic psychedelic psilocybin effectively alleviates anxiodepressive symptoms in patients with life-threatening illnesses when given in a supportive environment. These outcomes prompted Canada to establish legal pathways for therapeutic access to psilocybin, coupled with psychological support. Despite over one-hundred Canadians receiving compassionate access since 2020, there has been little examination of these 'real-world' patients. We conducted a prospective longitudinal survey which focused on Canadians who were granted Section 56 exemptions for legal psilocybin-assisted psychotherapy. Surveys assessing various symptom dimensions were conducted at baseline, two weeks following the session (endpoint), and optionally one day post-session. Participant characteristics were examined using descriptive statistics, and paired sample t-tests were used to quantify changes from baseline to the two-week post-treatment endpoint. Eight participants with Section 56 exemptions (four females, Mage = 52.3 years), all with cancer diagnoses, fully completed baseline and endpoint surveys. Significant improvements in anxiety and depression symptoms, pain, fear of COVID-19, quality of life, and spiritual well-being were observed. Attitudes towards death, medical assistance in dying, and desire for hastened death remained unchanged. While most participants found the psilocybin sessions highly meaningful, if challenging, one reported a substantial decrease in well-being due to the experience. These preliminary data are amongst the first to suggest that psilocybin-assisted psychotherapy can produce psychiatric benefits in real-world patients akin to those observed in clinical trials. Limited enrollment and individual reports of negative experiences indicate the need for formal real-world evaluation programs to surveil the ongoing expansion of legal access to psychedelics.
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Affiliation(s)
- Sara de la Salle
- Department of Psychiatry, McGill University, Montréal, Canada
- Lady Davis Institute at the Jewish General Hospital, Montréal, Canada
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Department of Neurology, University of California, San Francisco, USA
| | | | - Nicolas Garel
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 Boul. Edouard-Montpetit, Montréal, Canada
- Research Centre, Centre Hospitaller de L'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Canada
| | - Shannon Dames
- Health and Human Services, Vancouver Island University, Nanaimo, Canada
| | - Ryan Patchett-Marble
- Northern Ontario School of Medicine University, Thunder Bay, Canada
- Marathon Family Health Team, Marathon, Canada
| | - Soham Rej
- Department of Psychiatry, McGill University, Montréal, Canada
- Lady Davis Institute at the Jewish General Hospital, Montréal, Canada
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Sara Gloeckler
- Department of Psychiatry, McGill University, Montréal, Canada
- Lady Davis Institute at the Jewish General Hospital, Montréal, Canada
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Robin Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Department of Neurology, University of California, San Francisco, USA
| | - Kyle T Greenway
- Department of Psychiatry, McGill University, Montréal, Canada.
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
- Lady Davis Institute at the Jewish General Hospital, Montréal, Canada.
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3
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Chopra H, Furnish T, Verduzco‐Gutierrez M, Jevotovsky DS, Castellanos J. Long-COVID symptoms improved after MDMA and psilocybin therapy: A case report. Clin Case Rep 2024; 12:e8791. [PMID: 38813452 PMCID: PMC11133386 DOI: 10.1002/ccr3.8791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/02/2024] [Accepted: 03/07/2024] [Indexed: 05/31/2024] Open
Abstract
Key Clinical Message Long-COVID syndrome lacks effective holistic treatment options. We present a case of a 41-year-old fully vaccinated female with Long-COVID syndrome who obtained significant symptomatic relief after self-medicating with psilocybin and MDMA. Abstract Long-COVID, a syndrome persisting after the acute phase of coronavirus disease 2019 (COVID-19), lacks effective holistic treatment options. We present a case of a 41-year-old fully vaccinated female with Long-COVID syndrome who obtained significant symptomatic relief by self-prescribing psilocybin and MDMA. Future research is needed to assess safety and efficacy.
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Affiliation(s)
- Harman Chopra
- Johns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Tim Furnish
- University of California San Diego HealthSan DiegoCaliforniaUSA
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4
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Pop IA, Gielens E, Kottmann H, Achterberg P. Exploring the discourses around microdosing psychedelics within the r/microdosing online community. Soc Sci Med 2024; 347:116702. [PMID: 38520826 DOI: 10.1016/j.socscimed.2024.116702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
In the present contribution, we examine the practice of microdosing psychedelics (microdosing) through textual analysis of the content produced by a dedicated online community, the r/microdosing subreddit. We collected a comprehensive dataset of publicly available submissions from this community and used structural topic modelling to identify and analyse the prevalent topics within the discussions. Through our analysis, we identified 16 distinct topics that mapped into clinical, human enhancement, as well as self-medication narratives. Notably, we found that the majority of discussions revolved around "how to" topics, supporting our argument that such online communities serve as essential information hubs, facilitating the dissemination of practical knowledge related to microdosing practices among the general population. The identified impact of the Covid-19 pandemic on the prevalence of discussion topics suggests that individuals within the online community may perceive microdosing primarily as a means of self-medication during times of heightened stress and uncertainty. Our findings contribute to the field of health sociology and psychedelic research by shedding light on the sociocultural factors influencing healthcare practices, including the role of online communities in facilitating processes of self-medicalization and self-medication.
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Affiliation(s)
- Ioana Andreea Pop
- Tilburg University, Sociology Department, PO BOX 90153, 5000 LE, Tilburg, the Netherlands.
| | - Erwin Gielens
- Tilburg University, Sociology Department, PO BOX 90153, 5000 LE, Tilburg, the Netherlands.
| | - Hannah Kottmann
- Tilburg University, Sociology Department, PO BOX 90153, 5000 LE, Tilburg, the Netherlands.
| | - Peter Achterberg
- Tilburg University, Sociology Department, PO BOX 90153, 5000 LE, Tilburg, the Netherlands.
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Shah FI, Shehzadi S, Akram F, Haq IU, Javed B, Sabir S, Kazim Y, Ashfaq S. Unveiling the Psychedelic Journey: An Appraisal of Psilocybin as a Profound Antidepressant Therapy. Mol Biotechnol 2023:10.1007/s12033-023-00994-7. [PMID: 38117395 DOI: 10.1007/s12033-023-00994-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
Depression, a global health concern with significant implications for suicide rates, remains challenging to treat effectively with conventional pharmacological options. The existing pharmaceutical interventions for these illnesses need daily dosing, are accompanied by various adverse effects, and may exhibit limited efficacy in certain cases. However, hope emerges from an unlikely source-Psilocybin, a natural hallucinogen found in certain mushrooms. Recently, this enigmatic compound has garnered attention for its potential therapeutic benefits in addressing various mental health issues, including depression. Psilocybin alters mood, cognition, and perception by acting on a particular subtype of serotonin receptors in the brain. It's feasible that these shifts in consciousness will promote healing development, offering a novel approach to depression management. This comprehensive review explores psilocybin, derived from specific mushrooms, and its implications in the treatment of depression. The study examines new perspectives and therapeutic possibilities surrounding psilocybin, addressing existing gaps in academic literature. It delves into its biosynthesis, unique mechanisms of action, therapeutic applications, and anti-depressive effects. By uncovering the potential of this mind-altering substance, the review aims to advance psychiatric care, offering hope to those globally affected by depression.
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Affiliation(s)
| | | | - Fatima Akram
- Institute of Industrial Biotechnology, Government College University, Lahore, 54000, Pakistan.
| | - Ikram Ul Haq
- Institute of Industrial Biotechnology, Government College University, Lahore, 54000, Pakistan
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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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7
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Smith WR, Appelbaum PS. Novel ethical and policy issues in psychiatric uses of psychedelic substances. Neuropharmacology 2022; 216:109165. [PMID: 35718006 DOI: 10.1016/j.neuropharm.2022.109165] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/02/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Classic psychedelics and related substances have shown promising initial research results. However, they raise a number of relatively novel ethical and policy challenges in light of their psychoactive properties, their emergence from the unregulated "underground" settings in which they have been used, their rapid commercialization, and the means and speed with which they are moving from a Schedule 1 drug to legalized use. All of these issues are affected by the current limits to the evidence base on use of psychedelics. Here we survey these novel challenges, illustrating the issues raised regarding each, and offering suggestions for how to address them. Emerging findings on psychedelic therapies suggest promise in treating psychiatric disorders, including major depressive disorder with psilocybin (Carhart-Harris et al., 2021; Compass pathways, 2021; Davis et al., 2021) and post-traumatic stress disorder (PTSD) with 3,4-methylenedioxymethamphetamine (MDMA) (Mitchell et al., 2021). Additional research is underway on other conditions (Reiff et al., 2020). At this early stage in the research process, the published evidence supporting psychedelic use is limited by relatively small sample sizes (as compared to Phase 3 trials for conventional anti-depressants), highly selected and perhaps atypical participants, and the need for replication (Smith and Appelbaum, 2021b). Nevertheless, the promise of these findings and the emerging efforts at legalization and/or decriminalization in several parts of the country, utilizing a diversity of mechanisms, raise important ethical and policy questions that have received little systematic exploration. To help address this deficit, this commentary surveys four domains in which ethical and policy questions arise. We focus chiefly on psilocybin, the most promising of the psychedelics now being investigated, though our conclusions may generalize to other classic psychedelics or related agents, like MDMA. Of note, we focus here on questions that are relatively novel or particularly important for psychedelics. Many other ethical issues regarding psychedelics in both research and clinical contexts will be similar to those for other treatment modalities. As with other modalities, when used in clinical practice there will be ethical challenges regarding patient confidentiality, informed consent, balancing the risks and benefits of treatment, and provision of equitable access. Clinical research on psychedelic compounds is not unusual in raising concerns about the adequacy of understanding of randomization and possibility of allocation to the control arm of the trial, therapeutic misconception, and exclusion or exploitation of marginalized or otherwise disadvantaged groups (Emanuel et al., 2000). Regarding disadvantaged groups, like many other areas of medical research, early psychedelic research had a significant history of exploitation of vulnerable populations including imprisoned persons and people of color (Strauss et al., 2021). Although we acknowledge the importance of issues that are very similar to those for other treatment modalities, we do not discuss them in detail.
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Affiliation(s)
- William R Smith
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA; Scattergood Program for Applied Ethics of Behavioral Health Care, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, USA.
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, USA; Center for Law, Ethics & Psychiatry, New York State Psychiatric Institute, USA
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8
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Khan FI, Hassan F, Lai D. In Silico Studies on Psilocybin Drug Derivatives Against SARS-CoV-2 and Cytokine Storm of Human Interleukin-6 Receptor. Front Immunol 2022; 12:794780. [PMID: 35095870 PMCID: PMC8796858 DOI: 10.3389/fimmu.2021.794780] [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: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022] Open
Abstract
Various metabolites identified with therapeutic mushrooms have been found from different sources and are known to have antibacterial, antiviral, and anticancer properties. Over thousands soil growth-based mushroom metabolites have been discovered, and utilized worldwide to combat malignancy. In this study, psilocybin-mushroom that contains the psychedelic compounds such as psilacetin, psilocin, and psilocybine were screened and found to be inhibitors of SARS-CoV-2 Mprotease. It has been found that psilacetin, psilocin, and psilocybine bind to Mprotease with −6.0, −5.4, and −5.8 kcal/mol, respectively. Additionally, the psilacetin was found to inhibit human interleukin-6 receptors to reduce cytokine storm. The binding of psilacetin to Mprotease of SARS-CoV-2 and human interleukin-6 receptors changes the structural dynamics and Gibbs free energy patterns of proteins. These results suggested that psilocybin-mushroom could be utilized as viable potential chemotherapeutic agents for SARS-CoV-2.
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Affiliation(s)
- Faez Iqbal Khan
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Fakhrul Hassan
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Dakun Lai
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
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