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Perez N, Langlest F, Mallet L, De Pieri M, Sentissi O, Thorens G, Seragnoli F, Zullino D, Kirschner M, Kaiser S, Solmi M, Sabé M. Psilocybin-assisted therapy for depression: A systematic review and dose-response meta-analysis of human studies. Eur Neuropsychopharmacol 2023; 76:61-76. [PMID: 37557019 DOI: 10.1016/j.euroneuro.2023.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
Psilocybin is increasingly studied for its antidepressant effect, but its optimal dosage for depression remains unclear. We conducted a systematic review and a dose-response meta-analysis to find the optimal dosage of psilocybin to reduce depression scores. Following our protocol (CRD 42022220190) multiple electronic databases were searched from their inception until February 2023, to identify double-blind randomized placebo-controlled (RCTs) fixed-dose trials evaluating the use of psilocybin for adult patients with primary or secondary depression. A one-stage dose-response meta-analysis with restricted cubic splines was used. Cochrane risk of bias was used to assess risk of bias. Our analysis included seven studies with a total of 489 participants. Among these, four studies focused on primary depression (N = 366), including one study with patients suffering from treatment-resistant depression. The remaining three studies examined secondary depression (N = 123). The determined 95% effective doses per day (ED95) were 8.92, 24.68, and 36.08 mg/70 kg for patients with secondary depression, primary depression, and both subgroups, respectively. We observed significant dose-response associations for all curves, each plateauing at different levels, except for the bell-shaped curve observed in the case of secondary depression. Additionally, we found significant dose-response associations for various side effects, including physical discomfort, blood pressure increase, nausea/vomiting, headache/migraine, and the risk of prolonged psychosis. In conclusion, we discovered specific ED95 values for different populations, indicating higher ED95 values for treatment-resistant depression, primary depression, and secondary depression groups. Further RCTs are necessary for each population to determine the optimal dosage, allowing for maximum efficacy while minimizing side effects.
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Affiliation(s)
- Natacha Perez
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Florent Langlest
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Luc Mallet
- Univ Paris-Est Créteil, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France; Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Marco De Pieri
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland; Center for Research in Medical Pharmacology, Varese, Italy
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Gabriel Thorens
- Division of Addiction Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 70, Grand-Pré, CH-1202 Geneva, Switzerland
| | - Federico Seragnoli
- Division of Addiction Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 70, Grand-Pré, CH-1202 Geneva, Switzerland; Department of Political and Social Sciences, Institut of Psychology, University of Lausanne, Switzerland
| | - Daniele Zullino
- Division of Addiction Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 70, Grand-Pré, CH-1202 Geneva, Switzerland
| | - Matthias Kirschner
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Michel Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland.
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Thorens G, Penzenstadler L, Seragnoli F, Rothen S, Qusaj V, Zullino D. [Ethics in the practice of psychedelic-assisted psychotherapy]. Rev Med Suisse 2023; 19:1508-1512. [PMID: 37610195 DOI: 10.53738/revmed.2023.19.838.1508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
This article proposes 10 points considered essential on the ethics associated with the practice of psychotherapy assisted by psychedelics (PAP) : 1) respect of the legal framework (LStup) of the use of psychotropic drugs ; 2) adequately manage psychedelics (storage, production and safety) ; 3) announce adverse effects to the competent authority ; 4) guarantee a psychotherapeutic follow-up ; 5) guarantee the safety of the patients during the treatment ; 6) establish indications on the basis of scientific evidence ; 7) do not confuse personal recreational use and strict medical use ; 8) avoid proselytizing or bad medical practices ; 9) do not to consider the personal consumption of psychedelics as a competency in care and 10) ensure that access to care is equitable and reasonable.
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Affiliation(s)
- Gabriel Thorens
- Service d'addictologie, Département de psychiatrie, Hôpitaux universitaires de Genève, 70C rue Grand Pré, 1202 Genève
| | - Louise Penzenstadler
- Service d'addictologie, Département de psychiatrie, Hôpitaux universitaires de Genève, 70C rue Grand Pré, 1202 Genève
| | - Federico Seragnoli
- Psychologues FSP, Service d'Addictologie, Département de psychiatrie, Hôpitaux universitaires de Genève, 70C rue Grand Pré, 1202 Genève
| | - Stéphane Rothen
- Psychologues FSP, Service d'Addictologie, Département de psychiatrie, Hôpitaux universitaires de Genève, 70C rue Grand Pré, 1202 Genève
| | - Visar Qusaj
- Infirmier chef, Service d'addictologie, Département de psychiatrie, Hôpitaux universitaires de Genève, 70C rue Grand Pré, 1202 Genève
| | - Daniele Zullino
- Service d'addictologie, Département de psychiatrie, Hôpitaux universitaires de Genève, 70C rue Grand Pré, 1202 Genève
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Ponomarenko P, Seragnoli F, Calder A, Oehen P, Hasler G. Can psychedelics enhance group psychotherapy? A discussion on the therapeutic factors. J Psychopharmacol 2023:2698811231155117. [PMID: 36855289 DOI: 10.1177/02698811231155117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Despite the growth of psychedelic research, psychedelic-assisted group psychotherapy (PAGP) has received little attention in comparison to individual psychedelic-assisted psychotherapy models. METHODS In this article, we aim to discuss the therapeutic potential of PAGP, as well as outline existing models and the challenges of this approach. Using Irvin Yalom's 11 therapeutic factors of group therapy as a basic framework, we analyse current literature from clinical studies and neurobiological research relative to the topic of PAGP. RESULTS We argue that combining psychedelic substances and group psychotherapy may prove beneficial for increasing group connectedness and interpersonal learning, potentially enhancing prosocial behaviour with direct opportunities to practice newly acquired knowledge about previously maladaptive behavioural patterns. Challenges regarding this approach include a more rigid therapy structure and potential loss of openness from patients, which may be ameliorated by adequate therapeutic training. CONCLUSION We hope for this article to support clinical research on PAGP by presenting a therapeutic framework and outlining its mechanisms and challenges.
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Affiliation(s)
| | | | - Abigail Calder
- Department of Medicine, University of Freiburg, Villars-sur-Glâne, Switzerland
| | - Peter Oehen
- Private Practice for Psychiatry and Psychotherapy, Biberist, Switzerland
| | - Gregor Hasler
- Department of Medicine, University of Freiburg, Villars-sur-Glâne, Switzerland
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Kramer U, Beuchat H, Grandjean L, Seragnoli F, Djillali S, Choffat C, George E, Despland J, Kolly S, de Roten Y. Lessening of the pervasiveness of interpersonal patterns in borderline personality disorder explains symptom decrease after treatment: A process analysis. J Clin Psychol 2021; 78:772-784. [PMID: 34735740 PMCID: PMC9297848 DOI: 10.1002/jclp.23275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/31/2021] [Accepted: 10/06/2021] [Indexed: 11/07/2022]
Abstract
Background Problematic interpersonal patterns, as defined by the core conflictual relationship theme (CCRT) method, are part of the clinical presentation of clients with borderline personality disorder (BPD). So far, we do not know whether the pervasiveness of interpersonal patterns changes and if this change explains therapy outcome. Methods In a secondary analysis of a randomized controlled trial on a brief version of psychiatric treatment for BPD, a treatment with a psychodynamic focus, the present study included N = 39 clients. One early session and one late session of the treatment were transcribed and analyzed using the CCRT method. Results It appeared that pervasiveness of the predominant CCRT decreased over the course of the brief treatment; this effect was robust across treatment conditions. Change in pervasiveness in any CCRT component explained a small portion of variance of the decrease in borderline symptoms observed at the end of treatment. Discussion Lessening of pervasiveness of problematic in‐session interpersonal patterns may be hypothesized as potential mechanism of effective treatment for BPD which should be tested in controlled designs.
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Affiliation(s)
- Ueli Kramer
- Department of Psychiatry‐CHUV, Institute of PsychotherapyUniversity of LausanneLausanneSwitzerland
- Department of Psychiatry‐CHUV, General Psychiatry ServiceUniversity of LausanneLausanneSwitzerland
- Department of PsychologyUniversity of WindsorWindsorOntarioCanada
| | - Hélène Beuchat
- Department of Psychiatry‐CHUV, Institute of PsychotherapyUniversity of LausanneLausanneSwitzerland
| | - Loris Grandjean
- Department of Psychiatry‐CHUV, Institute of PsychotherapyUniversity of LausanneLausanneSwitzerland
| | - Federico Seragnoli
- Department of Psychiatry‐CHUV, Institute of PsychotherapyUniversity of LausanneLausanneSwitzerland
| | - Slimane Djillali
- Department of Psychiatry‐CHUV, Institute of PsychotherapyUniversity of LausanneLausanneSwitzerland
| | - Chloe Choffat
- Department of Psychiatry‐CHUV, Institute of PsychotherapyUniversity of LausanneLausanneSwitzerland
| | - Elisa George
- Department of Psychiatry‐CHUV, Institute of PsychotherapyUniversity of LausanneLausanneSwitzerland
| | - Jean‐Nicolas Despland
- Department of Psychiatry‐CHUV, Institute of PsychotherapyUniversity of LausanneLausanneSwitzerland
| | - Stéphane Kolly
- Department of Psychiatry‐CHUV, General Psychiatry ServiceUniversity of LausanneLausanneSwitzerland
| | - Yves de Roten
- Department of Psychiatry‐CHUV, Institute of PsychotherapyUniversity of LausanneLausanneSwitzerland
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Seragnoli F, Pires Martins D, Thorens G. [Microdosing LSD: practices and risks]. Rev Med Suisse 2021; 17:1108-1110. [PMID: 34106534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The practice of microdosing, which consists of ingesting a hallucinogen at 5-10% of a dose that would induce a psychedelic effect, has recently been the subject of growing interest by the media. The craze for microdosing has been relayed by the supposed effects of increased performance and creativity reported by professionals, especially in Silicon Valley. Despite this strong public interest, the evidence supporting this practice remains preliminary. Available studies are mostly based on single doses, leaving open the question of a possible stronger effect with regular doses. LSD's main effect is on the serotonin system, in particular on 5-HT2A receptors, a receptor involved in neurobiological processes underlying learning.
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Zullino D, Daeppen JB, Seragnoli F, Favrod Coune T, Thorens G, Simon O, Kuntz A. [What's new in addiction medicine]. Rev Med Suisse 2021; 17:10-12. [PMID: 33443823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The development of research, clinical practice and prevention in addiction medicine is, compared to other disciplines, more influenced by socio-political factors. Research on psychedelics has thus long been hampered by prohibitive policy but has recently been revived thanks to the relaxation of these political positions. The extensive prescription of baclofen for alcohol addiction is mainly the consequence of popular support and has so far not been clearly supported by specific research. The aim of the new Gambling Act was to harmonize the regulatory provisions for lotteries and betting on the one hand and casino gambling on the other, while at the same time opening up the market for online gambling.
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Affiliation(s)
| | | | | | | | | | - Olivier Simon
- Centre du jeu excessif, Service de médecine des addictions, CHUV, 1011 Lausanne
| | - André Kuntz
- Centre cantonal d'addictologie, Réseau fribourgeois de santé mentale, Route de Morat 8, 1700 Fribourg
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