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Ragnhildstveit A, Khan R, Seli P, Bass LC, August RJ, Kaiyo M, Barr N, Jackson LK, Gaffrey MS, Barsuglia JP, Averill LA. 5-MeO-DMT for post-traumatic stress disorder: a real-world longitudinal case study. Front Psychiatry 2023; 14:1271152. [PMID: 38076677 PMCID: PMC10710141 DOI: 10.3389/fpsyt.2023.1271152] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/03/2023] [Indexed: 02/12/2024] Open
Abstract
Psychedelic therapy is, arguably, the next frontier in psychiatry. It offers a radical alternative to longstanding, mainstays of treatment, while exciting a paradigm shift in translational science and drug discovery. There is particular interest in 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT)-a serotonergic psychedelic-as a novel, fast-acting therapeutic. Yet, few studies have directly examined 5-MeO-DMT for trauma- or stress-related psychopathology, including post-traumatic stress disorder (PTSD). Herein, we present the first longitudinal case study on 5-MeO-DMT for chronic refractory PTSD, in a 23-year-old female. A single dose of vaporized bufotoxin of the Sonoran Desert Toad (Incilius alvarius), containing an estimated 10-15 mg of 5-MeO-DMT, led to clinically significant improvements in PTSD, with next-day effects. This was accompanied by marked reductions in hopelessness and related suicide risk. Improvements, across all constructs, were sustained at 1-, 3-, 6-, and 12-months follow-up, as monitored by a supporting clinician. The subject further endorsed a complete mystical experience, hypothesized to underly 5-MeO-DMT's therapeutic activity. No drug-related, serious adverse events occurred. Together, results showed that 5-MeO-DMT was generally tolerable, safe to administer, and effective for PTSD; however, this was not without risk. The subject reported acute nausea, overwhelming subjective effects, and late onset of night terrors. Further research is warranted to replicate and extend these findings, which are inherently limited, non-generalizable, and rely on methods not clinically accepted.
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Affiliation(s)
- Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Ryan Khan
- Integrated Research Literacy Group, Draper, UT, United States
| | - Paul Seli
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Lisa Claire Bass
- Integrated Research Literacy Group, Draper, UT, United States
- Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - River Jude August
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | - Miriam Kaiyo
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | - Nathaniel Barr
- School of Humanities and Creativity, Sheridan College, Oakville, ON, Canada
| | | | - Michael Santo Gaffrey
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
- Department of Pediatrics, Division of Pediatric Psychology and Developmental Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
- Children’s Wisconsin, Milwaukee, WI, United States
| | | | - Lynnette Astrid Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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Brendle M, Ragnhildstveit A, Slayton M, Smart L, Cunningham S, Zimmerman MH, Seli P, Gaffrey MS, Averill LA, Robison R. Registered clinical trials investigating ketamine and esketamine for treatment-resistant depression: A systematic review. JPS 2023. [DOI: 10.1556/2054.2022.00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AbstractBackground and AimsKetamine and esketamine have garnered interest in both psychiatric research and clinical practice for treatment-resistant depression (TRD). In this review, we examined registered trials investigating the therapeutic use of ketamine or esketamine for TRD, with the aim of characterizing emerging trends and knowledge gaps.MethodsThe ClinicalTrials.gov electronic registry and results database was queried from inception to February 5, 2022, adhering to elements of the PRISMA guideline, we evaluated trial eligibility in the qualitative synthesis. Data regarding study design, drug regimens, and measures were subsequently abstracted and descriptively analyzed.ResultsThe search returned 86 records, of which 56 trials were included in the final review. The number of trials investigating ketamine and esketamine for TRD increased since 2008, with higher peaks observed in 2015 (n = 9) and 2021 (n = 9). Most trials were Phase 2 (13, 23.2%) or Phase 3 (11, 19.6%), gathering preliminary data on efficacy and/or further data on safety and efficacy with variant dosing and pharmacological approaches. By and large, trials examined ketamine and esketamine as individual versus combination treatments (45% and 25%, respectively). The Montgomery-Asberg Depression Rating Scale (MADRS) was most commonly used to assess clinical outcomes (75%).ConclusionsThere are increasingly large-scale and late-phase trials of esketamine over ketamine for TRD, coupled with efforts to centralize evidence on these medications. Yet several trials do not assess patient characteristics that may affect treatment response, such as age, sex, and race. By understanding these design limitations, scientists and clinicians can avoid research waste and funding bodies can judiciously direct support towards high priority research.
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Affiliation(s)
- Madeline Brendle
- Integrated Research Literacy Group, Draper, UT, USA
- Department of Pharmacotherapy, University of Utah College of Pharmacy, SLC, UT, USA
- Numinus Wellness, Draper, UT, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Pyschiatry, University of Cambridge, Cambridge, England, UK
| | - Matthew Slayton
- Integrated Research Literacy Group, Draper, UT, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Leo Smart
- Integrated Research Literacy Group, Draper, UT, USA
- Numinus Wellness, Draper, UT, USA
- Department of Neuroscience, Bates College, Lewiston, ME, USA
| | | | | | - Paul Seli
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | - Lynnette Astrid Averill
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs, National Center for PTSD – Clinical Neuroscience Division, West Haven, CT, USA
| | - Reid Robison
- Numinus Wellness, Draper, UT, USA
- Department of Psychiatry, University of Utah School of Medicine, UT, USA
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