Treatment-Resistant Depression (TRD)Depressive DisordersPTSDAnxiety DisordersAlcohol Use Disorder (AUD)Tobacco/Nicotine Use Disorder (TUD)Neuroimaging & Brain MeasuresSubstance Use Disorders (SUD)

Psychedelic drugs-a new era in psychiatry?

This review article by David Nutt gives an overview of where psychedelics research stands in June 2019.

Authors

  • David Nutt

Published

Dialogues in Clinical Neuroscience
meta Study

Abstract

This article covers the renaissance of classical psychedelic drugs such as psilocybin and LSD plus 3,4-methylene dioxymethamphetamine (MDMA-ecstasy) in psychiatric research. These drugs were used quite extensively before they became prohibited. This ban had little impact on recreational use, but effectively stopped research and clinical treatments, which up to that point had looked very promising in several areas of psychiatry. In the past decade, a number of groups have been working to re-evaluate the utility of these substances in medicine. So far highly promising preliminary data have been produced with psilocybin in anxiety, depression, smoking, alcoholism, and MDMA for post-traumatic stress disorder (PTSD) and alcoholism. These findings have led to the European Medicines Agency approving psilocybin for a phase 3 study in treatment-resistant depression and the Food and Drug Administration for PTSD with MDMA. Both trials should readout in 2020, and if the results are positive we are likely to see these medicines approved for clinical practice soon afterward.

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Research Summary of 'Psychedelic drugs-a new era in psychiatry?'

Introduction

Psychedelic substances such as mescaline, psilocybin and LSD have long histories of ritual and clinical use but were introduced to Western science only in the late 19th and early 20th centuries, with major developments after the discovery of LSD in 1943 and the isolation of psilocybin. Early mid-20th century research explored therapeutic applications across psychiatry and suggested safety advantages relative to contemporaneous psychotropics. However, widespread prohibition beginning in the 1960s (Schedule I classification) effectively halted clinical research for decades despite promising clinical signals. This paper reviews the recent renaissance of clinical and neuroscience research on classical psychedelics (notably psilocybin and LSD), MDMA, and related agents such as ketamine and ayahuasca. Nutt summarises historical context, neuropharmacology, key modern clinical trials (including both open-label and controlled studies), mechanistic neuroimaging findings, and practical challenges facing research and clinical translation. The review aims to appraise the current evidence base, highlight limitations, and outline the principal barriers and prospects for developing psychedelic-assisted treatments in psychiatry.

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