Depressive DisordersPTSDAnxiety DisordersObsessive-Compulsive Disorder (OCD)Substance Use Disorders (SUD)Eating DisordersSuicidalityPalliative & End-of-Life DistressMedicinal Chemistry & Drug Development

Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies

This review (2020) identified 15 studies (n=178) that used a variety of psychedelics to have overlapping therapeutic processes, were compared favorably over conventional treatments and often elicited other positive changes beyond the specific diagnosis.

Authors

  • Robert Schoevers
  • Eric Vermetten
  • Joost Breeksema

Published

CNS Drugs
meta Study

Abstract

Introduction

Interest in the use of psychedelic substances for the treatment of mental disorders is increasing. Processes that may affect therapeutic change are not yet fully understood. Qualitative research methods are increasingly used to examine patient accounts; however, currently, no systematic review exists that synthesizes these findings in relation to the use of psychedelics for the treatment of mental disorders.

Objective

To provide an overview of salient themes in patient experiences of psychedelic treatments for mental disorders, presenting both common and diverging elements in patients’ accounts, and elucidating how these affect the treatment process.

Methods

We systematically searched the PubMed, MEDLINE, PsycINFO, and Embase databases for English-language qualitative literature without time limitations. Inclusion criteria were qualitative research design; peer-reviewed studies; based on verbalized patient utterances; and a level of abstraction or analysis of the results. Thematic synthesis was used to analyze and synthesize results across studies. A critical appraisal of study quality and methodological rigor was conducted using the Critical Appraisal Skills Programme (CASP).

Results

Fifteen research articles, comprising 178 patient experiences, were included. Studies exhibited a broad heterogeneity in terms of substance, mental disorder, treatment context, and qualitative methodology. Substances included psilocybin, lysergic acid diethylamide (LSD), ibogaine, ayahuasca, ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Disorders included anxiety, depression, eating disorders, post-traumatic stress disorder, and substance use disorders. While the included compounds were heterogeneous in pharmacology and treatment contexts, patients reported largely comparable experiences across disorders, which included phenomenological analogous effects, perspectives on the intervention, therapeutic processes and treatment outcomes. Comparable therapeutic processes included insights, altered self-perception, increased connectedness, transcendental experiences, and an expanded emotional spectrum, which patients reported contributed to clinically and personally relevant responses.

Conclusions

This review demonstrates how qualitative research of psychedelic treatments can contribute to distinguishing specific features of specific substances, and carry otherwise undiscovered implications for the treatment of specific psychiatric disorders.

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Research Summary of 'Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies'

Introduction

Interest in clinical applications of psychedelics has resurged after decades of limited research, with contemporary studies exploring compounds such as psilocybin, LSD, ayahuasca (DMT-containing), MDMA, ibogaine and ketamine across a range of mental disorders including depression, anxiety (including end-of-life distress), PTSD, eating disorders, obsessive-compulsive disorder, substance use disorders and suicidal ideation. Earlier work has emphasised that therapeutic outcomes depend not only on pharmacology but also on extrapharmacological factors ('set' and 'setting'), and that the subjective, often ineffable, nature of psychedelic experiences may be poorly captured by quantitative measures alone. Breeksema and colleagues sought to fill a gap by systematically identifying and thematically synthesising qualitative studies that report patients' verbalised accounts of psychedelic-assisted treatments for mental disorders. The review aims to characterise salient themes in patient experience across substances and disorders, to identify common and divergent elements relating to phenomenology, perspectives on interventions, therapeutic processes and outcomes, and to consider how these patient-reported elements may inform understanding of mechanisms and treatment context.

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