Treatment-Resistant Depression (TRD)Depressive DisordersPTSDAnxiety DisordersPalliative & End-of-Life DistressMedicinal Chemistry & Drug Development

Psychedelics and Psychedelic-Assisted Psychotherapy

This review (2020) finds that randomised clinical trials (RCTs) support the efficacy of various psychedelic-assisted therapies for mental health disorders.

Authors

  • Charles Nemeroff

Published

American Journal of Psychiatry
meta Study

Abstract

Objective

The authors provide an evidenced-based summary of the literature on the clinical application of psychedelic drugs in psychiatric disorders.

Methods

Searches of PubMed and PsycINFO via Ovid were conducted for articles in English, in peer-reviewed journals, reporting on “psilocybin,” “lysergic acid diethylamide,” “LSD,” “ayahuasca,” “3,4-methylenedioxymethamphetamine,” and “MDMA,” in human subjects, published between 2007 and July 1, 2019. A total of 1,603 articles were identified and screened. Articles that did not contain the terms “clinical trial,” “therapy,” or “imaging” in the title or abstract were filtered out. The 161 remaining articles were reviewed by two or more authors. The authors identified 14 articles reporting on well-designed clinical trials investigating the efficacy of lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (MDMA), psilocybin, and ayahuasca for the treatment of mood and anxiety disorders, trauma and stress-related disorders, and substance-related and addictive disorders as well as in end-of-life care.

Results

The most significant database exists for MDMA and psilocybin, which have been designated by the U.S. Food and Drug Administration (FDA) as “breakthrough therapies” for posttraumatic stress disorder (PTSD) and treatment-resistant depression, respectively. The research on LSD and ayahuasca is observational, but available evidence suggests that these agents may have therapeutic effects in specific psychiatric disorders.

Conclusions

Randomized clinical trials support the efficacy of MDMA in the treatment of PTSD and psilocybin in the treatment of depression and cancer-related anxiety. The research to support the use of LSD and ayahuasca in the treatment of psychiatric disorders is preliminary, although promising. Overall, the database is insufficient for FDA approval of any psychedelic compound for routine clinical use in psychiatric disorders at this time, but continued research on the efficacy of psychedelics for the treatment of psychiatric disorders is warranted.

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Research Summary of 'Psychedelics and Psychedelic-Assisted Psychotherapy'

Introduction

Plant-derived hallucinogens have been used in religious and healing contexts across cultures for centuries, but systematic scientific investigation of their therapeutic potential only began in earnest following Albert Hofmann's synthesis of LSD at Sandoz Laboratories in 1938 and discovery of its psychoactive properties in 1943. A first wave of clinical research produced thousands of studies involving tens of thousands of patients, but was abruptly curtailed by the Controlled Substances Act of 1970, which classified LSD and other psychedelics as Schedule I compounds without recognised medical use. The past two decades have witnessed a carefully controlled revival of psychedelic research, with the FDA granting breakthrough therapy designation to both MDMA for PTSD and psilocybin for treatment-resistant depression — designations reflecting the preliminary but striking magnitude of clinical effects observed in phase II trials. This evidence-based review aimed to summarise the clinical literature on the therapeutic application of four psychedelic compounds — psilocybin, LSD, ayahuasca, and MDMA — across a range of psychiatric indications, with particular attention to the quality of the available trial evidence and the implications for future research and clinical development.

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Study Details

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