PTSDMDMAKetamine

Reviewing the potential of psychedelics for the treatment of PTSD

This review (2020) discusses the potential of MDMA, ketamine, classical psychedelics, and cannabinoids as potential treatments for PTSD.

Authors

  • Thomas Passie
  • Eric Vermetten
  • Joost Breeksema

Published

International Journal of Neuropsychopharmacology
individual Study

Abstract

There are few medications with demonstrated efficacy for the treatment of posttraumatic stress disorder (PTSD). Treatment guidelines have unequivocally designated psychotherapy as a first line treatment for PTSD. Yet, even after psychotherapy, PTSD often remains a chronic illness, with high rates of psychiatric and medical comorbidity. Meanwhile, the search for and development of drugs with new mechanisms of action has stalled. Therefore, there is an urgent need to explore not just novel compounds but novel approaches for the treatment of PTSD. A promising new approach involves the use of psychedelic drugs. Within the past few years, 2 psychedelics have received breakthrough designations for psychiatric indications from the US Food and Drug Administration, and several psychedelics are currently being investigated for the treatment of PTSD. This review discusses 4 types of compounds: 3,4-methylenedioxymethamphetamine, ketamine, classical psychedelics (e.g., psilocybin and lysergic acid diethylamide), and cannabinoids. We describe the therapeutic rationale, the setting in which they are being administered, and their current state of evidence in the treatment of PTSD. Each compound provides unique qualities for the treatment of PTSD, from their use to rapidly target symptoms to their use as adjuncts to facilitate psychotherapeutic treatments. Several questions are formulated that outline an agenda for future research.

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Research Summary of 'Reviewing the potential of psychedelics for the treatment of PTSD'

Introduction

PTSD remains difficult to treat with pharmacotherapy: only two drugs (paroxetine and sertraline) have official approval and both show limited efficacy. Current guidelines designate exposure-based psychotherapies as first-line treatments, yet a substantial proportion of patients—estimated in the extracted text at 40-60%—fail to respond adequately or drop out because processing traumatic memories can be intolerably distressing. The authors frame this clinical challenge as partly arising from the heterogeneity and complexity of PTSD, which may not be solvable by targeting a single neurotransmitter system, and argue there is an urgent need for novel compounds and novel treatment approaches that better enable engagement with traumatic memory processing in psychotherapy. Krediet and colleagues set out to review the potential of four classes of psychoactive compounds for PTSD: MDMA, ketamine, classical serotonergic psychedelics (for example, psilocybin and LSD), and cannabinoids. For each compound they describe the therapeutic rationale, typical clinical setting and administration, current evidence for efficacy in PTSD, and safety considerations. The review emphasises substance-assisted psychotherapy as a conceptual approach in which a drug is used to catalyse or augment psychotherapeutic work rather than as a simple symptomatic medication.

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Study Details

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