Serotonergic hallucinogens in the treatment of anxiety and depression in patients suffering from a life-threatening disease: A systematic review
This systematic review (2018) of 11 clinical trials (n=445) found that psychedelics (LSD, psilocybin) reduced symptoms of depression and anxiety in patients with life-threatening diseases (end-of-life).
Authors
- Peter Gasser
- Henrik Jungaberle
- Tomislav Majic
Published
Abstract
Anxiety and depression are some of the most common psychiatric symptoms of patients suffering with life-threatening diseases, often associated with a low quality of life and a poor overall prognosis. 5-HT2A-receptor agonists (serotonergic hallucinogens, ‘psychedelics’) like lysergic acid diethylamide (LSD) and psilocybin were first investigated as therapeutic agents in the 1960s. Recently, after a long hiatus period of regulatory obstacles, interest in the clinical use of these substances has resumed. The current article provides a systematic review of studies investigating psychedelics in the treatment of symptoms of existential distress in life-threatening diseases across different periods of research, highlighting how underlying concepts have developed over time. A systematic search for clinical trials from 1960 to 2017 revealed 11 eligible clinical trials involving a total number of N = 445 participants, of which 7 trials investigated the use of lysergic acid diethylamide (LSD) (N = 323), 3 trials investigated the use of psilocybin (N = 92), and one trial investigated the use of dipropyltryptamine (DPT) (N = 30). The 4 more recent randomized controlled trials (RCTs) (N = 104) showed a significantly higher methodological quality than studies carried out in the 1960s and 1970s. Evidence supports that patients with life threatening diseases associated with symptoms of depression and anxiety benefit from the anxiolytic and antidepressant properties of serotonergic hallucinogens. Some studies anecdotally reported improvements in patients´ quality of life and reduced fear of death. Moreover, low rates of side effects were reported in studies that adhered to safety guidelines. Further studies are needed to determine how these results can be transferred into clinical practice.
Research Summary of 'Serotonergic hallucinogens in the treatment of anxiety and depression in patients suffering from a life-threatening disease: A systematic review'
Introduction
Receiving a diagnosis of a life‑threatening physical illness commonly provokes profound emotional distress, including fear, hopelessness, loss of meaning and higher rates of anxiety and depression. The authors note that these problems—often described as "existential distress"—are associated with poorer quality of life, reduced treatment adherence and higher mortality, and that current pharmacological options specifically targeting existential distress are lacking. Psychotherapeutic approaches that enhance meaning have been developed, but there remains interest in pharmacological adjuncts for patients whose distress is refractory to conventional care. Reiche and colleagues set out to review systematically the clinical evidence for classic serotonergic hallucinogens (primarily LSD and psilocybin, and in one trial DPT) in treating anxiety and depression among patients with life‑threatening disease. The review aims to summarise trials conducted across historical periods, assess methodological quality and safety, and highlight how conceptual approaches (for example the role of "mystical" or peak experiences and the importance of set and setting) have evolved over time.
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Reiche, S., Hermle, L., Gutwinski, S., Jungaberle, H., Gasser, P., & Majić, T. (2018). Serotonergic hallucinogens in the treatment of anxiety and depression in patients suffering from a life-threatening disease: A systematic review. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 81, 1-10. https://doi.org/10.1016/j.pnpbp.2017.09.012
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