The development and mainstream integration of ecstasy over the past 45 years is best explained by a socio-cultural model rather than a purely medical or criminal one. The substance was shaped by successive groups—university students, gays, yuppies, and the New Age movement—each leaving its imprint. Ecstasy's link with techno music produced the socially integrated club scene and the initially countercultural rave movement. Over time, raves and ecstasy became absorbed into mainstream culture, inadvertently reinforcing capitalist postmodernity. The authors argue that a cultural perspective, emphasizing subculture, myths, and rituals, offers a more productive paradigm for drug research than current approaches, and propose blending academic and common knowledge for studying drug use.
Treatment-resistant depression (TRD) patients have often been excluded from antidepressant drug trials, leaving unclear clinical guidance. Intranasal esketamine, a non-monoaminergic treatment that modulates the glutamatergic system to improve neuroplasticity, offers a new option. A Spanish committee of nine psychiatrists expert in TRD reviewed literature from 2014 to 2024 and developed a consensus on practical management. They recommend a treatment algorithm for TRD with intranasal esketamine, including guidance for patients with psychiatric comorbidities and for those who show less than a 50% symptom reduction after the first induction phase. Treatment should occur at the patient's usual mental health center, with dose optimization and flexible management based on clinical progress. This is the first such consensus in Spain.
Adding mindfulness-based interventions to integrated rehabilitation treatment for people with psychosis reduces emotional withdrawal and social withdrawal, two specific negative symptoms that were not improved by rehabilitation alone. Negative symptoms such as emotional blunting and lack of interest in daily activities are difficult to treat with standard antipsychotic drugs and psychological therapies. In a randomized controlled trial, participants who received mindfulness training showed greater improvement in emotional and social engagement compared with those who received only integrated rehabilitation. The findings suggest that mindfulness can target particular negative symptoms that otherwise remain unaddressed.