Evidence indicates that ketamine is highly effective, has a lower side effect profile and is better tolerated compared to many augmentation strategies for refractory depression. This, combined with data on psychiatric treatment outcome mediators, suggests that earlier intervention with ketamine could improve outcomes for patients suffering from refractory depression.
Background ‘Inhalants’ have been associated with poorer mental health in adolescence, but little is known of associations with specific types of inhalants. Aims We aimed to investigate associations of using volatile substances, nitrous oxide and alkyl nitrates with mental health problems in adolescence. Method We conducted a cross-sectional analysis using data from 13- to 14-year-old...
Anxiety disorders are a major public health burden with limited treatment options. We investigated the long-term safety and efficacy of lysergic acid diethylamide (LSD)-assisted therapy in patients with anxiety with or without life-threatening illness. This study was an a priori-planned long-term follow-up of an investigator-initiated, two-centre trial that used a double-blind,...
Australia has just rescheduled two drugs controlled under the United Nations Psychotropic Drug Conventions, psilocybin and MDMA, as treatments for treatment-resistant depression and post-traumatic stress disorder respectively. This feature explores the reasons for these developments, the opportunities and challenges they provide to psychiatry communities and how along with health systems these...
Background Prior trials suggest that intravenous racemic ketamine is a highly effective for treatment-resistant depression (TRD), but phase 3 trials of racemic ketamine are needed. Aims To assess the acute efficacy and safety of a 4-week course of subcutaneous racemic ketamine in participants with TRD. Trial registration: ACTRN12616001096448 at www.anzctr.org.au. Method This phase 3,...
We, the Editors of BJPsych, have retracted the following article: Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression, Ionson, E., Limbachia, J., Rej, S., Puka, K., Newman, R. I., Wetmore, S., Burhan, A. M. and Vasudev, A, The British Journal of Psychiatry (2019), Cambridge University Press, 214(4), pp. 218–224. DOI:...
Ketamine therapy for treatment-resistant depression in European national health systems may only be considered after attempting all evidence-based antidepressant strategies outlined in clinical guidelines. This paper seeks to explain the ethical, regulatory and procedural framework for the off-label use of ketamine for treatment-resistant depression within a public healthcare system.Declaration...
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BACKGROUND Late-life depression (LLD) is a disabling disorder and antidepressants are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate variability...
The Varieties of Religious Experiences by William James: a 19th-century description of the psychosis spectrum by way of religious and mystical experiences – psychiatry in literature - Volume 213 Issue 6
BACKGROUND: Ketamine has been demonstrated to improve depressive symptoms.AimsEvaluation of efficacy, safety and feasibility of repeated oral ketamine for out-patients with treatment-resistant depression (TRD). METHOD: In a randomised, double-blind, placebo-controlled, proof-of-concept trial, 41 participants received either 1 mg/kg oral ketamine or placebo thrice weekly for 21 days...
Summary: It is now incontrovertible that heavy use of cannabis increases the risk of psychosis. There is a dose–response relationship and high potency preparations and synthetic cannabinoids carry the greatest risk. It would be wise to await the outcome of the different models of legalisation that are being introduced in North America, before deciding whether or not to follow suit. Declaration...
Summary Altered self-experiences arise in certain psychiatric conditions, and may be induced by psychoactive drugs and spiritual/religious practices. Recently, a neuroscience of self-experience has begun to crystallise, drawing upon findings from functional neuroimaging and altered states of consciousness occasioned by psychedelic drugs. This advance may be of great importance for psychiatry.
Highlights of this issue (Not so) legal highs?There's been a zombie outbreak in Gotham City.Before you yell for Batman, the culprit is a novel psychoactive substance ('legal high' to use the incorrect but problematically enduring term) called 'AK-47' that is causing a bizarre intoxication profile in consumers: Kaleidoscope (pp.237-238) investigates the rise of the ultra-potent...
Research suggests that an 8-week mindfulness-based cognitive therapy (MBCT) course may be effective for generalised anxiety disorder (GAD). To compare changes in anxiety levels among participants with GAD randomly assigned to MBCT, cognitive-behavioural therapy-based psychoeducation and usual care. In total, 182 participants with GAD were recruited (trial registration number: CUHK_CCT00267) and...
Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied. To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM. A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov:NCT00928980). Adults with recurrent...
BACKGROUND: Recent studies with intravenous (i.v.) application of ketamine show remarkable but short-term success in patients with MDD. Studies in patients with chronic pain have used different ketamine applications for longer time periods. This experience may be relevant for psychiatric indications. AIMS: To review the literature about the dosing regimen, duration, effects and side-effects of...
BACKGROUND: Sleep disturbances are commonly reported in the psychosis prodrome, but rarely explored in relation to psychotic experiences. AIMS: To investigate the relationship between specific parasomnias (nightmares, night terrors and sleepwalking) in childhood and later adolescent psychotic experiences. METHOD: The sample comprised 4720 individuals from a UK birth cohort. Mothers reported on...
Therapeutic potential of psychedelic agentsAmphetamine, methylphenidate, morphine, heroin and ketamine are all drugs that can potentially be used clinically but, whenever we hear the word MDMA, the first thoughts that come to mind are of ecstasy, rave parties and people behaving in an odd manner and experiencing hallucinations, paranoia and disinhibition.Recently, there has been a lot of...
Summary After a 40-year hiatus there is now a revisiting of psychedelic drug therapy throughout psychiatry, with studies examining the drugs psilocybin, ketamine, ibogaine and ayahuasca in the treatment of drug dependence. Limitations to these therapies are both clinical and legal, but the possibility of improving outcomes for patients with substance dependency imposes an obligation to research...
From its first use 3,4,-methylenedioxymethamphetamine (MDMA) has been recognised as a drug with therapeutic potential. Research on its clinical utility stopped when it entered the recreational drug scene but has slowly resurrected in the past decade. Currently there is enough evidence for MDMA to be removed from its Schedule 1 status of 'no medical use' and moved into Schedule 2 (alongside...
Edited by Allan Beveridge, Femi Oyebode and Rosalind Ramsay - LSD: My Problem Child By Albert Hofmann (transl. Jonathan Ott) Oxford University Press. 2013. £24.99 (hb). 248 pp. ISBN: 9780199639410 - Volume 203 Issue 2
Mindfulness-based cognitive therapy (MBCT) was developed as a psychological approach for people at risk for depressive relapse who wish to learn how to stay well in the long-term. In this article we set out the rationale for MBCT, outline the treatment approach, overview the efficacy research to date and look to future challenges.
Background Psilocybin is a classic psychedelic drug that has a history of use in psychotherapy. One of the rationales for its use was that it aids emotional insight by lowering psychological defences. Aims To test the hypothesis that psilocybin facilitates access to personal memories and emotions by comparing subjective and neural responses to positive autobiographical memories under psilocybin...
BACKGROUND: No longitudinal study has yet examined the association between substance use and brain volume changes in a population at high risk of schizophrenia. AIMS: To examine the effects of cannabis on longitudinal thalamus and amygdala-hippocampal complex volumes within a population at high risk of schizophrenia. METHOD: Magnetic resonance imaging scans were obtained from individuals at...