Psychiatric News
February 28, 2019
Nick Zagorski
Small studies over the past decade suggest that psychedelic compounds such as LSD, psilocybin, and MDMA, when used alongside behavioral therapy, can help people with difficult-to-treat mental disorders. In a 2014 pilot study, twelve participants with life-threatening illnesses who received two doses of LSD saw their average anxiety levels decrease by over 75 percent at two months, with improvement lasting 12 months. An observational pilot study found that half of enrolled patients stopped using opioids 30 days after one dose of ibogaine. The FDA granted breakthrough therapy status to MDMA for severe PTSD in 2017 and to psilocybin for treatment-resistant depression in 2018, expediting their review. Researchers caution that results may be inflated by self-selection bias and that psychedelics carry risks including high blood pressure, flashbacks, and potential misuse.
Psychiatric News
September 21, 2018
Lynne Lamberg
The American Academy of Sleep Medicine recommends image rehearsal therapy (IRT) as first-line treatment for PTSD-associated nightmares and nightmare disorder in adults. IRT involves imagining a more positive outcome for a nightmare's storyline and rehearsing the new scenario mentally 10 to 20 minutes a day. Nine randomized controlled trials enrolling nearly 800 subjects found IRT effective in reducing nightmare frequency and distress. Other interventions that may be used include various behavioral therapies and medications such as olanzapine, prazosin, and gabapentin. Clonazepam and venlafaxine are not recommended for nightmare disorder because studies found no benefits.
Psychiatric News
November 30, 2017
Richard Karel
The FDA granted breakthrough therapy designation for phase 3 trials of MDMA as a treatment for PTSD. Phase 2 trials with 107 patients with chronic, treatment-resistant PTSD found that therapy alone led to 23% remission, therapy plus two MDMA sessions led to 55% remission, and a third MDMA session raised efficacy to 61%. At one-year follow-up, 68% of those who received MDMA-facilitated therapy no longer had a PTSD diagnosis. MDMA dampens the limbic system via the 5HT1A receptor, allowing patients to confront traumatic memories without being overwhelmed by fear, unlike classical psychedelics that work through the 5HT2A receptor system.
Psychiatric News
December 31, 2014
Joan Arehart-Treichel
Ketamine can relieve symptoms of both unipolar and bipolar depression within hours, but its long-term antidepressant effects and safety profile remain unknown. Researchers at the National Institute of Mental Health are working to identify the neurobiological mechanisms and biomarkers of ketamine's antidepressant efficacy. Patients with a family history of alcohol use disorder respond better to ketamine's antidepressant effect than those without that genetic risk. Researchers use magnetic resonance spectroscopy to study glutamate changes in the prefrontal cortex during ketamine infusion. Recruiting and retaining patients for clinical trials is difficult because participants must suspend their outside lives for three to six months.
Psychiatric News
December 16, 2011
Joan Arehart-Treichel
Taking the hallucinogen psilocybin may boost positive feelings like bliss or a sense of oneness with the universe, but the authors question whether these feelings amount to genuine mystical experience or spiritual growth. The work examines the distinction between drug-induced altered states and authentic spiritual or mystical development, suggesting that the subjective experiences produced by psilocybin might not reflect true spiritual progress.
Psychiatric News
October 1, 2010
Aaron Levin
In a small phase 2 pilot study, MDMA (ecstasy) used as an adjunct to psychotherapy reduced PTSD symptoms more than placebo in patients with chronic, treatment-resistant posttraumatic stress disorder. Clinical response—a greater than 30 percent reduction on the Clinician-Administered PTSD Scale—occurred in 83 percent of those who took MDMA compared with 25 percent of those given placebo. The drug helped patients process traumatic memories without becoming overwhelmed. After an average of 3.5 years, some patients had relapsed but the majority had not. The authors emphasize the drug is not a magic bullet but a catalyst in the right therapeutic setting.
Psychiatric News
May 3, 2019
S. Caroff
A psychiatrist warns that the evidence for psychedelic medicine rests on small, selective pilot studies and is weak, while sensationalized accounts downplay serious risks such as triggering a psychotic episode or misuse in vulnerable populations. The author argues that these drugs can distort perceptions and alter conscious interpretations in unpredictable ways, and that expediting FDA approval of psychedelics is alarming given the ongoing catastrophe from mass-marketed opioids and the public health impact of other reality-altering substances. The piece calls for balanced scientific analysis and support for basic neuroscience rather than rushing to embrace each new trend.
Psychiatric News
May 3, 2019
P. Summergrad
Large-scale trials with careful oversight and risk-modification strategies are needed to counter risks in psychedelic medicine. Many compounds like ketamine, MDMA, and psilocybin have been tested only in small patient series, are difficult to blind, and have been studied by highly committed investigators rather than in larger populations. These agents have a complex history of nonmedical or illegal use, leading to Schedule 1 restrictions. Careful studies, appropriate regulatory processes, and skilled clinical judgment can help protect against enthusiasms that have not always proved valuable. There may be much to learn about mental functioning while affected by these compounds.