| Abstrakt: |
After nearly 50 years of prohibition, psychedelics such as ketamine, 3, 4-methylenedioxymethamphetamine (MDMA), psilocybin, and lysergic acid diethylamide (LSD) have reemerged as potential adjuncts to psychotherapy for psychiatric disorders. Numerous clinical studies have confirmed the antidepressant and antisuicidal effects of ketamine, culminating in the approval of intranasal (S)-ketamine in treatment-resistant depression (TRD) and depression with suicidal ideation. More recently, randomized controlled trials of psychedelic-assisted therapy have found that MDMA is safe and efficacious in severe and chronic posttraumatic stress disorder, while psilocybin has shown promise in TRD and end-of-life anxiety and depression. Although fewer modern clinical trials have evaluated LSD for psychiatric indications, preliminary findings suggest it could be effective for mood and substance use disorders. Psychedelics have generally been well-tolerated at therapeutic doses with few serious adverse effects. In addition, neuroimaging studies with psychedelics have offered insights into the neural underpinnings of psychiatric disease and the role of neurotransmitter dysfunction, specifically glutamate, in psychopathology. Despite these encouraging developments, psychedelic research warrants a cautious approach and a critical understanding of current and anticipated barriers to rigorous experimentation (eg, inadequate blinding, small sample sizes, unknown treatment mechanisms or potential long-term risks) and treatment implementation (eg, legal restrictions, high resource utilization of psychedelic-assisted therapy). This article will provide a narrative review of historical psychedelic research, discuss the current state of psychedelic treatment (focusing on approved drugs and late-stage clinical trials), and offer a balanced perspective on the possible pitfalls and future promise of psychedelics in psychiatry. [ABSTRACT FROM AUTHOR] |
