Licit use of illicit drugs for treating depression: the pill and the process.
The Journal of clinical investigation – June 17, 2024
Source: PubMed
Summary
Breakthrough treatments for depression may depend not just on the medication itself, but also on the therapeutic setting and support provided. Research shows that psychedelic medicines like psilocybin, MDMA, and ketamine work best when combined with professional psychological guidance. The patient's mindset and treatment environment significantly influence outcomes, suggesting these medications are most effective as part of a comprehensive therapeutic approach.
Abstract
Psilocybin, MDMA, and ketamine have emerged as potentially effective treatments for rapid amelioration of the symptoms of mood and related psychiatric disorders. All clinical data collected so far with regard to psilocybin or MDMA, which have reported positive outcomes for treating depression, anxiety, posttraumatic stress disorder, and drug or alcohol use disorders, have involved clinician-assisted intervention. While the case for ketamine is assumed to be different, the first report of the successful use of ketamine in psychiatry for treating depression was in combination with psychotherapy, and an emerging literature suggests that the subjective state of individual experiences with ketamine predicts clinical outcome. This Review will focus on (a) a brief review of the literature, showing that the context or the process of drug administration has been an integrative component of published work; (b) the importance of clinical trials to compare the efficacy of the drug ("pill") as a stand-alone treatment versus drug in combination with clinician-assisted psychological support ("process"); and (c) suggestions for future approaches in animal models that take into account the role of systems and behavioral neuroscience in explaining a potential role for context, experience, and expectancy in drug effect.