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John H. Krystal

Yale University

14 papers in the library · 1,228 citations · publishing 1992-2026

Papers

Changes in global and thalamic brain connectivity in LSD-induced altered states of consciousness are attributable to the 5-HT2A receptor

eLife October 25, 2018 Katrin H. Preller, Joshua B. Burt, Jie Lisa Ji et al. 416 citations

Lysergic acid diethylamide (LSD) reduces associative brain connectivity while increasing sensory-somatomotor and thalamic connectivity. These neural effects, along with the subjective experience, are fully blocked by ketanserin, a selective 5-HT2A receptor antagonist. The spatial pattern of LSD's effects across the brain matches the distribution of 5-HT2A receptor gene expression in humans. These results strongly implicate the 5-HT2A receptor in LSD's neuropharmacology, informing the neurobiology of psychedelics and guiding development of psychedelic-based therapeutics.

Comparative and Interactive Human Psychopharmacologic Effects of Ketamine and Amphetamine

Archives of General Psychiatry September 1, 2005 John H. Krystal, Edward Perry, Ralitza Gueorguieva et al. 323 citations

Ketamine and amphetamine produce different patterns of psychotic and cognitive effects in healthy people. Ketamine causes perceptual changes, negative symptoms, and memory disruption, while amphetamine triggers hostility, grandiosity, and somatic concern. Both drugs produce positive symptoms and euphoria, but their interaction reveals three patterns: amphetamine reduces ketamine-induced working memory impairment; the drugs additively increase thought disorder, arousal, and euphoria; and their combined effect on psychosis is less than additive. These results suggest that glutamate and dopamine systems contribute differently to psychosis, thought disorder, and euphoria, and that boosting prefrontal dopamine may help cognitive problems linked to glutamate dysfunction.

Psilocybin Induces Time-Dependent Changes in Global Functional Connectivity

Biological Psychiatry January 13, 2020 Katrin H. Preller, Patricia Duerler, Joshua B. Burt et al. 199 citations

Psilocybin, a hallucinogen derived from mushrooms, significantly enhances serotonin receptor activity, leading to notable changes in brain connectivity. In a study with 30 participants, functional magnetic resonance imaging revealed a 60% increase in functional connectivity in areas linked to sensory processing and emotional regulation after psilocybin administration. This shift suggests profound implications for psychology and medicine, particularly in treating mental health disorders. The findings underscore the potential of psychedelics in pharmacology, highlighting their ability to influence behavior through neurotransmitter pathways and chemical synthesis of alkaloids.

Chronic 3,4-Methylenedioxymethamphetamine (MDMA) Use: Effects on Mood and Neuropsychological Function?

The American Journal of Drug and Alcohol Abuse January 1, 1992 John H. Krystal, Lawrence H. Price, Charles Opsahl et al. 171 citations

Chronic use of MDMA (ecstasy) is associated with mild-to-moderate impairments in memory, as measured by the Wechsler Memory Scale, even when no memory deficits are apparent on clinical examination. In a study of nine individuals with extensive MDMA use, eight showed at least mild impairment on one or more neuropsychological tests. Despite previous evidence suggesting serotonin deficits in this group, none reported depressed mood or met criteria for an affective disorder at the time of testing. These findings raise concern about potential detrimental effects of MDMA on cognitive function and highlight important issues regarding serotonin's role in cognition and mood regulation.

Transcriptomics-informed large-scale cortical model captures topography of pharmacological neuroimaging effects of LSD

eLife July 12, 2021 Joshua B. Burt, Katrin H. Preller, Murat Demirtaş et al. 49 citations

A computational model that simulates how LSD affects human brain activity shows that the drug alters communication between cortical areas by increasing the sensitivity of pyramidal neurons via the serotonin-2A receptor. The model accurately reproduced changes in functional connectivity observed in brain scans, and fitting it to individual participants captured personal differences in drug response related to altered consciousness. This approach links molecular drug actions to large-scale brain network changes, offering a path toward personalized medicine.

Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023

Current Psychiatry Reports April 1, 2024 John L. Havlik, Syed Wahid, Kayla M. Teopiz et al. 30 citations

Treatment-resistant depression (TRD) has historically had very limited options, but recent advances have expanded knowledge of effective interventions. Psychotherapy can help as an add-on but not alone. Adjunctive non-antidepressant drugs like buprenorphine and antipsychotics show little recent support; side effects and high discontinuation rates may outweigh benefits. Strong recent evidence supports interventional approaches: electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation. Research on TRD should use internationally defined inclusion criteria for generalizable results.

Psilocybin: From Psychiatric Pariah to Perceived Panacea

American Journal of Psychiatry January 1, 2025 Adrienne Grzenda, Gregory A. Fonzo, Aaron Wolfgang et al. 14 citations

Current evidence does not support recommending psilocybin combined with psychological support (PST) as a psychiatric treatment. More rigorous clinical trials are needed to confirm its effectiveness in larger and more diverse patient groups, determine appropriate dosing, improve blinding methods, and understand how it works and for whom it works best. Comparing it directly with other proven treatments will clarify its potential future role in treating major psychiatric disorders.

Modulating amygdala activation to traumatic memories with a single ketamine infusion

medRxiv Preprint Server July 7, 2021 Or Duek, Yutong Li, Ben Kelmendi et al. 8 citations preprint

A single low-dose infusion of ketamine, an NMDA receptor antagonist, given after recalling a traumatic memory can weaken the fear response associated with post-traumatic stress disorder. In the study, people who received ketamine showed lower activity in the amygdala and hippocampus when re-exposed to trauma memories, compared to those who received midazolam. Ketamine also reduced communication between the amygdala and hippocampus, without affecting connections to the prefrontal cortex. These changes lasted at least 30 days after treatment, suggesting that human traumatic memories can be altered during a reconsolidation window, potentially offering a new approach to treating PTSD.

Ketamine Effects on Energy Metabolism, Functional Connectivity and Working Memory in Healthy Humans

bioRxiv Preprint Server February 21, 2023 Naomi R. Driesen, Peter Herman, Margaret A. Rowland et al. 5 citations preprint

Ketamine, an NMDAR antagonist, increased oxidative metabolism (CMRO2) and cerebral blood flow in the prefrontal cortex and other cortical regions, but did not alter resting-state cortical functional connectivity or brain-wide CBF-CMRO2 coupling. Higher baseline CMRO2 was associated with lower task-related prefrontal activation and greater working memory accuracy impairment under both saline and ketamine conditions. These findings suggest that CMRO2 and resting-state functional connectivity index distinct dimensions of neural activity, and that ketamine's impairment of working memory-related neural activity and performance relates to its induction of cortical metabolic activation.

Ketamine Alters Tuning of Neural and Behavioral Spatial Working Memory Precision

bioRxiv Preprint Server February 10, 2025 Masih Rahmati, Flora Moujaes, Nina Purg Suljič et al. 1 citation preprint

Working memory deficits in disorders like schizophrenia may stem from disrupted brain cell tuning. Using fMRI, researchers found that ketamine, which blocks NMDA receptors, broadens neural spatial tuning in healthy people, reducing the precision of brain responses across visual, parietal, and frontal areas and worsening spatial working memory accuracy. These tuning changes were more consistent across individuals and brain regions than overall activation changes and correlated with memory performance. The results link NMDA receptor disruption to altered brain circuit dynamics and memory impairment, offering a target for developing treatments.

A Robust and Reproducible Connectome Fingerprint of Ketamine is Highly Associated with the Connectomic Signature of Antidepressants

medRxiv Preprint Server April 10, 2020 Chadi G. Abdallah, Kyung-Heup Ahn, Lynnette A. Averill et al. 1 citation preprint

A robust and reproducible brain connectivity fingerprint (CFP) was identified during ketamine infusion in healthy participants, characterized by reduced connectivity within primary cortices and the executive network, but increased connectivity between the executive network and the rest of the brain. This same CFP measured one week after treatment in major depressive disorder patients predicted response to eight weeks of sertraline, but not placebo. The findings suggest a brain network biomarker that links ketamine's acute effects to the mechanisms of conventional antidepressants.

Enhancing cGMP signaling with psilocybin reduces head twitch and restructures the synaptic proteome while maintaining antidepressant response

bioRxiv (Cold Spring Harbor Laboratory) March 10, 2026 Gabriele Floris, Sarah J. Jefferson, Jocelyne Rondeau et al.

Combining psilocybin with a phosphodiesterase-9 inhibitor (PDE9i) reduces psychedelic-like effects in mice—measured by head twitch response—while preserving antidepressant effects against chronic stress. Proteomic analysis of the medial prefrontal cortex revealed enhanced synaptogenesis and reduced GPCR signaling pathways with the combination versus psilocybin alone. This suggests a potential strategy for developing serotonergic antidepressants that maintain efficacy without the intense psychedelic experience, which currently limits scalability of psilocybin therapy.

MDMA enhances prefrontal plasticity and representational drift during fear extinction

bioRxiv (Cold Spring Harbor Laboratory) March 8, 2026 Nitzan Geva, Sarah J. Jefferson, Emi Krishnamurthy et al.

MDMA increases spine density and the formation of new spines in the medial prefrontal cortex of mice, as shown by two-photon microscopy. Calcium imaging in the infralimbic cortex during fear extinction revealed that neural activity in this region became more correlated with the suppression of freezing behavior, indicating a strengthened role in extinction. Longitudinal cell registration showed accelerated representational drift across days in MDMA-treated mice, especially in neurons that suppressed activity to conditioned cues. These findings indicate that MDMA facilitates structural and functional neuroplasticity, which may underlie its enhancement of extinction learning.