European Psychiatry
April 1, 2024
S. Dames, C. Watler, P. Kryskow et al.
1 citation
Incorporating personal experience with non-ordinary states of consciousness into training for Psychedelic-Assisted Therapy (PaT) may benefit therapists by increasing comfort, self-assurance, and confidence in supporting others in such states. Experts note that therapists lacking lived experience may hold unrealistic expectations, overlook the importance of set and setting, or misunderstand the experience. The authors review arguments for and against including experiential training, acknowledging their own potential bias from personal experience. They emphasize that whether or not therapists undergo such training, maintaining personal wellness practices is essential to prevent burnout and secondary mental health consequences for both patients and providers. Cultivating a culture of self-care in mental health training and professional organizations is an urgent priority.
European Psychiatry
April 1, 2024
Venessa Tsang, C. Roney
1 citation
Patients awaiting psilocybin-assisted therapy (PAT) face complex application processes, fear of judgement, logistical and financial constraints, and systemic inequities. Health Canada's strict control through clinical trials and the Special Access Program creates challenges for primary care providers and limits involvement of trained practitioners. Moral distress from delayed or denied access underscores the urgency of addressing these barriers. Advocates recommend streamlined referrals, expedited services for end-of-life patients, formal billing infrastructure, practitioner education, expanded coverage, legislative adjustments, post-therapy support, and collaboration with non-profits and Indigenous Healers to promote equitable and effective PAT.
European Psychiatry
November 17, 2023
N. Veluri, Z. Mansuri
1 citation
Ketamine improved treatment-resistant depression symptoms and reduced suicidality by nine-fold and three-fold odds, respectively. Esketamine also improved treatment-resistant depression symptoms. The primary endpoint differed between ketamine (24 hours) and esketamine (28 days). Findings must be interpreted cautiously. Esketamine's effectiveness over 28 days appears promising for treatment-resistant depression.
European Psychiatry
November 17, 2023
K. Beck, A. Arumuham, S. Brugger et al.
1 citation
In people experiencing a first episode of psychosis, availability of N-methyl-D-aspartate receptors (NMDARs) in the hippocampus is lower than in matched healthy controls. Lower hippocampal NMDAR availability was linked to more severe overall, depressive, and general symptoms, and also to higher levels of the neurotransmitter glutamate in the striatum. No significant differences in NMDAR availability were found in other brain regions examined. These results support the hypothesis that reduced NMDAR function contributes to psychosis and point to the hippocampus as a key brain area involved.
European Psychiatry
November 17, 2023
L. Silva, L. Bravo
1 citation
LSD, a semi-synthetic hallucinogen first synthesized in 1938, was briefly used in psychiatry for alcoholism, neurosis, and psychosomatic disorders before its international prohibition in the 1970s. This non-systematic review found evidence that LSD may help treat drug and alcohol dependence and anxiety associated with life-threatening diseases. Modern neuroimaging shows LSD alters brain blood flow, electrical activity, and network communication patterns. Preclinical evidence indicates psychedelics affect neuroplasticity after both acute and chronic administration. When administered safely in a supervised psychotherapeutic setting, LSD may have potential for certain psychiatric conditions, warranting larger controlled studies.
European Psychiatry
November 17, 2023
E. Gaudre Wattinne, L. Mekaoui, M. Rothärmel et al.
1 citation
In a French early-access program, 66 patients with treatment-resistant depression received esketamine nasal spray. Most patients (79%) had a severe current depressive episode, the median disease duration was 12.2 years, and the current episode lasted a median of 2.6 years. All patients had tried at least two antidepressants (mean 4.2). Esketamine was started in full hospitalization for 55% of patients and in day hospitalization for 45%. Common side effects, occurring in more than 10% of patients, included dizziness, sedation, sleepiness, anxiety, and dissociation; these were typically brief and appeared after administration. The safety profile matched that seen in clinical trials.
European Psychiatry
March 1, 2023
Guy M. Goodwin, Lindsey Marwood, S. Mistry et al.
1 citation
A single dose of COMP360 psilocybin 25mg, a synthetic form of psilocybin, rapidly improved symptoms of depressed mood and anhedonia in adults with treatment-resistant depression, compared with a 1mg dose. Improvements were apparent by the day after administration and lasted up to 12 weeks for some symptoms. At Week 3, the largest differences on the clinician-rated MADRS scale were for Inability to Feel, Apparent Sadness, Lassitude, and Reported Sadness; on the self-rated QIDS-SR16, the largest difference was for Feeling Sad. The 10mg dose showed intermediate effects, suggesting a dose-related response.
European Psychiatry
March 1, 2023
V. W. L. Tsang, B. Tao, S. Dames et al.
1 citation
In a community-based ketamine-assisted therapy program (Roots to Thrive), 128 participants received 351 intramuscular injections (average 103 mg) and 96 sublingual doses (average 277 mg) over 12 weeks, alongside group therapy. Elevated blood pressure occurred transiently in about 12% more sessions than at baseline, with similar rates for both administration routes. Nausea was the most common side effect (12% of sessions), followed by headache (3%), vomiting (2.5%), and dizziness (seven sessions). Past psychedelic use or psychiatric diagnosis did not predict adverse events, but male participants had significantly less nausea. The program had no dropouts, suggesting good safety and tolerability.
European Psychiatry
June 1, 2022
Jaime Rodrigues, O. Nombora, Luiz Vicente Ribeiro
1 citation
A non-systematic review of the current evidence on serotoninergic psychoactive substances for obsessive-compulsive disorder (OCD) finds that, although research is limited to a few small studies, those conducted so far show clinically meaningful acute reductions in OCD symptoms after treatment with drugs such as psilocybin and lysergic acid diethylamide (LSD), along with possible longer-lasting benefits. Substance-assisted psychotherapy with psychedelics also shows promising results and appears suitable for OCD treatment. Studies indicate relatively good tolerability to these drugs. These early findings highlight the role of psychedelics in OCD treatment and the need for further research into efficacy, therapeutic mechanisms, and safety.
European Psychiatry
June 1, 2022
M. Turki, O. Abidi, S. Ellouze et al.
1 citation
Ketamine, traditionally used for anesthesia, shows promise as a rapid-acting treatment for several mental disorders that have not responded to other therapies. Its effectiveness in reducing suicidal thoughts has been reported. For treatment-resistant anxiety disorders, including obsessive-compulsive disorder and post-traumatic stress disorder, ketamine may offer a therapeutic option, with rapid anxiety-reducing effects noted in social anxiety and generalized anxiety disorder. In eating disorders, ketamine use was associated with complete remission of severe anorexia nervosa, including return to normal weight and reduced body preoccupations. When used alone or with other therapies, ketamine reduced alcohol and substance use, prolonged abstinence, reduced craving, and enhanced motivation. Side effects and short duration of action limit its use.
European Psychiatry
April 1, 2021
A. Fraga, Daniel Esteves-Sousa, João Facucho-Oliveira et al.
1 citation
Major depressive disorder affects over 300 million people worldwide, and about one-third of patients do not achieve remission with standard antidepressants, a condition known as treatment-resistant depression (TRD). Psilocybin, a classic hallucinogen from Psilocybe mushrooms, acts on serotonergic and glutamatergic systems. A narrative literature review of two clinical trials involving 32 patients with TRD found that two doses of psilocybin combined with psychological support significantly reduced depressive symptoms. All patients showed some symptom reduction one week after the second dose, with immediate and substantial improvements that could last up to six months. Due to small sample sizes, further research is needed to confirm these findings and understand psilocybin's mechanisms.
European Psychiatry
April 1, 2021
Clayton Peixoto, Fabiano Santos, Daianne Cardinalli Rêgo et al.
1 citation
A non-systematic review of recent clinical trials indicates that classic psychedelics (LSD, psilocybin, mescaline) and entactogens (MDMA) show promise for treating psychiatric disorders. In supportive settings with psychotherapy, psilocybin produces immediate and lasting antidepressant and anxiolytic effects, including in patients with life-threatening cancer. LSD may reduce anxiety and have anti-addictive properties. MDMA is effective for PTSD. Psychedelics are generally well-tolerated, with transient anxiety, headaches, nausea, and mild cardiovascular changes as common adverse effects; no persistent psychosis or suicidality has been demonstrated. Further evidence is needed to confirm therapeutic potential.
European Psychiatry
April 1, 2021
Nelson Descalço, Ana Beatriz Medeiros, Cátia Fernandes Santos et al.
1 citation
Promising findings suggest psilocybin, a potent hallucinogen, may offer relief for obsessive-compulsive disorder. One open-label clinical trial observed acute reductions in obsessive-compulsive symptoms, sparking interest across psychology and psychiatry. This initial data is encouraging for medicine and clinical psychology, prompting further rigorous clinical trials. These investigations aim to solidify psilocybin's potential in mental health research topics, exploring new therapeutic avenues for psychotherapists and advancing psychedelics and drug studies.
European Psychiatry
March 1, 2016
Arnt Schellekens, Toon van Oosteren, Thomas Knuijver et al.
1 citation
Ibogaine, a hallucinogen, reduces drug self-administration in animals, especially within the first 24 hours, but causes motor impairment and cerebral cell loss. In a meta-analysis of 27 animal studies, ibogaine did not affect conditioned place preference. Human data from 15 opiate-dependent patients treated with 10 mg/kg ibogaine are still being collected; initial observations show strong QTc prolongation and ataxia, with relatively mild opiate withdrawal symptoms. Ibogaine may reduce opiate withdrawal but carries risks of transient cardiac and cerebellar toxicity, warranting further systematic studies on its safety and efficacy for treating opiate dependence.
European Psychiatry
March 1, 2016
Inmaculada Peñuelas‐calvo, J. Sevilla Llewellyn-Jones, Aditya Sareen et al.
1 citation
A 36-year-old immigrant woman from South America began using ayahuasca daily as part of rituals performed by a community in Europe. Over time, she became socially isolated and developed delusional and mystical religious ideas, persecutory delusions, and auditory hallucinations in which Archangels spoke to her about creating music. She was involuntarily admitted to a mental health unit and treated with risperidone, which gradually resolved the hallucinations. After discharge, she continued outpatient treatment with injectable risperidone. The case highlights the need for clinicians to understand culturally unfamiliar substances like ayahuasca, which is undetectable in standard urine or blood tests.
European Psychiatry
January 1, 2009
P. Morrison, S. Kapur, R. Murray
1 citation
Intravenous delta-9-tetrahydrocannabinol (THC) can produce a temporary psychotic reaction in healthy people. In a double-blind, placebo-controlled experiment with 22 participants, a single 2.5 mg dose of THC significantly increased both self-reported and observer-rated positive psychotic symptoms, which were closely linked (correlation of 0.62). The symptoms involved a disrupted sense of self-agency and heightened paranoia. Participants also reported more negative symptoms, which were not due to sedation, and their working memory and executive function were consistently impaired. The findings suggest THC recreates symptoms across three major dimensions of schizophrenia without clouding consciousness. Preliminary evidence indicates that cannabidiol (CBD) may inhibit THC-induced positive symptoms.
European Psychiatry
June 23, 2026
Maximilian Preiß, Valentin Popper, Luna Helene Charlotte Faber et al.
No Summary
European Psychiatry
January 1, 2026
Shakila Meshkat, Qiaowei Lin, Rachel Sousa-Ho et al.
Control groups in psychedelic-assisted psychotherapy trials show substantial symptom improvement, likely due to non-specific factors such as expectancy and concurrent psychotherapy. A meta-analysis of 14 randomized controlled trials (643 participants) found that treatment groups had greater symptom reductions than control groups for depressive symptoms, PTSD symptoms, and anxiety symptoms. For PTSD, inactive placebo groups showed larger within-group improvements. The findings underscore the need for robust control conditions and careful interpretation of treatment effects in psychedelic research.
European Psychiatry
April 1, 2025
P. Andres-Olivera, Janis V. de la Iglesia, E. Dominguez-Alvarez et al.
Psilocybin, a psychedelic compound, shows promise for treating depression, particularly when standard treatments fail. This systematic review of studies published between 2019 and 2024 found that psilocybin leads to significant improvements in depressive symptoms compared to conventional therapies, with rapid and sustained symptom reduction and few adverse effects. The review concludes that psilocybin may be an effective and safe alternative, offering relief with fewer treatment sessions and a favorable safety profile, though more research is needed to understand its mechanisms and address current limitations.
European Psychiatry
April 1, 2025
Cristina Serritella, Federica Ferraiuolo, Mark Piccirillo et al.
Treatment with esketamine (Spravato) led to significant clinical improvement in most patients, as measured by the Clinical Global Impression and Dissociative Experience Scale II. Among 15 patients, dissociative symptoms decreased by an average of 14.65 points on the DES II (mean effect +0.98). CGI improvement showed an effect size of +56.57, with wide variability from +30.4 to +117.9. Two patients—a 31-year-old man and a 19-year-old woman—experienced clinical worsening with high dissociation, suggesting age and dissociative vulnerability may influence response. The scales proved complementary for monitoring change, and this work is the first attempt to differentiate traumatic from psychotic dissociation in esketamine-treated patients.
European Psychiatry
April 1, 2025
Ilídio Oliveira, A. L. Stephany, M. L. Geremias et al.
Ketamine reduces depressive symptoms similarly in people with anxious depression (AxD) and those with non-anxious depression (NAxD). A meta-analysis of eight clinical trials with 536 participants found no significant difference in symptom improvement between the two groups at 13 days or 26–28 days after treatment, nor in overall depression response. The AxD group had more severe baseline depressive symptoms, consistent with earlier reports. The authors conclude that ketamine is a viable treatment for anxious depression, a condition that may respond poorly to traditional antidepressants. The analysis is limited by few studies, small samples, and moderate heterogeneity.
European Psychiatry
April 1, 2025
L. Arvastson, E. Papanastasiou, K. Schmid et al.
A novel oral prolonged-release ketamine formulation (KET01) produces lower and delayed peak ketamine concentrations and higher levels of its metabolites, with limited dissociative effects compared to other ketamine formulations. In a randomized, double-blind phase 2 trial, 122 outpatients with treatment-resistant depression received 120 mg, 240 mg, or placebo daily for three weeks. A mediation analysis showed that the antidepressant effect of KET01 was not significantly mediated through dissociation, with an estimated mediation of -1.28% (confidence interval -28% to +11%). This challenges the common view that dissociation is necessary for ketamine's antidepressant effect, suggesting dissociative symptoms are merely adverse events of certain formulations.
European Psychiatry
April 1, 2025
E. E. Morales Castellano, P. Rivero Rodríguez, Marina Martínez Grimal et al.
Ayahuasca, a hallucinogenic brew used traditionally in Amazonian ceremonies, can trigger psychotic episodes in people with a history of psychiatric disorders. This case report describes a patient who developed a psychosis requiring hospitalization after consuming ayahuasca, with symptoms including hallucinations and delusions. Treatment with antipsychotics led to complete symptom resolution. The authors emphasize that hallucinogens may interact negatively with antipsychotic medications, reducing treatment effectiveness or causing adverse effects. Given ayahuasca's increasing use in developed societies, the report highlights the need for regulation, research, and psychoeducation about its potential risks, especially for vulnerable individuals.
European Psychiatry
August 27, 2024
M. J. Gordillo Montaño, L. Rodriguez Rodriguez, C. Pérez Aparicio et al.
A 23-year-old man with a history of depression and recent use of Kambo and Salvia divinorum developed a manic episode with psychotic symptoms, including mystical delusions and auditory hallucinations. The episode took about a month to resolve with treatment. The authors suggest that these substances, sometimes used as alternative therapies, may trigger severe psychiatric episodes in vulnerable patients, and note that later similar episodes were linked to other natural medicinal substances rather than Kambo.
European Psychiatry
August 27, 2024
L. Carrión Expósito, G. Chauca Chauca, R. Galan Armenteros et al.
In a 62-year-old patient with treatment-resistant major depressive disorder, intranasal esketamine led to marked improvement. From the fifth administration onward, the patient showed clear progress. At three months, the MADRS depression scale score dropped from a baseline of 46 to 14, and at six months to 1, indicating euthymia. The only adverse effect was very mild dizziness after each dose. This case suggests that esketamine can be a fast, safe, and well-tolerated option for patients who do not respond to other treatments.