Psychedelics as Psychiatric Medications
March 1, 2023
Deborah C. Mash
1 citation
Ibogaine, derived from the root bark of Tabernanthe iboga, has a century-long history of traditional ceremonial and medicinal use in Western Africa. It acts on multiple neurotransmitter systems including dopamine, serotonin, opioid, nicotinic, and glutamatergic pathways. The UK MHRA has approved a Phase 1/2a clinical trial; Phase 1 assesses safety at escalating doses, and Phase 2 is a randomized, placebo-controlled proof-of-concept study in patients seeking opioid detoxification. Existing clinical reports indicate ibogaine helps manage both physical opioid withdrawal symptoms and behavioral aspects of addiction that drive relapse.
Psychedelics as Psychiatric Medications
March 1, 2023
Mihai Avram, Felix Müller, Stefan Borgwardt
1 citation
Lysergic acid diethylamide (LSD) is a potent perception-altering chemical that has been both revered and demonized since its discovery. Before its ban in the late 1960s, it was used to model aspects of psychosis and treat alcohol addiction and anxiety. Recent clinical trials show LSD can be administered safely in clinical settings to healthy volunteers and clinical groups. Small studies suggest potential therapeutic uses for anxiety. LSD's perception-altering effects involve agonism at the 5-HT2A receptor. Neuroimaging reveals LSD enhances signal diversity and complexity, decreases resting-state connectivity within intrinsic brain networks, and increases between-network connectivity, including thalamocortical connectivity.
Psychedelics as Psychiatric Medications
March 1, 2023
David Castle, Nicole Ledwos, David Nutt
The renewed scientific interest in psychedelics and related drugs is promising for treating mental health disorders and addictions, but many questions remain unanswered. Key uncertainties include how these drugs work in the brain, how their biological effects interact with psychological support to produce therapeutic change, the duration of benefits, and long-term safety. The necessity of the psychedelic experience for therapeutic benefit, safe delivery of psychological support, integration into mainstream healthcare, funding, therapist training, and gold-standard trial designs addressing blinding, placebo response, and expectancy bias are all outstanding issues that need resolution as research expands across more disorders.
Psychedelics as Psychiatric Medications
March 1, 2023
James Linden, Daniel Robin
This chapter reviews several lesser-known psychedelic substances, some of which are among the most potent molecules and may hold significant medical potential. Unlike better-studied psychedelics, these compounds have novel effects that remain poorly understood, with limited clinical data available—in some cases, none. The overview covers five such substances, reflecting growing interest in psychedelic science to explore their possibilities.
Psychedelics as Psychiatric Medications
March 1, 2023
Michael C. Mithoefer, David E. Presti
MDMA was first synthesized by Merck in 1914 but not studied in humans until the 1970s–80s, when it was reported to reduce anxiety and increase emotional openness, making it a possible catalyst for psychotherapy. In 1985, after recreational use in dance scenes attracted media attention, the US government placed MDMA in Schedule 1, banning it for medical use. MDMA's pharmacological effects include releasing serotonin and other monoamines and raising oxytocin levels. Research on its effects is evolving, and links between its physiology and user experiences remain speculative. Controlled clinical trials of MDMA-assisted psychotherapy began in 2004, focusing on PTSD.
Psychedelics as Psychiatric Medications
March 1, 2023
Daniel Perkins, Simon G. D. Ruffell, Jerome Sarris
Ayahuasca, a psychedelic plant brew from the Amazon basin, is made from the ayahuasca vine (Banisteriopsis caapi) and DMT-containing leaves like chacruna (Psychotria viridis). Its harmala alkaloids act as MAOIs, preventing DMT breakdown, while DMT modulates serotonin and dopamine signaling. Used for centuries by indigenous tribes for healing, recent research suggests effectiveness for depression, anxiety, and addiction. Interest has surged, with many 'ayahuasca tourists' seeking treatment, and clinical research raises ethical issues around medicalization.
Psychedelics as Psychiatric Medications
March 1, 2023
Joanna C. Neill, Mohammed Shahid, Rosalind Gittins et al.
Before psychedelic-assisted therapy can be integrated into mainstream medicine, a thorough understanding of its risks and adverse effects is critical. Current clinical trials have left knowledge gaps, and a comprehensive analysis of human receptor pharmacology is needed to guide safe dosing and identify drug-drug interactions with common antidepressants, antipsychotics, and anticonvulsants. Post-approval pharmacovigilance will be essential for patient safety, and future trials must include more ethnically diverse populations. This innovation in psychiatry requires careful, stepwise safety and risk-benefit evaluations to maximize patient benefit.