Therapeutic advances in psychopharmacology
February 1, 2015
Hannah Steeds, Robin L Carhart-Harris, James M Stone
132 citations
Schizophrenia involves positive, negative, and cognitive symptoms, and about one-third of patients do not respond to existing medications. This review evaluates how drugs acting on dopaminergic, glutamatergic, serotonergic, cannabinoid, GABA, cholinergic, and kappa opioid systems model aspects of schizophrenia in animals and humans. Understanding interactions between these neurotransmitter systems and their links to symptoms is crucial for forming a coherent hypothesis of schizophrenia's pathogenesis and developing new therapies.
Therapeutic advances in psychopharmacology
January 1, 2023
Anya Ragnhildstveit, Jeremy Roscoe, Lisa C Bass et al.
49 citations
PTSD has few effective pharmacological treatments, and trauma-focused psychotherapies are limited by provider shortages and low patient engagement, often leading to chronic illness and reduced quality of life. Ketamine, an NMDA receptor antagonist already indicated for major depression with rapid antidepressant effects, shows transdiagnostic potential. A synthesis of clinical evidence—including case reports, chart reviews, open-label studies, and randomized trials—reveals high heterogeneity in presentation and treatment approach but encouraging signals of safety, efficacy, and durability. Future research directions are discussed.
Therapeutic advances in psychopharmacology
April 1, 2017
Álvaro López-díaz, José Luis Fernández-gonzález, José Evaristo Luján-jiménez et al.
27 citations
A case report describes a female patient hospitalized for months with treatment-resistant bipolar depression and chronic suicidal behavior. After repeated intravenous ketamine infusions with no notable side effects, she achieved complete clinical recovery for four weeks following discharge. Depressive symptoms returned in the fifth week, leading to hospital readmission after a suicide attempt. The report highlights ketamine's rapid but temporary antidepressant effects and the risk of relapse, underscoring concerns about its off-label use in clinical practice despite its potential for refractory depression.
Therapeutic advances in psychopharmacology
January 1, 2022
Otto Simonsson, Peter S Hendricks, Richard Chambers et al.
26 citations
In a US-representative sample of 2822 adults, lifetime use of classic psychedelics was linked to healthier tobacco-related and diet-related behaviors. Among the 613 who had used psychedelics, greater psychological insight during their most insightful experience was associated with healthier exercise habits, a healthy body mass index, and diet improvements. Psychological insight was also tied to self-reported health behavior improvements attributed to the psychedelic experience, including alcohol-related changes. The findings suggest that psychological insight during a classic psychedelic experience may promote positive health behavior change and better physical health, especially in weight management, though causality cannot be established.
Therapeutic advances in psychopharmacology
January 1, 2023
Vivian W L Tsang, Brendan Tao, Shannon Dames et al.
19 citations
A retrospective chart review of 128 participants in a 12-week ketamine-assisted group therapy program found that the treatment was well tolerated, with no dropouts. Across 448 sessions, elevated blood pressure occurred after 49.16% of sessions, while nausea affected 12.05% of participant-sessions, vomiting 2.52%, headache 3.35%, and dizziness in seven participant-sessions. Adverse events were transient and resolved with rest or medication. The findings suggest good safety and tolerability for intramuscular and sublingual ketamine dosing in a community group psychotherapy setting.
Therapeutic advances in psychopharmacology
April 1, 2016
Jessica A Meisner, Susan R Wilcox, Jeremy B Richards
19 citations
A 40-year-old man who took ibogaine to manage heroin withdrawal suffered acute cardiac arrest, leading to cerebral edema and brain death. The case, consistent with ibogaine-induced cardiotoxicity, underscores significant clinical risks. A review of the literature on ibogaine's history, mechanisms, and adverse effects accompanies the report. Clinicians should be aware of ibogaine's potential to cause cardiac arrest and provide informed counseling about the dangers of using it for opioid detoxification.
Therapeutic advances in psychopharmacology
January 1, 2024
Raymond Yan, Tyler Marshall, Atul Khullar et al.
11 citations
Over a 4-week course of eight intravenous ketamine infusions, adults with treatment-resistant depression reported improved sleep quality and an earlier circadian rhythm. Sleep quality, measured by the Pittsburgh Sleep Quality Index, improved significantly, as did depressive symptoms. Circadian rhythm, measured by the Morningness-Eveningness Questionnaire, shifted earlier. Improvements in sleep duration and daytime dysfunction were also observed. The effect on sleep quality was more prominent in patients with mixed features of depression, while the circadian shift was more prominent in those without mixed features. The study was small and uncontrolled, so findings are preliminary.
Therapeutic advances in psychopharmacology
January 1, 2025
Ahmed Elmosalamy, Idil Tarikogullari, Liliana Patarroyo-Rodriguez et al.
7 citations
About one-third of people with depression do not respond to standard treatments, a condition known as treatment-resistant depression (TRD). Intravenous (IV) ketamine and esketamine (given IV or as a nasal spray) are newer options for TRD, but only the nasal spray version of esketamine is FDA-approved. A meta-analysis of eight studies with 978 adults directly comparing IV ketamine with esketamine found that both treatments produced similar rates of response and remission after acute treatment, with a slight but not statistically significant advantage for IV ketamine. IV ketamine may work faster, but the evidence is mostly from observational studies, and large randomized trials are needed to confirm these findings.
Therapeutic advances in psychopharmacology
January 1, 2026
Alessandro Cuomo, Roger Mcintyre, Despoina Koukouna et al.
1 citation
Among 45 patients with treatment-resistant depression treated with intranasal esketamine alongside oral antidepressants in a routine clinic, depression severity scores dropped from an average of 40.0 to 22.9 at four weeks and to 9.70 at 52 weeks, with scores remaining near 9-10 at later follow-ups. Eight patients stopped treatment, mostly due to lack of efficacy or side effects. No manic symptoms emerged, and side-effect ratings were low. The findings suggest sustained symptom improvement and a favorable long-term safety profile for those who continued treatment, though the observational design, concurrent treatments, and survivor bias limit the conclusions.
Therapeutic advances in psychopharmacology
January 1, 2026
Yujuan Liu, Xiaorong Liu, Sebastian Olbrich et al.
Ketamine, a rapid-acting antidepressant for treatment-resistant depression, may work by altering the brain's excitation-inhibition balance, measurable via the aperiodic exponent of EEG power spectra. In a placebo-controlled trial of 24 patients with major depressive disorder, ketamine infusion significantly reduced the aperiodic exponent across the scalp. Patients who responded to treatment had steeper pretreatment occipital aperiodic exponents, which predicted better outcomes. A meta-analysis within the study revealed substantial variability in ketamine's effect on this measure. The occipital aperiodic exponent may serve as a biomarker for predicting antidepressant response, but further large-scale studies are needed.
Therapeutic advances in psychopharmacology
January 1, 2026
Zofia Kachlik, Wiesław Jerzy Cubała, Michał Walaszek et al.
Anhedonia, a core symptom of bipolar depression, often fails to improve with ketamine treatment in patients with treatment-resistant bipolar depression. In a retrospective analysis of 31 patients who received eight doses of ketamine, 45.2% did not achieve a 50% or greater reduction in anhedonia scores. Nonresponders tended to have higher body mass index, later illness onset, fewer hypomanic episodes, and lower employment rates. These metabolic, illness-course, and psychosocial factors may help predict which patients are less likely to benefit from ketamine's anti-anhedonic effects.
Therapeutic advances in psychopharmacology
January 1, 2026
Veronika Andrashko, Tomas Novak, Miloslav Kopecek et al.
Higher blood pressure during ketamine infusion was associated with better antidepressant response in people with depression. Among 39 patients who received a single intravenous dose of ketamine, those who responded at day 7 had significantly higher systolic and diastolic blood pressure during the infusion than nonresponders. Dissociation and psychotomimetic symptoms did not differ between responders and nonresponders. Concomitant antipsychotic medication was linked to worse antidepressant outcome and lower infusion-related blood pressure. Plasma levels of ketamine or norketamine did not correlate with blood pressure, dissociative symptoms, or psychotomimetic effects.
Therapeutic advances in psychopharmacology
January 1, 2026
Manfred Klöbl, Thomas Liebe, Gregor Dörl et al.
Ketamine reduces sexual arousal in a sex-specific manner, which may explain why it is used recreationally in chemsex settings despite dampening sexual experience. In two placebo-controlled crossover studies with 67 healthy volunteers, subacute S-ketamine lowered arousal to heterosexual stimuli in women and to lesbian stimuli in men, while decreasing sexual aversion to gay stimuli in both sexes. Late racemic ketamine reduced arousal to heterosexual stimuli in men but increased aversion to gay stimuli in women. Ketamine also modulated calcarine gyrus activity differently in men and women. These sex-dependent effects on brain activity and sexual response may relate to ketamine's known sex-specific influences on stress resilience and psychosis-like symptoms.
Therapeutic advances in psychopharmacology
January 1, 2026
Kristian Beichmann, Polina Catzeflis, Helena D Aicher et al.
In Switzerland, physicians provide psychedelic-assisted therapy (PAT) with psilocybin, LSD, or MDMA under case-by-case exemptions from the Federal Office of Public Health. An anonymous survey of 41 physicians found that PAT is used mainly for depression, anxiety, PTSD, and chronic pain. Most physicians work in private practices (82%) and use body-oriented (61%), psychodynamic (59%), and eclectic (54%) approaches. Psilocybin is the most used substance (85%), followed by MDMA (71%) and LSD (65.9%). Substance choice is linked to diagnosis: psilocybin for depression (54%) and substance use disorder (46%), MDMA for PTSD (86%) and anxiety (54%). Music is played in 90% of sessions. Group therapy is common; 42% provide both individual and group settings. Challenges include legal constraints, high patient expectations, and financial barriers.
Therapeutic advances in psychopharmacology
January 1, 2026
Zofia Kachlik, Wiesław Jerzy Cubała, Michał Walaszek
Ketamine and esketamine offer rapid antidepressant and anti-suicidal effects for treatment-resistant depression and bipolar depression, but differ from conventional antidepressants in their acute subjective effects, physiological profile, delivery models, and misuse potential. This narrative review synthesizes evidence from regulatory guidance, clinical trials, observational studies, and qualitative research to identify key patient information needs and proposes practical psychoeducational strategies. Core elements include explanations of indications, mechanisms, and treatment algorithms; guidance on visit preparation, scheduling, and monitoring; management of acute adverse effects; counselling on suicidality and substance misuse; and tailored considerations for special populations such as older adults, women of reproductive potential, and medically complex patients. The review proposes a patient-centred framework for psychoeducation and identifies priorities for future research.
Therapeutic advances in psychopharmacology
January 1, 2025
Aleksander Kwaśny, Wiesław Jerzy Cubała, Alina Wilkowska
Intravenous ketamine is effective for treatment-resistant bipolar depression, with dosing typically based on actual body weight. In a retrospective analysis of 22 inpatients, doses recalculated using formulas for lean body mass, ideal body weight, and body surface area were compared between responders and nonresponders. Body surface area-normalized doses ranged from 17.63 to 23.09 mg/m² in nonresponders and 15.73 to 23.89 mg/m² in responders. Lean body mass and ideal body weight recalculations at 0.5 mg/kg yielded lower relative doses, especially among nonresponders, suggesting potential underdosing. These preliminary findings do not support alternative dosing formulas over actual body weight, but replication in larger controlled studies is warranted.
Therapeutic advances in psychopharmacology
January 1, 2025
Diana McHerron, Michaela Barber, Rachel Ham et al.
Physical touch is often used as a supportive tool in psychedelic-assisted therapy, but participants under the influence of psychedelics have reduced capacity to consent and are more suggestible. Interviews with 16 researchers revealed three themes: flexible frameworks, therapeutic alliance, and boundary management. Researchers noted that consent to therapeutic touch should be established before dosing sessions and continually managed. Flexibility in consent protocols helped build therapeutic alliance but also created challenges in boundary management. Researchers emphasized the need for clearer ethical guidelines for handling changing preferences during dosing sessions and limits on expanding consent after drug administration.
Therapeutic advances in psychopharmacology
January 1, 2024
correction
This is a correction notice for a previously published article. It provides no new findings, arguments, or data.
Therapeutic advances in psychopharmacology
January 1, 2024
correction
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