JAMA
September 22, 2009
Michael S. Krasner
1,652 citations
Primary care physicians who participated in an intensive educational program in mindfulness, communication, and self-awareness showed sustained improvements in well-being and patient-centered attitudes. Over 15 months, mindfulness scores increased from 45.2 to 54.1, emotional exhaustion (a component of burnout) decreased from 26.8 to 20.0, depersonalization decreased from 8.4 to 5.9, and personal accomplishment increased from 40.2 to 42.6. Empathy scores rose from 116.6 to 121.2, and total mood disturbance dropped from 33.2 to 16.1. Improvements in mindfulness correlated with reduced mood disturbance and burnout and with increased empathy and emotional stability. Because this was a before-and-after study, randomized trials are needed to confirm these effects.
JAMA
August 31, 2023
Charles L Raison, Gerard Sanacora, Joshua Woolley et al.
493 citations
A single 25-mg dose of synthetic psilocybin, administered with psychological support, produced a clinically significant and sustained reduction in depressive symptoms and functional disability over 43 days in adults with major depressive disorder. In a phase 2 trial of 104 participants, those receiving psilocybin showed a mean 12.3-point greater improvement on the Montgomery-Asberg Depression Rating Scale at day 43 compared with those receiving a niacin placebo. Psilocybin also improved daily functioning and led to more sustained response, though not remission. No serious adverse events occurred, but psilocybin was associated with more overall and severe adverse events.
JAMA
March 27, 1987
G Dowling
301 citations
MDMA (Ecstasy) and its legal replacement MDEA (Eve) are considered safe by recreational users and psychotherapists, but five deaths associated with their use are reported. In three cases, the drugs may have contributed to death by triggering arrhythmias in people with underlying heart disease. In another case, MDMA use preceded bizarre and risky behavior leading to accidental death. In one case, MDMA was the immediate cause of death. Death from these drugs appears rare but does occur, especially in individuals with underlying cardiac disease.
JAMA
July 1, 1988
George A. Ricaurte
294 citations
MDMA, also known as ecstasy, is used recreationally and has been proposed as a therapy aid. In monkeys given repeated doses of 2.50, 3.75, or 5.00 mg/kg subcutaneously, the drug caused a dose-related depletion of serotonin and its metabolite 5-hydroxyindoleacetic acid across all brain regions examined two weeks later. These chemical deficits were accompanied by structural damage to serotonergic nerve fibers and pathological changes in nerve cell bodies within the dorsal raphe nucleus, but not the median raphe nucleus. The findings indicate MDMA acts as a selective serotonergic neurotoxin in nonhuman primates, suggesting humans using the drug may risk central serotonergic neuronal damage.
JAMA
June 15, 1970
Walter N. Pahnke
214 citations
The history of research with psychedelic drugs has involved a variety of methods and conflicting claims. In the 1950s, researchers initially claimed that lysergic acid diethylamide (LSD) could produce a model psychosis useful for understanding schizophrenia. As that promise faded, enthusiastic reports emerged about LSD as an aid to psychotherapy for alcoholism and other psychiatric disorders. These approaches were represented at the first international conference on LSD in 1959, with at least five more published proceedings on psychedelic drugs appearing since then.
JAMA
March 27, 1987
G Dowling
204 citations
MDMA (Ecstasy) and its legal replacement MDEA (Eve) are thought to be safe by recreational users and psychotherapists, but five deaths associated with their use are reported. In three cases, the drugs may have contributed to death by triggering arrhythmias in people with underlying heart disease. In one case, MDMA use led to bizarre, risky behavior resulting in accidental death. In another, MDMA was considered the immediate cause. Death from these drugs appears rare but does occur, and may be more common in individuals with pre-existing cardiac disease.
JAMA
August 14, 1987
Christopher R. Brown
168 citations
A 32-year-old woman experienced serious but reversible toxic reactions after ingesting an alleged 100 to 150 mg of MDMA (Ecstasy) powder. She arrived at the emergency department two hours later with agitation, hallucinations, combativeness, dilated pupils, rapid pulse (150 beats per minute), low blood pressure (90/50 mm Hg), rapid breathing (36/min), a high fever (41.6°C), and other symptoms. Her blood levels of MDMA were much higher than in any previously reported fatalities. Despite the severity, the reaction was reversible.
JAMA
March 18, 1988
Jamyl Alrazi
91 citations
A nearly fatal toxic reaction to 3,4-methylenedioxymethamphetamine (MDMA) occurred after an estimated dose of 100 to 150 mg, with blood levels of 6500 and 7000 ng/mL measured one and two hours after hospital admission. Before MDMA became a Schedule 1 drug in July 1985, psychiatrists used similar doses (100 to 150 mg) as a psychotropic catalyst and sensory disinhibitor without reported toxic effects. This case was part of a controlled study of MDMA metabolism and disposition in a single subject, performed before the drug was scheduled.
JAMA
December 9, 1983
Donald W. Goodwin
73 citations
In 1943, Swiss chemist Albert Hofmann accidentally absorbed LSD-25, a lysergic acid derivative, while working at Sandoz, experiencing vivid, kaleidoscopic visions and an intoxicated-like state—the first documented LSD trip. Hofmann had previously synthesized several profitable ergot-based drugs, but LSD did not become a commercial success for Sandoz.
JAMA
July 14, 1962
Sidney Cohen
65 citations
Lysergic acid diethylamide (LSD-25) was accidentally discovered two decades ago by Hofmann. Its ability to induce a model psychosis makes it a useful laboratory tool for studying psychotic-like phenomena. LSD-25 also serves as an adjunct to psychotherapy by enhancing recall of repressed memories and reducing ego defensiveness. It acts as a serotonin antagonist that alters cerebral synaptic transmission. Nearly 1,000 articles have examined its chemical, biological, and psychological effects. A 1960 survey of investigations and literature search found very few toxic or psychological complications, despite the substance's capacity to evoke delusions, hallucinations, depersonalization, and euphoria or depression.
JAMA
August 8, 1966
J. Thomas Ungerleider
61 citations
An analysis of 70 cases of adverse reactions to LSD, taken outside medical or research settings, reveals a wide range of psychiatric side effects, from depressive reactions to full psychotic states. The varied symptoms and patient characteristics underscore the risks associated with non-medical LSD use. Observations from these cases and from community users suggest that widespread use of LSD is a cause for concern.
JAMA
August 1, 2021
William R. Smith, Paul S. Appelbaum
60 citations
Psychedelic substance legalization initiatives raise concerns that can be informed by cautionary precedents from the legalization and commercialization of other controlled substances.
JAMA
April 15, 1968
José Egozcue
59 citations
People who use LSD have more chromosomal abnormalities in their white blood cells than non-users. Children exposed to LSD before birth also show higher rates of chromosome breakage. However, the amount of drug taken per dose, the number of doses, or the total dosage did not correlate with how often breaks occurred.
JAMA
November 3, 1969
Joe‐hin Tjio
55 citations
In a double-blind study, chromosomes from lymphocytes of 32 patients were examined before and after they took pure LSD in a controlled therapeutic setting, along with five black-market users who received pure LSD in a research setting. Statistical analysis showed no significant difference in chromosomal aberration rates before and after LSD. A follow-up study of eight normal subjects who had taken LSD in earlier experiments, using the same cytogenetic methods, also found no evidence of chromosomal damage. The results consistently indicate that, based on 72-hour cultures, there is no definite evidence that pure LSD damages human lymphocyte chromosomes in vivo.
JAMA
January 11, 1965
Arnold M. Ludwig
55 citations
Hallucinogenic substances such as LSD, psilocybin, and psilocin are far more potent than older agents like peyote and mescaline. Renewed interest in these drugs has led to speculation about their applications across diverse fields, including anthropology, where their socially sanctioned use in some cultures is described; fiction, where their role in utopian societies is imagined; and medicine, where they have been proposed for treating mental illness or inducing model psychoses. Others have suggested their use as educational tools or for triggering religious mystical experiences.
JAMA
August 14, 1987
C. Brown
52 citations
A 32-year-old woman experienced serious but reversible toxic reactions after ingesting 100 to 150 mg of MDMA (Ecstasy). Two hours later, she arrived at the emergency department with agitation, hallucinations, combativeness, dilated pupils, rapid pulse, low blood pressure, high fever, wheezing, and vertical nystagmus. Her blood levels of MDMA were much higher than in any previously reported fatalities. Despite the severity, the reactions were reversible.
JAMA
December 11, 1972
Cecil B. Jacobson
52 citations
Among 140 women who reported using LSD before or during pregnancy, 148 pregnancies were observed. Of 83 live births, 8 had major congenital defects. Among 65 abortions, 12 were spontaneous and 53 therapeutic. Four of 14 embryos from therapeutic abortions showed gross anomalies. 43% of first-trimester pregnancies ended in spontaneous abortion. Four of eight serial pregnancies resulted in defective embryos or infants. Eight of 12 women were unable to conceive again over 18 months. The use of other illicit drugs, infectious disease, and poor maternal nutrition prevent a definitive link between LSD and increased reproductive risk, but LSD ingestion, along with animal and DNA studies, suggests it might be hazardous to human reproduction.
JAMA
August 8, 1966
J. Thomas Ungerleider
43 citations
Adverse reactions to lysergic acid diethylamide (LSD) are diverse, with psychiatric side effects ranging from depressive reactions to psychotic states. In 70 cases, LSD was taken outside of medical or therapeutic settings. Observations of these cases and community users raise concern about the drug's widespread use.
JAMA
February 14, 1972
Peter Reich
41 citations
A 22-year-old student killed a stranger during a psychotic reaction triggered by lysergic acid diethylamide (LSD). Apart from a prior bad trip, he had no history of psychosis and showed no signs of it during four years of follow-up treatment.
JAMA
June 15, 1970
W. N. Pahnke
41 citations
The history of research with psychedelic drugs has produced conflicting claims about methods and results. In the 1950s, experimentalists claimed that lysergic acid diethylamide (LSD) could produce a model psychosis useful for understanding schizophrenia. As that promise faded, reports emerged about LSD as an aid to psychotherapy for alcoholism and other psychiatric disorders. By 1959, these approaches were represented at the first international conference devoted entirely to LSD, with at least five more published proceedings of such conferences on psychedelic drugs following. The most recent conference on producing states of consciousness was sponsored by the Menninger Foundation and the American Association of Humanistic Psychology in April 1969.
JAMA
June 1, 1970
William H. Mcglothlin
40 citations
In 121 pregnancies where mothers received low, infrequent medical doses of LSD, the rates of spontaneous abortion, premature birth, and birth defects were within normal ranges. For a smaller group of 27 pregnancies where LSD was taken both medically and nonmedically, the rate of spontaneous abortion was above average. Spontaneous abortions occurred significantly more often when the mother took LSD compared to when only the father did, but the data do not establish a clear causal link.
JAMA
December 2, 1968
David A. Hungerford
40 citations
Chromosomes from leukocytes of patients receiving intravenous lysergic acid diethylamide (LSD 25) were examined for aberrations. Before therapy, aberration frequencies in three of four patients matched those of control subjects. After each of three doses (usually 200 μg), some increase in aberration frequency and new types of aberrations appeared. However, follow-up samples taken one to six months after the final dose showed a return to control levels. The authors conclude that continued experimental therapy is not strongly contraindicated, but these results do not minimize potential cytogenetic hazards suggested by studies of drug abuse.
JAMA
September 13, 1971
Steven A. Friedman
37 citations
A patient developed life-threatening hyperthermia (106.4 °F or 41.3 °C axillary) after taking LSD, the first recorded instance of such severity in humans. The hyperthermia was rapidly reversed with alcoholic-ice soaks. Hallucinations ended about 18 hours later, and the patient recovered without obvious mental or physical injury. The episode may have been dose-related.
JAMA
July 12, 1965
Donald E. Widmann
37 citations
A book review describes a work that places hallucinogenic drugs in historical perspective, discussing their effects on the mind and potential uses as psychotherapy adjuncts or chemical warfare agents. The review notes the medical community's alarm over uncontrolled use of these drugs in a major city and the lay press's accounts of their mystic properties, described as "instant Zen." A significant challenge highlighted is the difficulty of conveying the nature of the drug experience, which the reviewer personally appreciates having taken a hallucinogen as part of a research project.
JAMA
August 31, 2023
Rachel Yehuda, Amy Lehrner
33 citations
Interest is growing among clinicians and researchers in using psychedelic drugs to treat mental health disorders such as depression, anxiety, posttraumatic stress disorder, eating disorders, and addictions.