Psychedelics for Psychiatric Disorders: Promise, Not Panacea

Serotonergic psychedelics such as psilocybin, LSD, and ayahuasca, when paired with supportive therapy, have reduced end-of-life anxiety in cancer patients, treatment-resistant depression, alcohol dependence, social anxiety in autistic adults, and nicotine dependence. MDMA-assisted therapy improves PTSD symptoms. Meta-analyses show promising effect sizes, but concerns remain about brief follow-ups, small samples, and poorly understood mechanisms. Generalization to the public is premature, and the proliferation of specialized clinics is not yet justified. Continued coordinated trials and judicious application are recommended, with realistic expectations that replication may yield smaller effects.

Study at a glance

Abstract

Initial promise and dire need have inspired the multiple research programs of the second psychedelic renaissance. Serotonergic psychedelics (psilocybin, lysergic acid diethylamide, and ayahuasca) have decreased end-of-life anxiety in cancer patients, treatment-resistant depression, alcohol dependence, social anxiety in autistic adults, and nicotine dependence when applied with supportive therapies. Methylenedioxymethamphetamine (MDMA), as part of a multisession treatment, improves symptoms of post-traumatic stress disorder and its negative correlates. Meta-analyses reveal promising effect sizes. Nevertheless, concerns about brief follow-ups, small samples, and other methodological issues remain. Mechanisms underlying improvement appear poorly understood. Generalization to the public is premature. The clarion call for more research appears justified. A proliferation of specialized clinics might not. Continued, coordinated trials and judicious application should be the rule, not the exception. Reasonable expectations of prediction intervals rather than patterns of statistical significance will also help the field, as replications might not show effects as large as in initial trials. [ Psychiatr Ann. 2022;52(9):354–358.]