Psychedelic medicines for end-of-life care: Pipeline clinical trial review 2022.

A scoping review of pipeline clinical trials identified 25 studies of psychedelic treatment for depression, anxiety, and existential distress at end of life, including 13 randomized controlled trials and 12 open-label trials. Investigational drugs included ketamine (11 trials), psilocybin (10), MDMA (2), and LSD (2); three trials involved microdosing, and fifteen incorporated psychotherapy. Only three trials assessed expectancy and blinding effectiveness beyond randomization. The review expects ongoing trials to extend evidence for psychedelic-assisted group therapy and microdosing, but head-to-head comparisons of different psychedelics and more rigorous studies controlling expectancy are still needed.

Study at a glance

Abstract

People with terminal illnesses often experience psychological distress and associated disability. Recent clinical trial evidence has stimulated interest in the therapeutic use of psychedelics at end of life. Much uncertainty remains, however, mainly due to methodological difficulties that beset existing trials. We conducted a scoping review of pipeline clinical trials of psychedelic treatment for depression, anxiety, and existential distress at end of life. Proposed, registered, and ongoing trials were identified from 2 electronic databases (ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform). Recent reviews and both commercial and non-profit organization websites were used to identify additional unregistered trials. In total, 25 studies were eligible, including 13 randomized controlled trials and 12 open-label trials. Three trials made attempts beyond randomization to assess expectancy and blinding effectiveness. Investigational drugs included ketamine (n = 11), psilocybin (n = 10), 3,4-methylenedioxymethamphetamine (n = 2), and lysergic acid diethylamide (n = 2). Three trials involved microdosing, and fifteen trials incorporated psychotherapy. A variety of onging or upcoming clinical trials are expected to usefully extend evidence regarding psychedelic-assisted group therapy and microdosing in the end-of-life setting. Still needed are head-to-head comparisons of different psychedelics to identify those best suited to specific indications and clinical populations. More extensive and rigorous studies are also necessary to better control expectancy, confirm therapeutic findings and establish safety data to guide the clinical application of these novel therapies.