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Psychiatry

New use for an old drug: oral ketamine for treatment-resistant depression

August 3, 2016 / Depression, Ketamine, Papers, Psychiatry, Psychology, Psychopharmacology, Publications / By / , ,

Abstract

Treatment-resistant depression (TRD) is a disabling disorder that can interfere with a patient’s capacity to understand and participate in medical care and thus negatively impact individual morbidity and mortality. Hospitalised patients with TRD may require rapid alleviation of severe symptomatology, particularly when suicidal or if unable to participate in care decisions. Ketamine is well known for its anaesthetic effects and its use as a ‘street’ drug; however, its action as an N-methyl-D-aspartate receptor antagonist makes ketamine a potential therapy for TRD. The majority of studies investigating ketamine for TRD have used intravenous drug delivery, demonstrating benefit for rapid alleviation and sustained response of depression symptoms. Oral ketamine for urgent alleviation of TRD symptoms is less reported. We describe rapid alleviation of severe TRD with oral ketamine in a severely ill postoperative hospitalised patient, and review the current literature on ‘off-label’ use of ketamine for treatment of refractory depression.

Swiatek, K. M., Jordan, K., & Coffman, J. (2016). New use for an old drug: oral ketamine for treatment-resistant depression. BMJ Case Reports, 2016, bcr2016216088. 10.1136/bcr-2016-216088

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Investigation of Personality Change Following MDMA-Assisted Psychotherapy for Post Traumatic Stress Disorder

August 1, 2016 / Anxiety disorders / PTSD, MDMA, Papers, Personal development, Personality, Psychiatry, Psychology, Publications / By / , , , , , ,

Wagner, M., Mithoefer, M., Mithoefer, A., MacAulay, R., Jerome, L., Bazaar-Klosinski, B., & Doblin, R. (2016). B-56Investigation of Personality Change Following MDMA-Assisted Psychotherapy for Post Traumatic Stress Disorder. Archives of Clinical Neuropsychology, 31(6), 634-634. 10.1093/arclin/acw043.131
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Treating Addiction: Perspectives from EEG and Imaging Studies on Psychedelics

July 25, 2016 / Ayahuasca, Depression, LSD, Mushrooms / Psilocybin, Papers, Psychiatry, Psychology, Publications, Substance Use Disorder / By / ,

Abstract

Despite reports of apparent benefits, social and political pressure beginning in the late 1960s effectively banned scientific inquiry into psychedelic substances. Covert examination of psychedelics persisted through the 1990s; the turn of the century and especially the past 10 years, however, has seen a resurgent interest in psychedelic substances (eg, LSD, ayahuasca, psilocybin). This chapter outlines relevant EEG and brain imaging studies evaluating the effects of psychedelics on the brain. This chapter also reviews evidence of the use of psychedelics as adjunct therapy for a number of psychiatric and addictive disorders. In particular, psychedelics appear to have efficacy in treating depression and alcohol-use disorders.

Tófoli, L. F., & de Araujo, D. B. (2016). Treating Addiction: Perspectives from EEG and Imaging Studies on Psychedelics. International Review of Neurobiology. 10.1016/bs.irn.2016.06.005
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Long-term follow up of psilocybin-assisted smoking cessation

July 21, 2016 / Mushrooms / Psilocybin, Papers, Psychiatry, Psychology, Psychotherapy, Publications, Substance Use Disorder / By / , ,

Abstract

Background: A recent open-label pilot study (N = 15) found that two to three moderate to high doses (20 and 30 mg/70 kg) of the serotonin 2A receptor agonist, psilocybin, in combination with cognitive behavioral therapy (CBT) for smoking cessation, resulted in substantially higher 6-month smoking abstinence rates than are typically observed with other medications or CBT alone. Objectives: To assess long-term effects of a psilocybin-facilitated smoking cessation program at ≥12 months after psilocybin administration.
Methods: The present report describes biologically verified smoking abstinence outcomes of the previous pilot study at ≥12 months, and related data on subjective effects of psilocybin.
Results: All 15 participants completed a 12-month follow-up, and 12 (80%) returned for a long-term (≥16 months) follow-up, with a mean interval of 30 months (range = 16–57 months) between target-quit date (i.e., first psilocybin session) and long-term follow-up. At 12-month follow-up, 10 participants (67%) were confirmed as smoking abstinent. At long-term follow-up, nine participants (60%) were confirmed as smoking abstinent. At 12-month follow-up 13 participants (86.7%) rated their psilocybin experiences among the five most personally meaningful and spiritually significant experiences of their lives.
Conclusion: These results suggest that in the context of a structured treatment program, psilocybin holds considerable promise in promoting long-term smoking abstinence. The present study adds to recent and historical evidence suggesting high success rates when using classic psychedelics in the treatment of addiction. Further research investigating psilocybin-facilitated treatment of substance use disorders is warranted.

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MDMA as a Probe and Treatment for Social Behaviors

July 14, 2016 / MDMA, Papers, Psychiatry, Psychology, Psychotherapy, Publications / By / ,

Abstract

MDMA, better known as the recreational drug “ecstasy,” is well known for stimulating a feeling of closeness and empathy in its users. We advocate that exploring its mechanism of action could lead to new treatments for psychiatric conditions characterized by impairments in social behavior.

Heifets, B. D., & Malenka, R. C. (2016). MDMA as a Probe and Treatment for Social Behaviors. Cell, 166(2), 269-272. http://dx.doi.org/10.1016/j.cell.2016.06.045
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MDMA and PTSD treatment: “PTSD: From novel pathophysiology to innovative therapeutics”

July 6, 2016 / Anxiety disorders / PTSD, MDMA, Papers, Psychiatry, Psychology, Publications / By /

Abstract

There is a range of therapies to treat Post Traumatic Stress Disorder (PTSD) but treatment resistance remains high, with many sufferers experiencing the chronic condition. Engagement in trauma-focused psychotherapy is difficult for some patients with PTSD, especially those with extreme affect dysregulation associated with recall of traumatic memories. In recent years there have been a number of neuroscientific and clinical studies examining the potential role for adjunctive drug-assisted psychotherapy using 3,4,-methylenedioxmethamphetamine (MDMA) as a treatment for PTSD. re-visiting of a novel approach to trauma-focused psychotherapy with Used just two or three times, under careful medical supervision and specialised psychotherapy support MDMA appears to facilitate the recall of traumatic memories without the user feeling overwhelmed by the negative affect that usually accompanies such memories. This therapeutic approach began in the 1980s and was subsequently shelved in the midst of public health concerns surrounding the recreational use of the drug ecstasy. When pharmaceutical grade MDMA is used in a clinical setting it does not share the same risk profiles as ecstasy. Recent phase one neurophysiological studies and phase two clinical studies are showing promise as a potential new approach to managing treatment-resistant PTSD.

Sessa, B. (2016). MDMA and PTSD Treatment. Neuroscience Letters. http://dx.doi.org/10.1016/j.neulet.2016.07.004
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Efficacy and safety of ketamine in bipolar depression: A systematic review

July 4, 2016 / Depression, Ketamine, Papers, Psychiatry, Psychology, Publications / By / , , , , , ,

Abstract

The depression is the most prevalent state throughout the life of the bipolar patient. Ketamine has been shown to be an effective and rapid treatment for depression. The objective of the present work is to perform a systematic review on the efficacy and safety of ketamine as treatment of bipolar depression, as well as its different patterns of administration. The search found 10 relevant manuscripts that met the inclusion criteria: one clinical trial, 5 cohort studies, and 4 case reports. Intravenous infusion was used in 60% of the studies. According to data, ketamine seems to be an effective and safe treatment for bipolar depression, although the length of its effect is short. Adverse effects observed generally occurred at the time of infusion, and tended to completely disappear within 1-2h. Therefore, more studies are necessary to explore new patterns of administration, as well as on its safety and adverse effects.

Alberich, S., Martínez-Cengotitabengoa, M., López, P., Zorrilla, I., Núñez, N., Vieta, E., & González-Pinto, A. (2016). Efficacy and safety of ketamine in bipolar depression: A systematic review. Revista de psiquiatria y salud mental. 10.1016/j.rpsm.2016.05.005

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Clinical Applications of Hallucinogens: A Review

July 1, 2016 / Cacti / Mescaline, Iboga / Ibogaine, Ketamine, LSD, MDMA, Mushrooms / Psilocybin, Other substances, Papers, Psychiatry, Psychology, Psychotherapy, Publications, Salvia / Salvinorin A / By / , ,

Abstract

Hallucinogens fall into several different classes, as broadly defined by pharmacological mechanism of action, and chemical structure. These include psychedelics, entactogens, dissociatives, and other atypical hallucinogens. Although these classes do not share a common primary mechanism of action, they do exhibit important similarities in their ability to occasion temporary but profound alterations of consciousness, involving acute changes in somatic, perceptual, cognitive, and affective processes. Such effects likely contribute to their recreational use. However, a growing body of evidence indicates that these drugs may have therapeutic applications beyond their potential for abuse. This review will present data on several classes of hallucinogens with a particular focus on psychedelics, entactogens, and dissociatives, for which clinical utility has been most extensively documented. Information on each class is presented in turn, tracing relevant historical insights, highlighting similarities and differences between the classes from the molecular to the behavioral level, and presenting the most up-to-date information on clinically oriented research with these substances, with important ramifications for their potential therapeutic value.

Garcia-Romeu, A., Kersgaard, B., & Addy, P. H. (2016). Clinical applications of hallucinogens: A review. Experimental and clinical psychopharmacology, 24(4), 229. 10.1037/pha0000084
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A Model for the Application of Target-Controlled Intravenous Infusion for a Prolonged Immersive DMT Psychedelic Experience

June 30, 2016 / DMT, Neuroscience, Papers, Psychiatry, Psychology, Psychopharmacology, Psychotherapy, Publications / By / ,

Abstract

The state of consciousness induced by N,N-dimethyltryptamine (DMT) is one of the most extraordinary of any naturally-occurring psychedelic substance. Users consistently report the complete replacement of normal subjective experience with a novel “alternate universe,” often densely populated with a variety of strange objects and other highly complex visual content, including what appear to be sentient “beings.” The phenomenology of the DMT state is of great interest to psychology and calls for rigorous academic enquiry. The extremely short duration of DMT effects—less than 20 minutes—militates against single dose administration as the ideal model for such enquiry. Using pharmacokinetic modelling and DMT blood sampling data, we demonstrate that the unique pharmacological characteristics of DMT, which also include a rapid onset and lack of acute tolerance to its subjective effects, make it amenable to administration by target-controlled intravenous infusion. This is a technology developed to maintain a stable brain concentration of anaesthetic drugs during surgery. Simulations of our model demonstrate that this approach will allow research subjects to be induced into a stable and prolonged DMT experience, making it possible to carefully observe its psychological contents, and provide more extensive accounts for subsequent analyses. This model would also be valuable in performing functional neuroimaging, where subjects are required to remain under the influence of the drug for extended periods. Finally, target-controlled intravenous infusion of DMT may aid the development of unique psychotherapeutic applications of this psychedelic agent.

Gallimore, A. R. and Strassman, R. (2016). A Model for the Application of Target-Controlled Intravenous Infusion for a Prolonged Immersive DMT Psychedelic Experience. Frontiers in Pharmacology. http://dx.doi.org/10.3389/fphar.2016.00211
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Ketamine abuse potential and use disorder

June 27, 2016 / Ketamine, Neuroscience, Papers, Psychiatry, Psychopharmacology, Publications, Safety, Toxicology / By / , , ,

Abstract

Ketamine is a noncompetitive antagonist of N-methyl-d-asparate (NMDA) receptor and has been long used as an anesthetic agent in humans and veterinary medicine. The present article reviews the epidemiology, pharmacology, neurochemistry, and treatment of ketamine abuse. Ketamine has a unique mood controlling property and a number of studies have demonstrated a significant and rapid antidepressant effect of ketamine. However, the therapeutic value of ketamine to treat psychiatric disorders faces a major challenge that ketamine also owns significant reinforcing and toxic effects. Its abuse has posted severe harms on individuals and society. Disrupted learning and memory processing has long been related with ketamine use. It is hypothesized that ketamine blocks NMDA receptors on gamma-aminobutyric acid (GABA) neurons inside the thalamic reticular nucleus, which leads to disinhibition of dopaminergic neurons and increased release of dopamine. Currently, there is no specific treatment for treating every ketamine patient presenting peripheral toxicity. Interestingly, ketamine psychotherapy has been suggested to be a promising approach to treat addiction of other drugs. Future research can continue to develop creative ways to investigate potential mechanism and treatments related to ketamine abuse that have posted severe individual and social harms.

Liu, Y., Lin, D., Wu, B., & Zhou, W. (2016). Ketamine abuse potential and use disorder. Brain research bulletin. http://dx.doi.org/0.1016/j.brainresbull.2016.05.016
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