Psychedelics appear promising for treating psychiatric disorders, but more research needed
The current body of research regarding psychedelics has produced insufficient evidence to recommend FDA approval of any psychedelic compound for routine clinical use in psychiatric disorders, according to study findings published in American Journal of Psychiatry. However, researchers noted the need to further study the efficacy of psychedelics for treating psychiatric disorders.
“Randomized clinical trials support the efficacy of MDMA [3,4-methylenedioxymethamphetamine] in the treatment of PTSD and psilocybin in the treatment of depression and cancer-related anxiety, and there is emerging preliminary evidence on the efficacy of LSD and ayahuasca in depression and other psychiatric disorders,” Collin M. Reiff, MD, clinical assistant professor in the department of psychiatry at New York University Grossman School of Medicine, told Healio Psychiatry. “These compounds have novel mechanisms of action that are very different from antidepressants, such as selective serotonin reuptake inhibitors, and can produce a wide range of cognitive, perceptual and emotional effects, including empathy. Understanding these effects and the relationship to their primary mechanism of action provides opportunities to understand complex ideas, such as creativity and social relatedness.”
Over the past decade, the number of published review articles and clinical trials showing the potential therapeutic benefits of psychedelic compounds has steadily increased. However, the U.S. Drug Enforcement Agency currently classifies psilocybin, ayahuasca, LSD and MDMA as Schedule 1 substances.
Reiff and colleagues sought to summarize the available evidence in the scientific literature regarding the safety and efficacy of psychedelic compounds for treating psychiatric disorders.
To do so, they searched databases for articles related to the substances’ administration among human subjects and included those published between 2007 and July 1, 2019. They identified and screened 1,603 articles and excluded those missing the terms “clinical trial,” “therapy” or “imaging” in the title or abstract, which left them with 161 remaining articles. From these, the researchers identified 14 articles that reported on well-designed clinical trials investigating the efficacy of LSD, MDMA, psilocybin and ayahuasca for the treatment of anxiety and mood disorders, substance-related and addictive disorders, and trauma and stress-related disorders, as well as in end-of-life care.
Results showed that the most significant database exists for psilocybin and MDMA, which the FDA has designated as breakthrough therapies for treatment-resistant depression and PTSD, respectively. Although research on ayahuasca and LSD is observational, the researchers noted that available evidence suggests their potential therapeutic effects in specific psychiatric disorders, including suicidal ideation and substance use disorders, respectively.
“The idea that one or two psilocybin-assisted psychotherapy sessions can lead to remission for months afterward presents a novel paradigm for treating depression,” Reiff told Healio Psychiatry. “The efficacy of MDMA for PTSD is also remarkable and may offer hope for patients who are resistant to the current standards of care, trauma-focused therapies and SSRI medication.” – by Joe Gramigna
Disclosures: Reiff reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.