Talking to Your Patients About Psychedelics: Using an Informed Approach and Understanding Indications, Risks, and Benefits

References (73)

1. Walsh CA, Gorfinkel L, Shmulewitz D, et al. Use of lysergic acid diethylamide by major depression status. JAMA Psychiatry. 2024;81(1):89–96. PubMed
2. Preller KH, Vollenweider FX. Phenomenology, structure, and dynamic of psychedelic states. Curr Top Behav Neurosci. 2018;36:221–256. PubMed CrossRef
3. Vollenweider FX, Liechti ME, Gamma A, et al. Acute psychological and neurophysiological effects of MDMA in humans. J Psychoactive Drugs. 2002;34(2):171–184. PubMed CrossRef
4. Nichols DE. Psychedelics. Pharmacol Rev. 2016;68(2):264–355. PubMed
5. Ly C, Greb AC, Cameron LP, et al. Psychedelics promote structural and functional neural plasticity. Cell Rep. 2018;23(11):3170–3182. PubMed CrossRef
6. Carhart-Harris RL, Leech R, Erritzoe D, et al. Functional connectivity measures after psilocybin inform a novel hypothesis of early psychosis. Schizophr Bull. 2013;39(6):1343–1351. PubMed CrossRef
7. Carhart-Harris RL, Friston KJ. Rebus and the anarchic brain: toward a unified model of the brain action of psychedelics. Pharmacol Rev. 2019;71(3):316–344. PubMed CrossRef
8. Goodwin GM, Malievskaia E, Fonzo GA, et al. Must psilocybin always “assist psychotherapy”? Am J Psychiatry. 2024;181:20–25. PubMed
9. Schenberg EE, King F IV, da Fonseca JE, et al. Is poorly assisted psilocybin treatment an increasing risk? Am J Psychiatry. 2024;181(1):75–76.
10. Carhart-Harris RL, Roseman L, Haijen E, et al. Psychedelics and the essential importance of context. J Psychopharmacol. 2018;32(7):725–731. PubMed CrossRef
11. Noorani T. Containment matters: set and setting in contemporary psychedelic psychiatry. Philosophy, Psychiatry Psychol. 2021;28(3):201–216.
12. Oehen P, Gasser P. Using a MDMA- and LSD-group therapy model in clinical practice in Switzerland and highlighting the treatment of trauma-related disorders. Front Psychiatry. 2022;13:863552. PubMed CrossRef
13. Therapeutic Goods Administration. Canberra A, ed. Notice of final decisions to amend (or not amend) the current poisons standard in relation to psilocybine and MDMA. Department of Health, Commonwealth of Australia; 2023.
14. Aday JS, Barnett BS, Grossman D, et al. Psychedelic commercialization: a wide spanning overview of the emerging psychedelic industry. Psychedelic Med. 2023;1(3):150–165.
15. Hall W. Why was early therapeutic research on psychedelic drugs abandoned? Psychol Med. 2022;52(1):26–31. PubMed
16. Young J. Moral panic: its origins in resistance, ressentiment and the translation of fantasy into reality. Br J Criminol. 2009;49(1):4–16.
17. Barnett BS, Arakelian M, Beebe D, et al. American psychiatrists’ opinions about classic hallucinogens and their potential therapeutic applications: a 7-year follow up survey. Psychedelic Med. 2024;2(1):1–9.
18. Goodwin GM, Aaronson ST, Alvarez O, et al. Single-dose psilocybin for a treatment-resistant episode of major depression. N Engl J Med. 2022;387(18):1637–1648. PubMed CrossRef
19. Raison CL, Sanacora G, Woolley J, et al. Single-dose psilocybin treatment for major depressive disorder: a randomized clinical trial. JAMA. 2023;330(9):843–853. PubMed CrossRef
20. Bogenschutz MP, Ross S, Bhatt S, et al. Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry. 2022;79(10):953–962. PubMed CrossRef
21. Holze F, Gasser P, Müller F, et al. Lysergic acid diethylamide-assisted therapy in patients with anxiety with and without a life-threatening illness: a randomized, double-blind, placebo-controlled phase II study. Biol Psychiatry. 2023;93(3):215–223. PubMed CrossRef
22. Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021;27(6):1025–1033. PubMed CrossRef
23. Mitchell JM, Marcela Ot’alora M, van der Kolk B, et al. MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nat Med. 2023;29(10):2473–2480. PubMed CrossRef
24. Danforth AL, Struble CM, Yazar-Klosinski B, et al. MDMA-assisted therapy: a new treatment model for social anxiety in autistic adults. Prog Neuropsychopharmacol Biol Psychiatry. 2016;64:237–249. PubMed CrossRef
25. Sessa B, Higbed L, O’Brien S, et al. First study of safety and tolerability of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in patients with alcohol use disorder. J Psychopharmacol. 2021;35(4):375–383. PubMed CrossRef
26. Monson CM, Wagner AC, Mithoefer AT, et al. MDMA-facilitated cognitive behavioural conjoint therapy for posttraumatic stress disorder: an uncontrolled trial. Eur J Psychotraumatol. 2020;11(1):1840123. PubMed CrossRef
27. Moreno FA, Wiegand CB, Taitano EK, et al. Safety, tolerability, and efficacy of psilocybin in 9 patients with obsessive-compulsive disorder. J Clin Psychiatry. 2006;67(11):1735–1740. PubMed CrossRef
28. ClinicalTrials.gov. Psilocybin-facilitated treatment for chronic pain. Accessed May 24, 2024. https://www.clinicaltrials.gov/study/NCT05068791?term=psilocybin%20functional%20neurologic&rank=8
29. ClinicalTrials.gov. Assessment of psilocybin (TRP-8802) in concert with psychotherapy in patients with irritable bowel syndrome (IBS). Accessed May 24, 2024. https://www.clinicaltrials.gov/study/NCT06206265?term=NCT06206265&rank=1
30. Floriano I, Silvinato A, Bernardo WM. The use of esketamine in the treatment of patients with severe depression and suicidal ideation: systematic review and meta-analysis. Rev Assoc Med Bras (1992). 2023;69(4):e2023D694. PubMed CrossRef
31. Marcantoni WS, Akoumba BS, Wassef M, et al. A systematic review and meta analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 - January 2019. J Affect Disord. 2020;277:831–841. PubMed CrossRef
32. Witt K, Potts J, Hubers A, et al. Ketamine for suicidal ideation in adults with psychiatric disorders: a systematic review and meta-analysis of treatment trials. Aust N Z J Psychiatry. 2020;54(1):29–45. PubMed CrossRef
33. Holze F, Ley L, Müller F, et al. Direct comparison of the acute effects of lysergic acid diethylamide and psilocybin in a double-blind placebo-controlled study in healthy subjects. Neuropsychopharmacology. 2022;47(6):1180–1187. PubMed CrossRef
34. Holze F, Vizeli P, Muller F, et al. Distinct acute effects of LSD, MDMA, and d amphetamine in healthy subjects. Neuropsychopharmacology. 2020;45(3):462–471. PubMed CrossRef
35. Suleiman Z, Ik K, Bo B. Evaluation of the cardiovascular stimulation effects after induction of anaesthesia with ketamine. J West Afr Coll Surg. 2012;2(1):38–52. PubMed
36. Riva-Posse P, Reiff CM, Edwards JA, et al. Blood pressure safety of subanesthetic ketamine for depression: a report on 684 infusions. J Affect Disord. 2018;236:291–297. PubMed CrossRef
37. Chang M, Juruena MF, Young AH. Ketamine cystitis following ketamine therapy for treatment-resistant depression - case report. BMC Psychiatry. 2024;24(1):9. PubMed
38. Mueller PD, Korey WS. Death by “ecstasy”: the serotonin syndrome? Ann Emerg Med. 1998;32(3):377–380. PubMed
39. Budisavljevic MN, Stewart L, Sahn SA, et al. Hyponatremia associated with 3,4- methylenedioxymethylamphetamine (“ecstasy”) abuse. Am J Med Sci. 2003;326(2):89–93. PubMed
40. Simonsson O, Goldberg SB, Chambers R, et al. Prevalence and associations of classic psychedelic-related seizures in a population-based sample. Drug Alcohol Depend. 2022;239:109586. PubMed CrossRef
41. Koenig X, Hilber K. The anti-addiction drug ibogaine and the heart: a delicate relation. Molecules. 2015;20(2):2208–2228. PubMed CrossRef
42. Alper KR, Stajić M, Gill JR. Fatalities temporally associated with the ingestion of ibogaine. J Forensic Sci. 2012;57(2):398–412. PubMed CrossRef
43. Cherian KN, Keynan JN, Anker L, et al. Magnesium-ibogaine therapy in veterans with traumatic brain injuries. Nat Med. 2024;30(2):373–381. PubMed CrossRef
44. Ling S, Ceban F, Lui LMW, et al. Molecular mechanisms of psilocybin and implications for the treatment of depression. CNS Drugs. 2022;36(1):17–30. PubMed
45. Cao C, Barros-Álvarez X, Zhang S, et al. Signaling snapshots of a serotonin receptor activated by the prototypical psychedelic LSD. Neuron. 2022;110(19):3154–3167.e7. PubMed CrossRef
46. Luethi D, Kolaczynska KE, Walter M, et al. Metabolites of the ring-substituted stimulants MDMA, methylone and MDPV differentially affect human monoaminergic systems. J Psychopharmacol. 2019;33(7):831–841. PubMed CrossRef
47. Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med. 1997;337(9):581–588. PubMed CrossRef
48. Libânio Osório Marta RF. Metabolism of lysergic acid diethylamide (LSD): an update. Drug Metab Rev. 2019;51(3):378–387. PubMed
49. Dinis-Oliveira RJ. Metabolism of psilocybin and psilocin: clinical and forensic toxicological relevance. Drug Metab Rev. 2017;49(1):84–91. PubMed CrossRef
50. Dishotsky NI, Loughman WD, Mogar RE, et al. LSD and genetic damage. Science. 1971;172(3982):431–440. PubMed CrossRef
51. Barnett BS, Ziegler K, Doblin R, et al. Is psychedelic use associated with cancer?: interrogating a half-century-old claim using contemporary population-level data. J Psychopharmacol. 2022;36(10):1118–1128. PubMed CrossRef
52. Ricaurte GA, Yuan J, Hatzidimitriou G, et al. Retracted: severe dopaminergic neurotoxicity in primates after a common recreational dose regimen of MDMA (“ecstasy”). Science. 2002;297(5590):2260–2263. PubMed CrossRef
53. Barnett BS, Doblin R. Dissemination of erroneous research findings and subsequent retraction in high-circulation newspapers: a case study of alleged MDMA-induced dopaminergic neurotoxicity in primates. J Psychoactive Drugs. 2021;53(2):104–110. PubMed CrossRef
54. Carbonaro TM, Bradstreet MP, Barrett FS, et al. Survey study of challenging experiences after ingesting psilocybin mushrooms: acute and enduring positive and negative consequences. J Psychopharmacol. 2016;30(12):1268–1278. PubMed CrossRef
55. Gorman I, Nielson EM, Molinar A, et al. Psychedelic harm reduction and integration: a transtheoretical model for clinical practice. Front Psychol. 2021;12:645246. PubMed CrossRef
56. Kramer EN, Reddy K, Shapiro B. A suicide attempt following psilocybin ingestion in a patient with no prior psychiatric history. Psychiatry Res Case Rep. 2023;2(1):100118.
57. Frosch WA, Robbins ES, Stern M. Untoward reactions to lysergic aciddiethylamide (LSD) resulting in hospitalization. N Engl J Med. 1965;273(23):1235–1239. PubMed CrossRef
58. Nutt DJ, King LA, Phillips LD, et al. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010;376(9752):1558–1565. PubMed CrossRef
59. Schifano F. Potential human neurotoxicity of MDMA (“ecstasy”): subjective self reports, evidence from an Italian drug addiction centre and clinical case studies. Neuropsychobiology. 2000;42(1):25–33. PubMed CrossRef
60. Liu Y, Lin D, Wu B, et al. Ketamine abuse potential and use disorder. Brain Res Bull. 2016;126(Pt 1):68–73. PubMed CrossRef
61. Simonsson O, Mosing MA, Osika W, et al. Adolescent psychedelic use and psychotic or manic symptoms. JAMA Psychiatry. 2024;81:579–585. PubMed CrossRef
62. Honk L, Stenfors CUD, Goldberg SB, et al. Longitudinal associations between psychedelic use and psychotic symptoms in the United States and the United Kingdom. J Affect Disord. 2024;351:194–201. PubMed
63. Aaronson ST, van der Vaart A, Miller T, et al. Single-dose synthetic psilocybin with psychotherapy for treatment-resistant bipolar type ii major depressive episodes: a nonrandomized open-label trial. JAMA Psychiatry. 2024;81(6):555–562. PubMed
64. Gukasyan N, Griffiths RR, Yaden DB, et al. Attenuation of psilocybin mushroom effects during and after SSRI/SNRI antidepressant use. J Psychopharmacol. 2023;37(7):707–716. PubMed CrossRef
65. Becker AM, Holze F, Grandinetti T, et al. Acute effects of psilocybin after escitalopram or placebo pretreatment in a randomized, double-blind, placebo controlled, crossover study in healthy subjects. Clin Pharmacol Ther. 2022;111(4):886–895. PubMed CrossRef
66. Goodwin GM, Croal M, Feifel D, et al. Psilocybin for treatment resistant depression in patients taking a concomitant SSRI medication. Neuropsychopharmacology. 2023;48(10):1492–1499. PubMed CrossRef
67. Liechti ME, Vollenweider FX. The serotonin uptake inhibitor citalopram reduces acute cardiovascular and vegetative effects of 3,4- methylenedioxymethamphetamine (“ecstasy”) in healthy volunteers. J Psychopharmacol. 2000;14(3):269–274. PubMed CrossRef
68. Pilgrim JL, Gerostamoulos D, Woodford N, et al. Serotonin toxicity involving MDMA (ecstasy) and moclobemide. Forensic Sci Int. 2012;215(1–3):184–188. PubMed CrossRef
69. Nayak SM, Gukasyan N, Barrett FS, et al. Classic psychedelic coadministration with lithium, but not lamotrigine, is associated with seizures: an analysis of online psychedelic experience reports. Pharmacopsychiatry. 2021;54(5):240–245. PubMed CrossRef
70. Vollenweider FX, Vollenweider-Scherpenhuyzen MF, Bäbler A, et al. Psilocybin induces schizophrenia-like psychosis in humans via a serotonin-2 agonist action. Neuroreport. 1998;9(17):3897–3902. PubMed CrossRef
71. APA. Resource document on ethical and practical implications of psychedelics in psychiatry. American Psychiatric Association. Accessed May 24, 2024. https://www.psychiatry.org/getattachment/998071b6-138e-40d1-a482-e7b8e85d4f90/Resource-Document-Psychedelics-in-Psychiatry.pdf
72. MAPS. Maps psychedelic integration station. Accessed July 29, 2024. https://maps.org/integration-station/
73. JHMI. Psychedelic risks, side effects, and potential harms. Accessed May 24, 2024. https://www.youtube.com/watch?v=xUS2I8PNOH0