Psychedelics in the treatment of unipolar and bipolar depression

Bosch, Oliver G.; Halm, Simon; Seifritz, Erich

doi:10.1186/s40345-022-00265-5

Cited by 10 publications

(6 citation statements)

References 151 publications

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“…However, studying psychedelics as monotherapy in the treatment of bipolar disorders is not encouraged currently because of their potential to trigger manic episodes. 124 Thyroid-hormone augmentation for TRBD is another area which needs further investigation. 125 …”

Section: Future Trends and Directionsmentioning

confidence: 99%

Treatment-Resistant Bipolar Depression: Therapeutic Trends, Challenges and Future Directions

Elsayed¹,

Ercis²,

Pahwa³

et al. 2022

NDT

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Introduction Bipolar disorder (BD) is a chronic mental illness impacting 1–2% of the population worldwide and causing high rates of functional impairment. Patients with BD spend most of their time in depressive episodes and up to one-third of patients do not respond to adequate doses of medications. Although no consensus exists for definition of treatment-resistant bipolar depression (TRBD), failure of symptoms improvement despite an adequate trial of two therapeutic agents is a common theme of TRBD. In this paper, we review the evidence base of therapeutic interventions, challenges, and potential future directions for TRBD. Methods We conducted a literature search for randomized controlled trials on PubMed for the treatment of TRBD and ongoing trials for the treatment of TRBD/bipolar depression on clinicaltrials.gov. Results Several therapeutic agents have been investigated for TRBD. Adjunctive pramipexole and modafinil have data supporting short-term efficacy in TRBD, along with limited data for racemic intravenous ketamine. Celecoxib augmentation of escitalopram and treatment with metformin in patients with insulin resistance showed promising results. Right unilateral electroconvulsive therapy displayed statistically significant response rate and improvement, but not remission compared to pharmacotherapy. Trials for transcranial magnetic stimulation (TMS) have failed to show a significant difference from sham treatment in TRBD. Future Trends Pharmacological treatments with novel mechanisms of actions like brexpiprazole and vortioxetine are being investigated following successes in unipolar depression. Modified TMS protocols such as accelerated TMS are under investigation. Innovative approaches like psychedelic-assisted psychotherapy, interleukin-2, fecal microbiota transplantation and multipotent stromal cells are being studied. Conclusion Evidence on current treatment modalities for TRBD is limited with low efficacy. More research is needed for successful treatment of TRBD. Effective therapies and innovative approaches to treatment are being investigated and could show promise.

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Section: Future Trends and Directionsmentioning

confidence: 99%

Treatment-Resistant Bipolar Depression: Therapeutic Trends, Challenges and Future Directions

Elsayed¹,

Ercis²,

Pahwa³

et al. 2022

NDT

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“…Dolezal et al suggested that shame-sensitive practice is essential for the trauma-informed approach (Dolezal, 2022;Dolezal and Gibson, 2022). Bosch et al reviewed psychedelics in the treatment of bipolar depression, commenting that the integration of these promising and fascinating substances into contemporary biomedicine seems feasible and even desirable (Bosch et al, 2022). Szmulewicz et al reported a case of mania after ayahuasca consumption in a man with bipolar disorder (Szmulewicz et al, 2015); Oliveira et al reported a similar case (Oliveira et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Ayahuasca in the treatment of bipolar disorder with psychotic features–A retrospective case study

Turkia¹

2023

Preprint

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Ayahuasca is a plant-based brew of indigenous Amazonian origin. It has psychedelic, anti-inflammatory, neuroprotective, cytotoxic, and anti-parasitic effects, which are primarily due to monoamine oxidase inhibitors (MAOIs) and N,N-dimethyltryptamine (DMT). This article describes the case of a woman in her late thirties with complex trauma due to severe, years-long sexual abuse in early childhood, resulting in a decades-long chronic condition involving suicidality. She was diagnosed with bipolar disorder and borderline personality disorder, but refused to accept either of them. She presented with delusional parasitosis and deep dissociation. Despite being severely psychotic in private, she appeared high-functioning in public, hiding most of her symptoms. In her mid-thirties, she participated in an ayahuasca ceremony in a legal setting. It resolved her suicidality, eliminated her social isolation, and reduced her shame related to her early trauma. Nine more ceremonies alleviated her distress further. Her abuser also participated in an ayahuasca ceremony and confirmed her memories of childhood abuse. The first interview was conducted 1.5 years after her first ceremony, and a follow-up interview 2.5 years later. She had experienced sixteen additional ceremonies, recognized the validity of her bipolar disorder diagnosis, and believed her early trauma to be its sole cause. Her core trauma remained partially unresolved, but her dissociative symptoms continued to decrease. She had observed several other instances of psychosis and bipolar disorder in which ayahuasca had resulted in positive effects. This case study contributes to a better understanding of the use of ayahuasca in bipolar disorder and severe traumatization. It also reviews the current state-of-the-art in the treatment of bipolar disorder using low-dose ayahuasca, and a case in which bipolar disorder was resolved with LSD.

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“…Psilocybin, the active ingredient in certain varieties of hallucinogenic mushrooms, which are commonly known as "magic mushrooms," has long been utilized as a psychedelic substance in religious and spiritual rituals and as a treatment for neuropsychiatric disorders in recent times [1][2][3]. The term "psychedelics" (serotonergic hallucinogens) refers to a class of "powerful psychoactive substances that alter perception and mood and affect numerous cognitive processes" [4,5].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Pharmacy Students' Attitudes About the Therapeutic Use of Psilocybin

Bhuiya,

Jacobs,

Wang

et al. 2023

Cureus

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BackgroundPsilocybin has been studied for its potential therapeutic benefits, particularly for the treatment of psychiatric disorders such as anxiety, depression, and obsessive-compulsive disorder. While more research is needed as psilocybin-assisted therapy becomes more prevalent, future pharmacists will probably be involved at some level. At present, pharmacists receive minimal training on psilocybin, and little is known about their attitudes toward its use for medical purposes. Findings from recent clinical studies have attempted to establish the safety and medical efficacy of psilocybin, leading to an increased interest in therapeutic psilocybin use in the United States. This study aimed to assess if self-assessed knowledge of psilocybin, concerns about adverse effects, and opinions about legalization will make statistically significant contributions to pharmacy students' attitudes about psilocybin use in practice. MethodsPharmacy students' self-assessed knowledge, concern for potential adverse effects, and perceptions of psilocybin were investigated using a cross-sectional survey study design. Data were collected from March 13 to April 7, 2023, from a convenience sample of 161 pharmacy students enrolled in an accredited pharmacy school in the southern region of the United States using a 41-item anonymous quantitative survey developed by the researchers that contained validated scales. The survey was delivered electronically. Multiple regression modeling was conducted to determine if self-assessed knowledge, concerns for adverse effects, and opinions about legalization would predict pharmacy students' attitudes about therapy-assisted psilocybin use. This study was approved by the Institutional Review Board of the authors' university. ResultsThe mean age of the 161 participants was 24 years (SD = 2.981; range 20-40 years). Twenty (12.4%) participants reported previous use of psilocybin for recreational purposes and two (1.2%) reported having used it therapeutically. Many (n =121; 75.2%) of the participants believed that psilocybin should be decriminalized for therapeutic use, but only 54 (33.5%) thought it should be decriminalized for recreational use. A multiple linear regression model predicting "attitudes about psilocybin" (dependent variable) produced significant results: (F(4, 122) = 40.575, p < 0.001), with an R2 = 0.571 (adjusted R2 = 0.557). Greater "self-assessed knowledge about psilocybin," less "concern about possible negative effects," greater "belief in the decriminalization of psilocybin for recreational use," and greater "belief in the decriminalization of psilocybin for therapeutic use" (all independent variables) were associated with more positive perceptions about medical psilocybin. The percentage of variance in the scores accounted for by the model was 57%. ConclusionsPharmacy students may lack information and training regarding psilocybin and report a desire to learn more about it. Their attitudes about medical psilocybin may be driven by this desire to learn in addition to concerns about ...

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Psychedelics in the treatment of unipolar and bipolar depression

Cited by 10 publications

References 151 publications

Treatment-Resistant Bipolar Depression: Therapeutic Trends, Challenges and Future Directions

Treatment-Resistant Bipolar Depression: Therapeutic Trends, Challenges and Future Directions

Ayahuasca in the treatment of bipolar disorder with psychotic features–A retrospective case study

Predictors of Pharmacy Students' Attitudes About the Therapeutic Use of Psilocybin

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