Review of otential sychedelic reatments for PTSD

Henner, Ryan L.; Keshavan, Matcheri S.; Hill, Kevin P.

doi:10.1016/j.jns.2022.120302

Cited by 25 publications

(21 citation statements)

References 118 publications

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“…Psychedelic therapy could also yield important treatment gains in cases of PTSD (Henner et al 2022;Figueiredo et al 2021;Rubin-Kahana et al, 2021;Davis et al 2020;Doblin, 2002) and eating conditions Teixeira et al, 2021;Renelli et al 2020), Obsessive Compulsive Disorder (OCD) (Ehrmann et al 2021) as well as other common mental health conditions (Nutt and Carhart-Harris, 2021;Simonsson, Sexton and Hendricks, 2021;Krebs and Johansen, 2013).…”

Section: Introductionmentioning

confidence: 99%

Pattern Breaking: A Complex Systems Approach to Psychedelic Medicine

Hipólito¹,

Mago²,

Rosas³

et al. 2022

Preprint

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There is growing evidence for the safety and efficacy of psychedelic therapy in mental health care. What is less understood however, is how psychedelics act to yield therapeutic results. In this paper we propose that psychedelics act as destabilisers — both in a psychological and a neurophysiological sense. Our proposed framework builds on the ‘entropic brain’ hypothesis, according to which psychedelics increase the entropy of spontaneous cortical activity and, in parallel, the richness or depth of content of psychological experience. The so-called ‘RElaxed Beliefs Under pSychedelics’ (REBUS) model is a predictive-coding inspired extension to this hypothesis, which states that psychedelics’ entropic action is paralleled by a relaxation of prior assumptions. Here we adopt a complex systems theory (CST) perspective, proposing that psychedelics act as destabilisers of excessively reinforced fixed points — or ‘attractors’ — which translates as the breaking of excessively reinforced or overweighted patterns of thinking or behaving. Our CST approach explains how psychedelic-induced increases in brain entropy destabilise neurophysiological set-points that are synonymous with overweighted priors, thereby augmenting and enriching the account given by REBUS. We believe that this perspective helps inspire conceptualisations of psychedelic psychotherapy — bearing relevance both to the peak psychedelic experience and subsequent sub-acute period of potential recovery. We discuss implications for risk mitigation and treatment optimization in psychedelic medicine.

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Section: Introductionmentioning

confidence: 99%

Pattern Breaking: A Complex Systems Approach to Psychedelic Medicine

Hipólito¹,

Mago²,

Rosas³

et al. 2022

Preprint

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“…The use of psychedelics to enhance the clinical benefits of psychotherapy is not a new idea, with experiments in the 1950–1970's trialing “classic” psychedelics like LSD in the treatment of several psychiatric illnesses ( 14 , 53 ). The scheduling of LSD, MDMA, and other psychedelics has made research more difficult, but these molecules have recently become of increased interest due to the need for more effective treatments for psychiatric illnesses like PTSD ( 54 , 55 ). A simple search of PubMed using the term “psychedelics” returned 1,510 possible matches published in the past 12 months alone.…”

Section: Ptsd Treatmentmentioning

confidence: 99%

A proposed mechanism for the MDMA-mediated extinction of traumatic memories in PTSD patients treated with MDMA-assisted therapy

Sottile

Vida

2022

Front. Psychiatry

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Post-traumatic stress disorder (PTSD) is a devastating psychiatric disorder afflicting millions of people around the world. Characterized by severe anxiety, intrusive thoughts, pervasive nightmares, an assortment of somatic symptoms, associations with severe long-term health problems, and an elevated risk of suicide, as much as 40–70% of patients suffer from refractory disease. 3,4-Methylenedioxy-methamphetamine (MDMA), like classic psychedelics such as psilocybin, have been used to enhance the efficacy of psychotherapy almost since their discovery, but due to their perceived potential for abuse and inclusion on USFDA (United States Food and Drug Administration) schedule 1, research into the mechanism by which they produce improvements in PTSD symptomology has been limited. Nevertheless, several compelling rationales have been explored, with the pro-social effects of MDMA thought to enhance therapeutic alliance and thus facilitate therapist-assisted trauma processing. This may be insufficient to fully explain the efficacy of MDMA in the treatment of psychiatric illness. Molecular mechanisms such as the MDMA mediated increase of brain-derived neurotrophic factor (BDNF) availability in the fear memory learning pathways combined with MDMA's pro-social effects may provide a more nuanced explanation for the therapeutic actions of MDMA.

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“…The table below shows possible outcomes from patients with alcohol use disorder and conducting a treatment protocol comprising 14 psychotherapy sessions, wherein 3 of the 14 psychotherapy sessions are MDMA-assisted psychotherapy sessions. Each MDMA-assisted psychotherapy sessions includes an initial dose (100–150 mg) and an optional booster dose of about half the initial dose. …”

Section: Important Compound Classesmentioning

confidence: 99%