OPEN Foundation

Day: 1 October 2016

A Double-Blinded, Randomized, Placebo-Controlled Sub-Dissociative Dose Ketamine Pilot Study in the Treatment of Acute Depression and Suicidality in a Military Emergency Department Setting

October 1, 2016 / Depression, Ketamine, Papers, Psychiatry, Psychology, Publications / By / , , , , , ,

Abstract

Background: Rates of completed suicide in the military have increased. Options are limited for acute relief of depression and suicidal ideation. Traditional treatments’ effects take weeks to months. A novel, rapid, therapeutic target has emerged with the N-methyl-D-aspartate antagonist ketamine. Previous studies suggest that a single dose of intravenous (IV) ketamine rapidly alleviates depression and suicidality.

Methods: In this proof of concept study, an active duty convenience sample population presenting to the emergency department (ED) meeting criteria for inpatient psychiatric admission as a result of depression and suicidal thinking were randomized to receive either a subdissociative dose (0.2 mg/kg) of IV ketamine or equivalent volume of normal saline (placebo). Subjects were evaluated for symptoms throughout a 4-hour ED course, at hospital discharge, and 2 weeks postdischarge.

Results: Methodological problems limited analyzable data to 10 subjects. Two of three who received ketamine experienced dramatic decreases in suicidality and hopelessness within 40 minutes. No such improvements were seen in any of seven controls over the 4-hour observation in the ED. At discharge from the hospital, there was no clinically significant difference. No subjects described adverse symptoms.

Conclusion: Despite methodology difficulties noted in this pilot study, there was statistical improvement in intervention group versus controls.

Burger, J., Capobianco, M., Lovern, R., Boche, B., Ross, E., Darracq, M. A., & McLay, R. (2016). A Double-Blinded, Randomized, Placebo-Controlled Sub-Dissociative Dose Ketamine Pilot Study in the Treatment of Acute Depression and Suicidality in a Military Emergency Department Setting. Military Medicine, 181(10), 1195-1199. 10.7205/MILMED-D-15-00431
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Psychedelics in the treatment of unipolar mood disorders: A systematic review

October 1, 2016 / Depression, LSD, Mushrooms / Psilocybin, Other subjects, Papers, Psychiatry, Psychology, Psychotherapy, Publications / By / , , , ,

Abstract

Unipolar mood disorders, including major depressive disorder and persistent depressive disorder (dysthymia), confer high rates of disability and mortality and a very high socioeconomic burden. Current treatment is suboptimal in most cases and there is little of note in the pharmaceutical development pipeline. The psychedelic drugs, including lysergic acid diethylamide and psilocybin, were used extensively in the treatment of mood disorders, and other psychiatric conditions, before their prohibition in the late 1960s. They are relatively safe when used in medically controlled environments, with no reported risk of dependence. Here, we present a systematic review of published clinical treatment studies using psychedelics in patients with broadly defined unipolar mood disorder, and consider their place in psychiatry. Whilst all the included studies have methodological shortcomings, of 423 individuals in 19 studies, 335 (79.2%) showed clinician-judged improvement after treatment with psychedelics. A recently completed pilot study in the UK favours the use of psilocybin with psychological support in treatment resistant depressive disorder. The evidence overall strongly suggests that psychedelics should be re-examined in modern clinical trials for their use in unipolar mood disorders and other non-psychotic mental health conditions.

Rucker, J. J., Jelen, L. A., Flynn, S., Frowde, K. D., & Young, A. H. Psychedelics in the Treatment of Unipolar Mood Disorders: A Systematic Review.
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Lysergic Acid Diethylamide and mystical experiences

October 1, 2016 / History, LSD, Mystical experiences, Other substances, Papers, Publications / By /

Abstract

The term psychedelic (“mind-manifesting”) was coined by British psychiatrist Humphry Osmond in 1956 to refer to a unique class of mind-altering chemicals with distinctive effects that set them apart from other drugs with hallucinogenic properties. Some psychedelics come from natural sources that have been traditionally featured in religious, ritual, and healing practices of indigenous cultures of the Americas (Anderson, 1980; Hofmann, 1983; Salak, 2007; Smith, 2000); such drugs include mescaline (from peyote and San Pedro cacti), psilocybin and psilocin (from Psilocybe mushrooms), and dimethyltryptamine or DMT (from the leaves of Psychotria viridis). Many other psychedelics have partly or wholly synthetic origins. The most potent psychedelic agent yet discovered is the semisynthetic ergot derivative lysergic acid diethylamide (LSD), which has distinctive effects at the microscopic dose of 25 μg; a typical psychedelic dose ranges from 50 to 200 μg. There are also a number of purely synthetic psychedelics, many of which are chemically related to both amphetamine and mescaline (Shulgin & Shulgin, 1991). One of the most potent of these is dimethoxymethylamphetamine, or DOM, which was known as “STP” when introduced to the hippie subculture of San Francisco in the late 1960s. More familiar today is methylenedioxymethamphetamine (MDMA, ecstasy), which has only mild or partial psychedelic effects as opposed to full psychedelics such as LSD, psilocybin, and mescaline; MDMA is thus sometimes described as an “entactogen,” meaning “touch within” (Bravo, 2001; Smith, 2000), as opposed to full psychedelics or “entheogens,” meaning “God within.” A newer, extremely potent synthetic psychedelic, 2-(4-iodo-2,5-dimethoxyphenyl)-N-[fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][(2-methoxyphenyl)methyl] ethanamine (2CI-NBOMe, or “N-Bomb”), was invented in 2003 and is useful as a laboratory tool to map brain serotonin receptors (Ettrup et al., 2010). The threshold dose is several hundred micrograms, making this psychedelic second in potency only to LSD. Media reports indicate that 2CI-NBOMe has been sold to drug users on pieces of blotter paper, like LSD, and often misrepresented as the latter drug. Unfortunately 2CI-NBOMe has a much lower therapeutic index than LSD, hence several highly publicized deaths appear to have been caused by this drug (e.g., Hastings, 2013; Poklis et al., 2014) and, in some cases, possibly misattributed to LSD. Some of the deaths resulted from drug-induced seizures, whereas in other cases the individuals killed themselves accidentally or purposefully in a drug-induced psychotic or delirious state. By contrast, fatal reactions are extremely uncommon with the “classic” psychedelics LSD, psilocybin, and mescaline.

Lyvers, M. (2016). Lysergic Acid Diethylamide and mystical experiences. 10.1016/B978-0-12-800212-4.00078-9
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The Relationship between depression and use of ecstasy among adolescents in Taiwan

October 1, 2016 / Depression, MDMA, Papers, Psychology, Publications / By / , , ,

Abstract

Introduction: The aim of this cross-sectional study was to examine the relationship between depression and ecstasy use among adolescents in Taiwan by controlling for the effects of demographic characteristics and cannabis use.

Methods: A total of 10,262 adolescents aged 12-18 years completed research questionnaires that assessed their severity of depression, status of ecstasy use, and history of cannabis use. The participants were grouped into non-users, ex-users, and current users. Severity of depression among these three adolescent groups was compared using analysis of covariance (ANCOVA), considering the history of cannabis use and demographic characteristics as covariates.
Results: After controlling for history of cannabis use and age, the study found that current ecstasy users experienced more severe depressive symptoms than ex-users and non-users. The difference between ex-users and non-users was not significant.
Conclusion: This study found that current ecstasy users had more severe depressive symptoms than non-users and ex-users. Psychological health professionals must monitor depressive symptoms among adolescent ecstasy users and provide emotional regulation strategies and psychological intervention for those with significant depression.
Lee, K. H., Su, C. H., Hsiao, R. C., Yen, C. N., & Yen, C. F. (2016). The Relationship between depression and use of ecstasy among adolescents in Taiwan. Neuropsychiatry (London), 6(4), 124-127. 10.4172/Neuropsychiatry.1000130
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The Entheogen Reformation

October 1, 2016 / Ayahuasca, Cacti / Mescaline, Consciousness, History, LSD, Mushrooms / Psilocybin, Mystical experiences, Papers, Personal development, Psychiatry, Psychology, Publications, Religious studies, Spirituality / By /

Abstract

In addition to promising leads for treating PTSD, addictions, depression, and death anxiety, 21st Century research at medical schools finds that with careful screening, insightful attention to the variables of set, setting, and dosage, psychedelic drug administration often facilitates significant spiritual experiences, meaningfulness, altruism, well-being, and similar prospiritual effects. This article calls for theologians, professors of religious studies, philosophy, sociology, and psychology to update their courses. It challenges leaders of religious organizations, ‘‘How can your institution incorporate these practices and benefit from them?’’

Roberts, T. B. (2016). THE ENTHEOGEN REFORMATION. Association for Transpersonal Psychology, 26.

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30 April - Q&A with Rick Strassman

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