OPEN Foundation

Psychology

Ketamine: Future Treatment For Unresponsive Depression?

Abstract

Major Depressive Disorder (MDD) is a debilitating mental health condition which accounts for a significant portion of worldwide disability. Historically, the suggested pharmacotherapy to treat MDD have been monoaminergic-acting antidepressants, such as SSRIs or SNRIs. These drugs can provide relief, but often take weeks to noticeably improve depressive symptoms and are not always effective, leading to a condition known as Treatment-Resistant Depression (TRD). It is believed that 50% MDD sufferers in Ireland suffer from TRD, and thus the development of improved pharmacotherapies is necessary. One emerging therapy is low dose, intravenous (R-S)-Ketamine (ketamine). While the molecular basis of ketamine’s therapeutic effect has not been fully determined, it has shown to effectively and swiftly mitigate the symptoms of TRD. Barriers do exist preventing the legal prescription of ketamine, including its questionable safety profile and risk of inducing dependence. Despite this, ketamine remains a promising pharmacotherapy for TRD and further investigation is required.

Frere, M., & Tepper, J. (2016). Ketamine: Future Treatment For Unresponsive Depression?. Irish Medical Journal. 10147/620895
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The Resurrection Of Psychedelic Psychiatry And Its Role In Addiction Treatment

Abstract

Psychedelic psychiatry, a field which was previously popular between 1950-1970, has recently received a renewed interest as several recent studies have highlighted the potential role of hallucinogens in the treatment of addictions and various mental illnesses. This paper looks at evidence supporting the use of LSD, ibogaine and ayahuasca to treat various addictions and discusses the barriers to further exploration of the therapeutic potential of psychedelic substances.

Skocylas, R. (2016). The resurrection of psychedelic psychiatry and its role in addiction treatment. UBC Medical Journal, 8(1).
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Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences

Abstract

Acute and enduring adverse effects of psilocybin have been reported anecdotally, but have not been well characterized. For this study, 1993 individuals (mean age 30 yrs; 78% male) completed an online survey about their single most psychologically difficult or challenging experience (worst “bad trip”) after consuming psilocybin mushrooms. Thirty-nine percent rated it among the top five most challenging experiences of his/her lifetime. Eleven percent put self or others at risk of physical harm; factors increasing the likelihood of risk included estimated dose, duration and difficulty of the experience, and absence of physical comfort and social support. Of the respondents, 2.6% behaved in a physically aggressive or violent manner and 2.7% received medical help. Of those whose experience occurred >1 year before, 7.6% sought treatment for enduring psychological symptoms. Three cases appeared associated with onset of enduring psychotic symptoms and three cases with attempted suicide. Multiple regression analysis showed degree of difficulty was positively associated, and duration was negatively associated, with enduring increases in well-being. Difficulty of experience was positively associated with dose. Despite difficulties, 84% endorsed benefiting from the experience. The incidence of risky behavior or enduring psychological distress is extremely low when psilocybin is given in laboratory studies to screened, prepared, and supported participants.

Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology, 0269881116662634.
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The effects of MDMA on socio-emotional processing: Does MDMA differ from other stimulants?

Abstract

±3,4-Methylenedioxymethamphetamine (MDMA) is a popular recreational drug that enhances sociability and feelings of closeness with others. These “prosocial” effects appear to motivate the recreational use of MDMA and may also form the basis of its potential as an adjunct to psychotherapy. However, the extent to which MDMA differs from prototypic stimulant drugs, such as dextroamphetamine, methamphetamine, and methylphenidate, in either its behavioral effects or mechanisms of action, is not fully known. The purpose of this review is to evaluate human laboratory findings of the social effects of MDMA compared to other stimulants, ranging from simple subjective ratings of sociability to more complex elements of social processing and behavior. We also review the neurochemical mechanisms by which these drugs may impact sociability. Together, the findings reviewed here lay the groundwork for better understanding the socially enhancing effects of MDMA that distinguish it from other stimulant drugs, especially as these effects relate to the reinforcing and potentially therapeutic effects of the drug.

Bershad, A. K., Miller, M. A., Baggott, M. J., & de Wit, H. (2016). The effects of MDMA on socio-emotional processing: Does MDMA differ from other stimulants?. Journal of Psychopharmacology, 0269881116663120.
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Ketamine for Depression: An Update

Abstract

A decade has now passed since research into the antidepressant effects of ketamine began in earnest, after the clinical trial reported by Zarate et al. in 2006 (1). In that proof-of-concept study, 18 medication-free patients with treatment-resistant major depressive disorder (TRD) showed a large reduction in core depressive symptoms within hours of receiving a single low-dose 0.5 mg/kg intravenous infusion of ketamine as measured by the 21-item Hamilton Depression Rating Scale compared with saline placebo.

Murrough, J. W. (2016). Ketamine for Depression: An Update. Biological Psychiatry, 80(6), 416-418. http://dx.doi.org/10.1016/j.biopsych.2016.07.005
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Psilocybin: panacea or placebo?

Abstract

We write with reference to the study on psilocybin for treatment-resistant depression, reported by Robin L Carhart-Harris and colleagues in The Lancet Psychiatry. Although we are relieved that attention is once again being given to basic research into depression—after the hiatus created the effective abandonment of this area of research by Big Pharma from 2010 onwards—we are nonetheless deeply concerned that the mistakes that led to this withdrawal are in danger of being repeated. Carhart-Harris and colleagues’ study included 12 patients, and although the investigators reported that eight patients achieved complete remission at 1 week, only five of these patients were still in complete remission after 3 months of follow-up.

Hendrie, C., & Pickles, A. (2016). Psilocybin: panacea or placebo?. The Lancet Psychiatry, 3(9), 805-806. http://dx.doi.org/10.1016/S2215-0366(16)30103-1
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