Tuesday, 11 August 2009
New Uses for Psychedelic Drugs
New Uses for Psychedelic Drugs
Psychedelic drugs have elicited new interest for potential therapeutic benefits, Walter A. Brown, MD, said in another presentation at the Congress.
Ketamine has psychedelic properties such as dissociation and perceptual alteration, but is also used legitimately as an anesthetic and analgesic. Work going back to 2000 suggests that it also is "a uniquely rapid acting and effective antidepressant," said Dr. Brown, Clinical Professor of Psychiatry at Brown University School of Medicine. In a small, double-blinded placebo-controlled study published that year, Berman and colleagues found that intravenous ketamine infusion significantly improved scores on the Hamilton Depression Rating Scale in 4 of 8 patients with major depressive disorder. The effects lasted several days, much longer than any "psychedelic" or dissociative side effects, Dr. Brown said. He cited another study, presented by Sanjay Mathew, MD, and colleagues at the 2008 meeting of the New Clinical Drug Evaluation Unit of the National Institute of Mental Health, held last May, in which 20 treatment-resistant patients who were on either lamotrigine or a placebo were followed after receiving a 40-minute infusion of ketamine. The dissociative symptoms lasted about 90 minutes, but 24 hours after the infusion, the patients' scores on the Montgomery-Asberg Depression Rating Scale (MADRS) had improved. Patients in both the lamotrigine and the placebo groups showed striking benefits in individual MADRS components, including concentration, sadness, suicidal and pessimistic thoughts, and sleep and appetite difficulties. Patients required infusions 3 times a week to maintain this effect, but they became tolerant of the dissociative symptoms over time.
Another agent, psilocybin, is a tryptamine alkaloid found in the "psychedelic" mushrooms. In a few small studies, psilocybin has emerged as a potential treatment for obsessive-compulsive disorder (in a modified, double-blind study in which patients received varying doses) and cluster headaches (based on clinical interviews with headache sufferers describing the effects of their psilocybin use). And in a study that truly evokes the spirit of the 1960s, psilocybin also was shown to enhance and prolong spiritual experiences and deepen their meaning for people open to such events. Dr. Brown reported that a study is now under way under the direction of Charles Grob, MD, at Harbor-UCLA Medical Center to examine the drug's ability to relieve the pain and anguish of terminal cancer.
Lieberman JA, Stroup TS, McEvoy JP, et al, for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209-1223. Abstract
Stroup TS, McEvoy JP, Swartz MS, et al. The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development. Schizophr Bull. 2003;29:15-31. Abstract
Tarsy D. Neuroleptic-induced extrapyramidal reactions: classification, description, and diagnosis. Clin Neuropharmacol. 1983;6 :S9-S26. Abstract
Kane JM. In: Bloom FE (Kupfer DJ, ed.). Psychopharmacology: The Fourth Generation of Progress. Philadelphia, Pa: Lippincott Williams & Wilkins; 1995:1485-1495.
Woerner MG, Kane JM, Lieberman JA, et al. The prevalence of tardive dyskinesia. J Clin Psychopharmacol. 1991 ;11:34-42. Abstract
Schooler NR, Kane JM. Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry. 1982 ;39:486-487.
Miller DD, McEvoy JP, Davis SM, et al. Clinical correlates of tardive dyskinesia in schizophrenia: baseline data from the CATIE schizophrenia trial. Schizophr Res. 2005 ;80:33-43. Abstract
Kinon BJ, Jeste DV, Kollack-Walker S, et al. Olanzapine treatment for tardive dyskinesia in schizophrenia patients: a prospective clinical trial with patients randomized to blinded dose reduction periods. Prog Neuropsychopharmacol Biol Psychiatry. 2004 ;28:985-996. Abstract
Beasley CM, Dellva MA, Tamura RN, et al. Randomised double-blind comparison of the incidence of tardive dyskinesia in patients with schizophrenia during long-term treatment with olanzapine or haloperidol. Br J Psychiatry. 1999 ;174:23-30. Abstract
Berman RM, Cappiello A, Anand A, et al. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000 ;47:351-354. Abstract
Mathew S, 48th Annual NCDEU Meeting, May 2008.
Moreno FA, Wiegand CB, Taitano EK, Delgado PL. Safety, tolerability, and efficacy of psilocybin in 9 patients with obsessive-compulsive disorder. J Clin Psychiatry. 2006;67:1735-1740. Abstract
Sewell RA, Halpern JH, Pope HG Jr. Response of cluster headache to psilocybin and LSD. Neurology. 2006;66:1920-1922. Abstract
Griffiths RR, Richards WA, McCann U, Jesse R. Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology. 2006;187:268-283. Abstract