Are Psychedelics Something New in Teaching Psychopharmacology?

This editorial paper aims to inform the attitude of medical health professionals towards psychedelics, with regard to evaluating their therapeutic potential in accordance with a rigorous application of the scientific method, while taking social, historical, political, and cultural factors that have influenced their legal status and the discontinuation of prior research. The paper highlights the need for psychiatrists to engage with a rational and evidence-based discourse on drug policy that neither glorifies or demonizes psychedelic substances, in step with the ongoing efforts to apply modern standards of randomized placebo-controlled clinical trials. An outstanding challenge for psychiatrists is the manner of communication with patients seeking advice on psychedelic self-medication, in face of alienating by refusing to discuss the matter due to their legal status, while conveying a realistic picture that is proportionate to the degree of scientific evidence that is currently available.

Abstract

“These are interesting times for the practice and teaching of psychopharmacology. For instance, the repurposing of ketamine, the dissociative anesthetic, from anesthesiology into the practice of psychiatry, has garnered considerable interest as a potential innovation in the treatment of major depression. Similarly attracting attention is the re-emergence of psychedelic drugs as potential treatments for a wide range of psychiatric disorders. Baby-boomer psychiatrists will remember the age of psychedelics in the 1960s, while subsequently trained generations of psychiatrists rarely, if ever, heard about them as potential treatments. A hiatus occurred for psychedelic research, from the mid-1970s into the mid-1990s . Despite this hiatus, careful scientific studies with psychedelics began in the mid1990s, by a few investigators. A July 31, 2020, ClinicalTrials.gov search using the term psychedelics  listed 268 National Institute of Health trials for the treatment of both medical and psychiatric conditions, the latter of which include depression, anxiety, obsessive compulsive disorder, posttraumatic stress disorder (PTSD), substance use disorders, and cognitive impairment. Psychedelic drugs include “classical” psychedelics like lysergic acid diethylamide (LSD), psilocybin, and ayahuasca, which are agonists at the serotonin 2A receptor, and empathogens like 3,4-methylenedioxymethamphetamine (MDMA), which release and inhibit the reuptake of serotonin and dopamine. Sometimes, other compounds, like ketamine, and atypical hallucinogens are also called psychedelics. Psilocybin, found in some mushrooms, and ayahuasca, consisting of two plant-based compounds, have been part of sacred ceremonies of ancient cultures and provide an interface between Western psychiatry and traditional indigenous healing approaches. State-of-the-art human studies with psychedelics are not easy to conduct given regulatory challenges and complex design issues, including providing an appropriate control group and blinding. Nevertheless, over the past couple decades, enough evidence has gradually accumulated to warrant Food and Drug Administration (FDA) trials. Psilocybin is currently in early phase 2 trials for the treatment of major depressive disorder and treatment-resistant depression under an FDA breakthrough therapy designation. MDMA is in the midst of phase 3 trials for PTSD , also under a breakthrough therapy designation. Time will tell whether these treatments will ultimately gain FDA approval, but their re-emergence may represent a teachable moment. This editorial focuses on teaching residents about these fascinating and ancient compounds called psychedelics, because they present an opportunity to educate our residents regarding aspects of the scientific method, including its relationship to the social, historical, political, and cultural factors that influence research, the clinical response to public experimentation, and policy. We have parsed the teachable moments into basic, practical, and curious lessons from psychedelics.”

Authors: Alan K. Louie, Eugene V. Beresin, John Coverdale, Richard Balon, Anthony P. S. Guerrero, Mary K. Morreale, Rashi Aggarwal & Adam M. Brenner

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