The newspaper even stated that
“psilocybin and MDMA are poised to be the hottest new therapeutics since
Prozac.” Prozac (fluoxetine) changed the practice of psychiatry worldwide
when it was approved as the first selective serotonin inhibitor in 1987 in the USA.
Many newspapers and online portals around the world blew the same horn. The
enthusiastic headlines followed 2 publications in renowned medical journals. A paper
in Nature Medicine demonstrated the superiority of
3,4-methylendioxy-N-methylamphetamine (MDMA) over placebo, administered in
conjunction with manualized psychotherapy, in 90 patients with post-traumatic stress
disorder (PTSD) [2]. The effect size was large (0.91). The sponsor of the study, the
Multidisciplinary Association for Psychedelic Studies (MAPS), which had received
“breakthrough status” for MDMA in PTSD by the Food and Drug
Administration (FDA), expects approval for the compound in that indication as early
as 2023. The second paper that gained worldwide attention had been published just a
few weeks earlier in the New England Journal of Medicine. Researchers from
Imperial College London documented a numerically, but not statistically, larger
decrease in depression self-rating scale scores in 30 patients treated with
psilocybin compared to 29 patients treated with the reference antidepressant
escitalopram [3]. Although the study was seemingly underpowered and has several
other methodological limitations, it underscores the hope that psilocybin could be
an effective and completely novel therapy for depression. Two large ongoing studies
with three-digit patient numbers, one international multicentric (NCT03775200) and
one German bicentric (NCT04670081), will provide conclusive evidence of whether
psilocybin represents a real breakthrough treatment for depression. However, there
are risks associated with the current euphoria, and some of the researchers who
initiated the “psychedelic renaissance” about 15 years ago warn that
it “could go off the rails” [4]. Only the responsible handling of
these powerful substances and the careful scientific evaluation of their benefits
and risks will prevent this. This special issue of Pharmacopsychiatry will
discuss some of the multifaceted aspects of the use of psychedelics as treatments
for psychiatric disorders.
It is important to be aware of the historical roots of our current medical practices.
This is particularly true of the use of psychedelics for medical purposes. Nichols
and Walter in their thoughtful review provide an overview of the historical basis on
which all current psychedelic treatment research is based [5]. Treatment with a
psychedelic is not just the application of a pill. Rather, it must always be
embedded in psychotherapeutic support. The scope and nature of this
psychotherapeutic program are the subjects of intense research, the current status
of which is presented in the overview by Nayak and Johnson [6]. What is the
mechanism of action of psychedelics? The entire spectrum of psychological and
biological processes that are triggered by psychedelics is the subject of the review
by Mertens and Preller [7]. They discuss the current state of research using the
example of 2 possible future therapeutic indications, affective and substance use
disorders. Finally, psychedelic therapy not only requires a new infrastructure in
which it is carried out but also must be integrated into the existing system and
differentiated from the recreational use of these substances. Many social,
political, and cultural questions are affected by this enculturation. The challenges
of how psychedelics could be implemented in a future mental health care system are
discussed by Gründer and Jungaberle [8].
The editors of Pharmacopsychiatry are pleased to provide a state-of-the-art
update of the current status of the use of psychedelics in psychiatry in this issue.
The journal will certainly accompany the development of one of the most interesting
subjects in psychiatry in the years to come.
