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DOI: 10.1055/a-2453-0910
Psychedelika in der Psychiatrie: eine offene Debatte
Psychedelics in psychiatry: an open debate
Zusammenfassung
Der Einsatz von Psychedelika in Psychiatrie und Psychotherapie wird vertieft wissenschaftlich untersucht, national wie international zunehmend fachlich und gesellschaftlich diskutiert sowie international bereits teilweise klinisch praktiziert. Der Artikel bietet eine kurze Standortbestimmung auch hinsichtlich Evidenzlage, kritischer klinischer Fragen und Risiken. Rechtliche, ethische und ökonomische Aspekte werden beleuchtet, therapeutische Qualifikationen möglicher Anwender werden diskutiert und es wird unter Benennung noch aktueller Herausforderungen auf eine mögliche klinisch-psychiatrische Einbettung eingegangen. Insgesamt wird besprochen, unter welchen Voraussetzungen in der Anwendung von Psychedelika ein gewisses Potenzial hinsichtlich Erweiterung des Behandlungsspektrums psychischer Erkrankungen liegen könnte, insb. angesichts auch unter derzeitigen Methoden häufig therapieresistenter und chronischer Verläufe. Auf jeden Fall wären wesentliche grundsätzliche Fragen vor einer eventuellen Einführung zu klären.
Abstract
The application of psychedelics in psychiatry and psychotherapy is increasingly the subject of scientific evaluation and discussion in national and international professional and general society, and, internationally, has already been partly applied in the clinical setting. The manuscript provides a basic description of the state of the art regarding evidence and clinical issues; law, ethics and economics are addressed; therapeutic qualification of potential users and a potentially clinical embedding in psychiatry are discussed, taking into consideration current challenges. Thus, the discussion will cover the circumstances under which the application of psychedelics might have a potential to broaden the spectrum of treatments in certain psychiatric conditions, particularly in the context of chronicity and treatment resistance to current methods. However, basic and critical issues have to be clarified before eventual implementation.
Publication History
Received: 17 November 2023
Accepted after revision: 27 October 2024
Article published online:
12 December 2024
© 2024. Thieme. All rights reserved.
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Literatur
- 1 Reiff CM, Richman EE, Nemeroff CB. et al. Psychedelics and Psychedelic-Assisted Psychotherapy. Am J Psychiatry 2020; 177: 391-410
- 2 Herwig U, Mertens L, Perez Rosal S. et al. Psychedelika in der Psychiatrie – Entwicklungen und die Stellung in Deutschland [Psychedelics in Psychiatry – Development and Current State in Germany]. Fortschr Neurol Psychiatr 2023; 91: 311-318
- 3 Roth BL, Gumpper RH. Psychedelics as Transformative Therapeutics. Am J Psychiatry 2023; 180: 340-347
- 4 Carhart-Harris R, Giribaldi B, Watts R, Baker-Jones M. et al. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med 2021; 384: 1402-1411
- 5 Goodwin GM, Aaronson ST, Alvarez O. et al. Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression. N Engl J Med 2022; 387: 1637-1648
- 6 Carhart-Harris RL. Translational Challenges in Psychedelic Medicine. N Engl J Med 2023; 388: 476-477
- 7 Daws RE, Timmermann C, Giribaldi B. et al. Increased global integration in the brain after psilocybin therapy for depression. Nat Med 2022; 28: 844-851
- 8 Nardou R, Sawyer E, Song YJ. et al. Psychedelics reopen the social reward learning critical period. Nature 2023; 618: 790-798
- 9 Mitchell JM, Bogenschutz M, Lilienstein A. et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 2021; 27: 1025-1033
- 10 Peck SK, Shao S, Gruen T. et al. Psilocybin therapy for females with anorexia nervosa: a phase 1, open-label feasibility study. Nat Med 2023;
- 11 Brody H. Psychedelic medicine faces the acid test. Nature 2022; 609: S79
- 12 Davis AK, Barrett FS, May DG. et al. Effects of psilocybin-assisted therapy on major depressive disorder: a randomized clinical trial. JAMA Psychiatry 2021; 78: 481-489
- 13 Weiss B, Erritzoe D, Giribaldi B. et al. A critical evaluation of QIDS-SR-16 using data from a trial of psilocybin therapy versus escitalopram treatment for depression. J Psychopharmacol 2023; 2698811231167848
- 14 Goodwin GM, Croal M, Feifel D. et al. Psilocybin for treatment resistant depression in patients taking a concomitant SSRI medication. Neuropsychopharmacology 2023;
- 15 von Rotz R, Schindowski EM, Jungwirth J. et al Single-dose psilocybin-assisted therapy in major depressive disorder: A placebo-controlled, double-blind, randomised clinical trial. EClinicalMedicine 2022; 56: 101809 Erratum in: EClinicalMedicine. 2023; 56:101841
- 16 Bogenschutz MP, Ross S, Bhatt S. et al Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2022; 1 79: 953-962
- 17 McClure-Begley TD, Roth BL. The promises and perils of psychedelic pharmacology for psychiatry. Nat Rev Drug Discov 2022; 21: 463-473
- 18 Ko K, Kopra EI, Cleare AJ, Rucker JJ. Psychedelic therapy for depressive symptoms: A systematic review and meta-analysis. J Affect Disord 2023; 322: 194-204
- 19 Haridy R. Australia to prescribe MDMA and psilocybin for PTSD and depression in world first. Nature 2023; 619: 227-228
- 20 Mertens LJ, Koslowski M, Betzler F. et al. Methodological challenges in psychedelic drug trials: Efficacy and safety of psilocybin in treatment-resistant major depression (EPIsoDE) – Rationale and study design. Neuroscience Applied. 2022 100104.
- 21 Pollan: How to change your mind. Penguin Random House, Canada 2018 ISBN: 9780735224155
- 22 Mertens L, Gründer G. Klassische Psychedelika als Therapeutika in der Psychiatrie. Psychopharmakotherapie 2020; 27: 171-180
- 23 Gründer G, Brand M, Kärtner L. et al. Sind Psychedelika schnell wirksame Antidepressiva? [Are psychedelics fast acting antidepressant agents?]. Nervenarzt 2022; 93: 254-262
- 24 Drozdz SJ, Goel A, McGarr MW. et al. Ketamine Assisted Psychotherapy: A Systematic Narrative Review of the Literature. J Pain Res 2022; 15: 1691-1706
- 25 GBA 2021: Nutzenbewertungsverfahren zum Wirkstoff Esketamin (Depression, therapieresistent, in Kombination mit SSRI oder SNRI) – Gemeinsamer Bundesausschuss (g-ba.de)
- 26 Smith KW, Sicignano DJ, Hernandez AV, White CM. MDMA-Assisted Psychotherapy for Treatment of Posttraumatic Stress Disorder: A Systematic Review With Meta-Analysis. J Clin Pharmacol 2022; 62: 463-471
- 27 Siegel JS, Daily JE, Perry DA, Nicol GE. Psychedelic Drug Legislative Reform and Legalization in the US. JAMA Psychiatry 2023; 80: 77-83
- 28 Mulligan B. Canada Opens Access for Psilocybin and MDMA Therapy – Anylaw. 2022
- 29 Schlag AK, Aday J, Salam I. et al. Adverse effects of psychedelics: From anecdotes and misinformation to systematic science. J Psychopharmacol 2022; 36: 258-272
- 30 Nichols DE, Grob CS. Is LSD toxic?. Forensic Sci Int 2018; 284: 141-145
- 31 Nichols DE. Psychedelics. Pharmacol Rev 2016; 68: 264-355
- 32 Nutt DJ, King LA, Phillips LD. Independent Scientific Committee on Drugs. Drug harms in the UK: a multicriteria decision analysis. Lancet 2010; 6 376: 1558-1565
- 33 Simonsson O, Sexton JD, Hendricks PS. Associations between lifetime classic psychedelic use and markers of physical health. J Psychopharmacol 2021; 35: 447-452
- 34 Smith-Apeldoorn SY, Veraart JK, Spijker J. et al. Maintenance ketamine treatment for depression: a systematic review of efficacy, safety, and tolerability. Lancet Psychiatry 2022; 9: 907-921
- 35 Fonseca DA, Ribeiro DM, Tapadas M, Cotrim MD. Ecstasy (3,4-methylenedioxymethamphetamine): Cardiovascular effects and mechanisms. Eur J Pharmacol 2021; 903: 174156
- 36 Costa G, Gołembiowska K. Neurotoxicity of MDMA: Main effects and mechanisms. Exp Neurol 2022; 347: 113894
- 37 Pantoni MM, Kim JL, Van Alstyne KR, Anagnostaras SG. MDMA and memory, addiction, and depression: dose-effect analysis. Psychopharmacology 2022; 239: 935-949 Erratum in: Psychopharmacology 2022; 239(7): 2369
- 38 Roseman L, Nutt DJ, Carhart-Harris RL. Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression. Front Pharmacol 2018; 8: 974
- 39 Goodwin GM, Malievskaia E, Fonzo GA, Nemeroff CB. Must Psilocybin Always "Assist Psychotherapy"?. Am J Psychiatry 2023; appiajp20221043
- 40 Shaw L, Rea K, Lachowsky NJ, Roth EA. Magic Mushroom Use: A Qualitative Interview Study of Post-Trip Impacts and Strategies for Optimizing Experiences. J Psychoactive Drugs 2023; 55: 151-158
- 41 Hendricks PS, Thorne CB, Clark CB, Coombs DW, Johnson MW. Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population. J Psychopharmacol 2015; 29: 280-288
- 42 McNamee S, Devenot N, Buisson M. Studying Harms Is Key to Improving Psychedelic-Assisted Therapy-Participants Call for Changes to Research Landscape. JAMA Psychiatry 2023; 80: 411-412
- 43 Anderson BT, Danforth AL, Grob CS. Psychedelic medicine: safety and ethical concerns. Lancet Psychiatry 2020; 7: 829-830
- 44 Nichols DE. Differences Between the Mechanism of Action of MDMA, MBDB, and the Classic Hallucinogens. Identification of a New Therapeutic Class: Entactogens. Journal of Psychoactive Drugs 1986; 18: 305-313
- 45 Spiegel-online: https://www.spiegel.de/ausland/australien-psychiater-duerfen-psychedelika-verschreiben-erstes-land-weltweit-a-22fbcbbb-89ad-4f9f-a197-f7314253bbf2?sara_ref=re-em-em-sh
- 46 Deutsches Ärzteblatt: Australien erlaubt Partydrogen wie MDMA als Medizin (aerzteblatt.de)
- 47 Yaden DB, Potash JB, Griffiths RR. Preparing for the Bursting of the Psychedelic Hype Bubble. JAMA Psychiatry 2022; 79: 943-944
- 48 Phelps J, Shah RN, Lieberman JA. The Rapid Rise in Investment in Psychedelics—Cart Before the Horse. JAMA Psychiatry 2022; 79: 189-190
- 49 Phelps J. Developing guidelines and competencies for the training of psychedelic therapists. J Humanist Psychol 2017; 57: 450-487
- 50 Passie T, Guss J, Krähenmann R. Lower-dose psycholytic therapy – A neglected approach. Front Psychiatry 2022; 13: 1020505
- 51 Peck SK, Shao S, Gruen T. et al. Psilocybin therapy for females with anorexia nervosa: a phase 1, open-label feasibility study. Nat Med 2023;
- 52 Ching THW, Grazioplene R, Bohner C. et al Safety, tolerability, and clinical and neural effects of single-dose psilocybin in obsessive-compulsive disorder: protocol for a randomized, double-blind, placebo-controlled, non-crossover trial. Front Psychiatry 2023; 25 14: 1178529
- 53 Barber GS, Aaronson ST. The Emerging Field of Psychedelic Psychotherapy. Curr Psychiatry Rep 2022; 24: 583-590
- 54 van Elk M, Yaden DB. Pharmacological, neural, and psychological mechanisms underlying psychedelics: A critical review. Neurosci Biobehav Rev 2022; 140: 104793
- 55 Gründer G, Jungaberle H. The Potential Role of Psychedelic Drugs in Mental Health Care of the Future. Pharmacopsychiatry 2021; 54: 191-199
- 56 McCrone P, Fisher H, Knight C. et al. Cost-effectiveness of psilocybin-assisted therapy for severe depression: exploratory findings from a decision analytic model. Psychol Med 2023;