het is engels maar wel zo leuk om te lezen dus bij deze:
Nancy A. Melville
December 30, 2013
Tuning In to Psychedelics' Therapeutic Potential
Decades after psychedelic drugs became popular agents for recreational use and were subsequently made illegal, a select group of researchers is revisiting their therapeutic potential for mental illness.
Psilocybin, the active ingredient in "magic mushrooms," lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (MDMA), ketamine, mescaline, and other substances have been the subject of recent and ongoing research as potential treatments for psychiatric disorders, including severe depression, addiction, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), among others, with promising results.
Among the most fascinating aspects of drugs such as psilocybin, LSD, and MDMA is that the potential therapeutic benefits are not the result of taking a daily pill for months or years but rather can come from a single treatment lasting several hours ― yet described by many as being so intensely profound as to be life-changing.
"In one recent study [of psilocybin], conducted at Johns Hopkins in normal volunteers, approximately 3 out of 4 participants described the experience as the single or top 5 most profoundly meaningful experience of their life," said Stephen Ross, MD, director of addiction psychiatry, New York University (NYU) Tisch Hospital, and principal investigator on the NYU Psilocybin Cancer Project.
"It is a tremendously interesting model that a single dose can have therapeutic utility for months. That is a novel development in mental health," he told Medscape Medical News.
Dr. Ross has also been evaluating the effects of psilocybin in cancer patients ― terminal and nonterminal ― with severe existential distress and death anxiety.
For the study, patients received a dose of 0.3 mg/kg of psilocybin. They also were given highly targeted psychotherapy prior to the treatment session and afterwards to help recall and remember the experience and to integrate it with the patients' lives.
Among 32 cancer patients involved in the 9-month phase 2 clinical trial, most have emerged from the approximately 6- to 8-hour therapy session reporting that they had an out-of-body experience.
"The majority of the subjects describe stories of having had symbolic encounters with their cancer, such as visualizing a black cloud of cancer leaving their body, having encounters with transcendental forces, near-death experiences, journeys to earlier parts of their life, journeys into the future or into highly symbolic landscapes," he said.
Common themes described by the patients include a sense of profound calmness and serenity, being in touch with sacred elements, having a sense of universal love, having connectivity between their consciousness and the universe ― having "mystical experiences," Dr. Ross said.
Dr. Stephen Ross
"People will say things like, 'I realize now that the only thing in the universe that matters is love,' and they will feel a heightened awareness of things they need to do and a pressing need to go and make amends with people in their lives."
One patient described having envisioned his own death during the treatment, but not in a manner that involved anxiety or fear.
"[The patient] came from the experience saying, 'I am not scared of death anymore because I have experienced it ― there's nothing more to fear,' " Dr. Ross explained.
"Some of these experiences are kind of hard to conceptualize or understand, but without a doubt, what we have seen is significant clinical improvement with our patients in the aggregate," he added.
None of the patients in the study experienced severe side effects or anxiety, which is consistent with the bulk of clinical studies with psilocybin. Importantly, exclusion criteria for the study included any history or family history of schizophrenia, psychosis, or bipolar disorders.
"There have been 450 doses of psilocybin administered in research settings in the US in the last decade, and there have been 0 serious adverse psychological events," said Dr. Ross. "No one has become psychotic or addicted or needed any medication for anxiety during a session."
Data on the study are still under evaluation, but Dr. Ross noted that the effects of psilocybin in improving patients' depression lasted from several weeks to as long as 1 year.
Continued analysis will determine whether any patient characteristics are associated with improved response, but Dr. Ross said a strong correlation was observed between the intensity of patients' mystical experience and their clinical improvement.
"We are still trying to understand whether it is a biological effect or a more powerful psychological experience, but in looking at 25 of the 32 patients so far, it definitely looks like there is a very significant treatment effect."
What is crucial to psilocybin treatment is that the drug is administered in a highly controlled, calm, and comfortable setting. Dr. Ross said the one downside of the treatment is the concern of its desirability as a recreational drug.
Dr. Ross is one of only 4 researchers in the United States currently using psilocybin in clinical trials. His laboratory has a research license for Schedule I drugs, and he obtains synthetic psilocybin from Organix Inc, of Woburn, Massachusetts, which is also licensed by the federal government to produce the compound.
"It worries me that young people could see this research and say, 'Oh, psilocybin is safe ― I can just go out and do this.' The fact is, this will never be a drug that you can go out and get at the pharmacy and take by yourself," he said.
"It will only be available in a specially licensed center, administered by specially licensed therapists with training and under a lot of supervision to patients who have been very carefully screened. That is the only way it could be clinically administered and feasible, from my perspective."
The NYU laboratory works in tandem with other research teams at the Univeristy of California, Los Angeles (UCLA), and Johns Hopkins University, which has been studying the effects on cancer patients with depression as well as for smoking cessation, and the University of New Mexico, which is studying psilocybin for alcohol dependence.
Although the number of centers are few, these efforts have already pushed psilocybin research well beyond what might be called a "re-emerging" stage, said Dr. Ross.
"Ten years ago, there were only 2 people, and 15 years ago, only 1, so it may still be a tiny group of us who have taken this on, but it is a growing group, and I think the re-emergence of the field has already occurred," he said.
"I think we're in the next phase, where we will soon see a new kind of explosion of research into this, because the applicability therapeutically is incredibly broad."
The Psilocybin Therapy Session
To achieve the most productive and positive therapeutic value and to avoid the kinds of negative experiences or "bad trips" that gave psychedelic drugs a bad name, psilocybin or MDMA is administered under the most rigorously controlled conditions ― with lots of preparation beforehand, lots of support during the treatment session, and lots of reinforcement afterward.
In researching psilocybin for the treatment of depression in cancer patients at New York University's Psilocybin Cancer Project, the therapy begins weeks before the drug is administered. The patient, under the guidance of a therapist, undergoes a "life review" ― a detailed narrative of the patient's life. The patients also provide a narrative of their cancer and how it has affected them. Even a spiritual history is requested.
"A spiritual history is taken because these drugs can induce a spiritual state," said Stephen Ross, MD, director of addiction psychiatry at New York University Tisch Hospital and principal investigator of the project.
The drug is administered in a relaxed, comfortable, living room setting, where the patient is attended for the entire session by 2 therapists. Throughout the session, preselected, soothing, inspirational music with no lyrics is played.
Prior to taking the psilocybin, there is almost a ritualistic preparation in which the patient stands and states his or her goals for the experience, somewhat consistent with the traditional use of the therapy in indigenous cultures.
"The 2 therapists and the patient stand and hold hands, and the patient is asked to state their intention, which is usually something like, 'I want to rid myself of the fear of this cancer,' " said Dr. Ross.
As the drug begins to take effect, the patient lies down, is provided with eyeshades, and is asked to focus internally while the 2 therapists sit by the bed to offer any support.
The therapists do not offer guided imagery but allow the patients to follow their own chosen intentions.
"It is the patient's stated focus that sets the stage for the drug to have a therapeutic effect," Dr. Ross said.
The session typically lasts for 2 to 4 hours.
When the session ends, patients are asked to recount the experiences they had, and the rest of the day is spent as an extended psychotherapy session.
"The patient is still somewhat in an altered state and has greater access to their unconscious material, so we have them sort of free-associate during this time," Dr. Ross said.
Patients are sent home at the end of the day and are asked to record as much of the experience as they can remember. They come back the next day for more integrative psychotherapy to help put the experience of the therapy in the context of their life.
"We have them write it down, and we go back to the experience again and again. We really want them to imprint the memory."
Therapy sessions in the weeks or months following the treatment session continue to reinforce the lessons and insights learned from the psilocybin experience.
Dr. Ross reports no relevant financial relationships.
Nancy A. Melville
December 30, 2013
Tuning In to Psychedelics' Therapeutic Potential
Decades after psychedelic drugs became popular agents for recreational use and were subsequently made illegal, a select group of researchers is revisiting their therapeutic potential for mental illness.
Psilocybin, the active ingredient in "magic mushrooms," lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (MDMA), ketamine, mescaline, and other substances have been the subject of recent and ongoing research as potential treatments for psychiatric disorders, including severe depression, addiction, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), among others, with promising results.
Among the most fascinating aspects of drugs such as psilocybin, LSD, and MDMA is that the potential therapeutic benefits are not the result of taking a daily pill for months or years but rather can come from a single treatment lasting several hours ― yet described by many as being so intensely profound as to be life-changing.
"In one recent study [of psilocybin], conducted at Johns Hopkins in normal volunteers, approximately 3 out of 4 participants described the experience as the single or top 5 most profoundly meaningful experience of their life," said Stephen Ross, MD, director of addiction psychiatry, New York University (NYU) Tisch Hospital, and principal investigator on the NYU Psilocybin Cancer Project.
"It is a tremendously interesting model that a single dose can have therapeutic utility for months. That is a novel development in mental health," he told Medscape Medical News.
Dr. Ross has also been evaluating the effects of psilocybin in cancer patients ― terminal and nonterminal ― with severe existential distress and death anxiety.
For the study, patients received a dose of 0.3 mg/kg of psilocybin. They also were given highly targeted psychotherapy prior to the treatment session and afterwards to help recall and remember the experience and to integrate it with the patients' lives.
Among 32 cancer patients involved in the 9-month phase 2 clinical trial, most have emerged from the approximately 6- to 8-hour therapy session reporting that they had an out-of-body experience.
"The majority of the subjects describe stories of having had symbolic encounters with their cancer, such as visualizing a black cloud of cancer leaving their body, having encounters with transcendental forces, near-death experiences, journeys to earlier parts of their life, journeys into the future or into highly symbolic landscapes," he said.
Common themes described by the patients include a sense of profound calmness and serenity, being in touch with sacred elements, having a sense of universal love, having connectivity between their consciousness and the universe ― having "mystical experiences," Dr. Ross said.
Dr. Stephen Ross
"People will say things like, 'I realize now that the only thing in the universe that matters is love,' and they will feel a heightened awareness of things they need to do and a pressing need to go and make amends with people in their lives."
One patient described having envisioned his own death during the treatment, but not in a manner that involved anxiety or fear.
"[The patient] came from the experience saying, 'I am not scared of death anymore because I have experienced it ― there's nothing more to fear,' " Dr. Ross explained.
"Some of these experiences are kind of hard to conceptualize or understand, but without a doubt, what we have seen is significant clinical improvement with our patients in the aggregate," he added.
None of the patients in the study experienced severe side effects or anxiety, which is consistent with the bulk of clinical studies with psilocybin. Importantly, exclusion criteria for the study included any history or family history of schizophrenia, psychosis, or bipolar disorders.
"There have been 450 doses of psilocybin administered in research settings in the US in the last decade, and there have been 0 serious adverse psychological events," said Dr. Ross. "No one has become psychotic or addicted or needed any medication for anxiety during a session."
Data on the study are still under evaluation, but Dr. Ross noted that the effects of psilocybin in improving patients' depression lasted from several weeks to as long as 1 year.
Continued analysis will determine whether any patient characteristics are associated with improved response, but Dr. Ross said a strong correlation was observed between the intensity of patients' mystical experience and their clinical improvement.
"We are still trying to understand whether it is a biological effect or a more powerful psychological experience, but in looking at 25 of the 32 patients so far, it definitely looks like there is a very significant treatment effect."
What is crucial to psilocybin treatment is that the drug is administered in a highly controlled, calm, and comfortable setting. Dr. Ross said the one downside of the treatment is the concern of its desirability as a recreational drug.
Dr. Ross is one of only 4 researchers in the United States currently using psilocybin in clinical trials. His laboratory has a research license for Schedule I drugs, and he obtains synthetic psilocybin from Organix Inc, of Woburn, Massachusetts, which is also licensed by the federal government to produce the compound.
"It worries me that young people could see this research and say, 'Oh, psilocybin is safe ― I can just go out and do this.' The fact is, this will never be a drug that you can go out and get at the pharmacy and take by yourself," he said.
"It will only be available in a specially licensed center, administered by specially licensed therapists with training and under a lot of supervision to patients who have been very carefully screened. That is the only way it could be clinically administered and feasible, from my perspective."
The NYU laboratory works in tandem with other research teams at the Univeristy of California, Los Angeles (UCLA), and Johns Hopkins University, which has been studying the effects on cancer patients with depression as well as for smoking cessation, and the University of New Mexico, which is studying psilocybin for alcohol dependence.
Although the number of centers are few, these efforts have already pushed psilocybin research well beyond what might be called a "re-emerging" stage, said Dr. Ross.
"Ten years ago, there were only 2 people, and 15 years ago, only 1, so it may still be a tiny group of us who have taken this on, but it is a growing group, and I think the re-emergence of the field has already occurred," he said.
"I think we're in the next phase, where we will soon see a new kind of explosion of research into this, because the applicability therapeutically is incredibly broad."
The Psilocybin Therapy Session
To achieve the most productive and positive therapeutic value and to avoid the kinds of negative experiences or "bad trips" that gave psychedelic drugs a bad name, psilocybin or MDMA is administered under the most rigorously controlled conditions ― with lots of preparation beforehand, lots of support during the treatment session, and lots of reinforcement afterward.
In researching psilocybin for the treatment of depression in cancer patients at New York University's Psilocybin Cancer Project, the therapy begins weeks before the drug is administered. The patient, under the guidance of a therapist, undergoes a "life review" ― a detailed narrative of the patient's life. The patients also provide a narrative of their cancer and how it has affected them. Even a spiritual history is requested.
"A spiritual history is taken because these drugs can induce a spiritual state," said Stephen Ross, MD, director of addiction psychiatry at New York University Tisch Hospital and principal investigator of the project.
The drug is administered in a relaxed, comfortable, living room setting, where the patient is attended for the entire session by 2 therapists. Throughout the session, preselected, soothing, inspirational music with no lyrics is played.
Prior to taking the psilocybin, there is almost a ritualistic preparation in which the patient stands and states his or her goals for the experience, somewhat consistent with the traditional use of the therapy in indigenous cultures.
"The 2 therapists and the patient stand and hold hands, and the patient is asked to state their intention, which is usually something like, 'I want to rid myself of the fear of this cancer,' " said Dr. Ross.
As the drug begins to take effect, the patient lies down, is provided with eyeshades, and is asked to focus internally while the 2 therapists sit by the bed to offer any support.
The therapists do not offer guided imagery but allow the patients to follow their own chosen intentions.
"It is the patient's stated focus that sets the stage for the drug to have a therapeutic effect," Dr. Ross said.
The session typically lasts for 2 to 4 hours.
When the session ends, patients are asked to recount the experiences they had, and the rest of the day is spent as an extended psychotherapy session.
"The patient is still somewhat in an altered state and has greater access to their unconscious material, so we have them sort of free-associate during this time," Dr. Ross said.
Patients are sent home at the end of the day and are asked to record as much of the experience as they can remember. They come back the next day for more integrative psychotherapy to help put the experience of the therapy in the context of their life.
"We have them write it down, and we go back to the experience again and again. We really want them to imprint the memory."
Therapy sessions in the weeks or months following the treatment session continue to reinforce the lessons and insights learned from the psilocybin experience.
Dr. Ross reports no relevant financial relationships.
