Tieteelliset julkaisut

Tulokset kategoriasta aihe hakusanalla masennus. Takaisin


Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. (Carhart-Harris RL, Bolstridge M, Day CMJ, Rucker J, Watts R,.., 2018)
Julkaisu:Psychopharmacology
Tiivistelmä: RATIONALE:
Recent clinical trials are reporting marked improvements in mental health outcomes with psychedelic drug-assisted psychotherapy.

OBJECTIVES:
Here, we report on safety and efficacy outcomes for up to 6 months in an open-label trial of psilocybin for treatment-resistant depression.

METHODS:
Twenty patients (six females) with (mostly) severe, unipolar, treatment-resistant major depression received two oral doses of psilocybin (10 and 25 mg, 7 days apart) in a supportive setting. Depressive symptoms were assessed from 1 week to 6 months post-treatment, with the self-rated QIDS-SR16 as the primary outcome measure.

RESULTS:
Treatment was generally well tolerated. Relative to baseline, marked reductions in depressive symptoms were observed for the first 5 weeks post-treatment (Cohen's d = 2.2 at week 1 and 2.3 at week 5, both p < 0.001); nine and four patients met the criteria for response and remission at week 5. Results remained positive at 3 and 6 months (Cohen's d = 1.5 and 1.4, respectively, both p < 0.001). No patients sought conventional antidepressant treatment within 5 weeks of psilocybin. Reductions in depressive symptoms at 5 weeks were predicted by the quality of the acute psychedelic experience.

CONCLUSIONS:
Although limited conclusions can be drawn about treatment efficacy from open-label trials, tolerability was good, effect sizes large and symptom improvements appeared rapidly after just two psilocybin treatment sessions and remained significant 6 months post-treatment in a treatment-resistant cohort. Psilocybin represents a promising paradigm for unresponsive depression that warrants further research in double-blind randomised control trials.
Yhdiste:Psilosybiini
Aihe:Masennus
Menetelmät:open label, seuranta
Otoskoko:20
Muuta:Seurantatutkimus tutkimuksesta Carhart-Harris ym. (2016).
Tagit:
DOI:10.1007/s00213-017-4771-x
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813086/


Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression. (Roseman L, Nutt DJ, Carhart-Harris RL, 2018)
Julkaisu:Frontiers in Pharmacology
Tiivistelmä: Introduction: It is a basic principle of the "psychedelic" treatment model that the quality of the acute experience mediates long-term improvements in mental health. In the present paper we sought to test this using data from a clinical trial assessing psilocybin for treatment-resistant depression (TRD). In line with previous reports, we hypothesized that the occurrence and magnitude of Oceanic Boundlessness (OBN) (sharing features with mystical-type experience) and Dread of Ego Dissolution (DED) (similar to anxiety) would predict long-term positive outcomes, whereas sensory perceptual effects would have negligible predictive value.

Materials and Methods: Twenty patients with treatment resistant depression underwent treatment with psilocybin (two separate sessions: 10 and 25 mg psilocybin). The Altered States of Consciousness (ASC) questionnaire was used to assess the quality of experiences in the 25 mg psilocybin session. From the ASC, the dimensions OBN and DED were used to measure the mystical-type and challenging experiences, respectively. The Self-Reported Quick Inventory of Depressive Symptoms (QIDS-SR) at 5 weeks served as the endpoint clinical outcome measure, as in later time points some of the subjects had gone on to receive new treatments, thus confounding inferences. In a repeated measure ANOVA, Time was the within-subject factor (independent variable), with QIDS-SR as the within-subject dependent variable in baseline, 1-day, 1-week, 5-weeks. OBN and DED were independent variables. OBN-by-Time and DED-by-Time interactions were the primary outcomes of interest.

Results: For the interaction of OBN and DED with Time (QIDS-SR as dependent variable), the main effect and the effects at each time point compared to baseline were all significant (p = 0.002 and p = 0.003, respectively, for main effects), confirming our main hypothesis. Furthermore, Pearson's correlation of OBN with QIDS-SR (5 weeks) was specific compared to perceptual dimensions of the ASC (p < 0.05).

Discussion: This report further bolsters the view that the quality of the acute psychedelic experience is a key mediator of long-term changes in mental health. Future therapeutic work with psychedelics should recognize the essential importance of quality of experience in determining treatment efficacy and consider ways of enhancing mystical-type experiences and reducing anxiety.
Yhdiste:Psilosybiini
Aihe:Yleiset vaikutukset, masennus
Menetelmät:Open label, seuranta, haastattelu, kysely
Otoskoko:20
Muuta:
Tagit:
DOI:10.3389/fphar.2017.00974
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776504/


Serotonergic hallucinogens in the treatment of anxiety and depression in patients suffering from a life-threatening disease: A systematic review. (Reiche S, Hermle L, Gutwinski S, Jungaberle H, Gasser P, Maj.., 2018)
Julkaisu:Progress in Neuro-Psychopharmacology & Biological Psychiatry
Tiivistelmä: Anxiety and depression are some of the most common psychiatric symptoms of patients suffering with life-threatening diseases, often associated with a low quality of life and a poor overall prognosis. 5-HT2A-receptor agonists (serotonergic hallucinogens, 'psychedelics') like lysergic acid diethylamide (LSD) and psilocybin were first investigated as therapeutic agents in the 1960s.

Recently, after a long hiatus period of regulatory obstacles, interest in the clinical use of these substances has resumed. The current article provides a systematic review of studies investigating psychedelics in the treatment of symptoms of existential distress in life-threatening diseases across different periods of research, highlighting how underlying concepts have developed over time.

A systematic search for clinical trials from 1960 to 2017 revealed 11 eligible clinical trials involving a total number of N=445 participants, of which 7 trials investigated the use of lysergic acid diethylamide (LSD) (N=323), 3 trials investigated the use of psilocybin (N=92), and one trial investigated the use of dipropyltryptamine (DPT) (N=30). The 4 more recent randomized controlled trials (RCTs) (N=104) showed a significantly higher methodological quality than studies carried out in the 1960s and 1970s.

Evidence supports that patients with life threatening diseases associated with symptoms of depression and anxiety benefit from the anxiolytic and antidepressant properties of serotonergic hallucinogens. Some studies anecdotally reported improvements in patients´ quality of life and reduced fear of death.

Moreover, low rates of side effects were reported in studies that adhered to safety guidelines. Further studies are needed to determine how these results can be transferred into clinical practice.
Yhdiste:Psykedeelit yleisesti, LSD, psilosybiini
Aihe:Kuolemaan liittyvä ahdistus, masennus
Menetelmät:Kirjallisuuskatsaus
Otoskoko:0
Muuta:
Tagit:
DOI:10.1016/j.pnpbp.2017.09.012
URL: https://www.sciencedirect.com/science/article/pii/S02785846173063...


Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. (Griffiths RR, Johnson MW, Carducci MA, Umbricht A, Richards .., 2016)
Julkaisu:Journal of Psychopharmacology
Tiivistelmä: Cancer patients often develop chronic, clinically significant symptoms of depression and anxiety. Previous studies suggest that psilocybin may decrease depression and anxiety in cancer patients. The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety.

This randomized, double-blind, cross-over trial investigated the effects of a very low (placebo-like) dose (1 or 3 mg/70 kg) vs. a high dose (22 or 30 mg/70 kg) of psilocybin administered in counterbalanced sequence with 5 weeks between sessions and a 6-month follow-up. Instructions to participants and staff minimized expectancy effects. Participants, staff, and community observers rated participant moods, attitudes, and behaviors throughout the study.

High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety. Participants attributed improvements in attitudes about life/self, mood, relationships, and spirituality to the high-dose experience, with >80% endorsing moderately or greater increased well-being/life satisfaction. Community observer ratings showed corresponding changes. Mystical-type psilocybin experience on session day mediated the effect of psilocybin dose on therapeutic outcomes.
Yhdiste:psilosybiini
Aihe:kuolemaan liittyvä ahdistus, masennus
Menetelmät:vaihtovuoroinen, kaksoissokkoutettu, lumekontrolloitu, seuranta
Otoskoko:56
Muuta:
Tagit: kuolemaan liittyvä ahdistus, masennus, psilosybiini
DOI:10.1177/0269881116675513
URL: http://journals.sagepub.com/doi/pdf/10.1177/0269881116675513


Antidepressive, anxiolytic, and antiaddictive effects of ayahuasca, psilocybin and lysergic acid diethylamide (LSD): a systematic review of clinical trials published in the last 25 years. (Dos Santos RG, Osório FL, Crippa JA, Riba J, Zuardi AW, Hal.., 2016)
Julkaisu:Therapeutic Advances in Psychopharmacology
Tiivistelmä: To date, pharmacological treatments for mood and anxiety disorders and for drug dependence show limited efficacy, leaving a large number of patients suffering severe and persistent symptoms. Preliminary studies in animals and humans suggest that ayahuasca, psilocybin and lysergic acid diethylamide (LSD) may have antidepressive, anxiolytic, and antiaddictive properties.

Thus, we conducted a systematic review of clinical trials published from 1990 until 2015, assessing these therapeutic properties. Electronic searches were performed using the PubMed, LILACS, and SciELO databases. Only clinical trials published in peer-reviewed journals were included. Of these, 151 studies were identified, of which six met the established criteria.

Reviewed studies suggest beneficial effects for treatment-resistant depression, anxiety and depression associated with life-threatening diseases, and tobacco and alcohol dependence. All drugs were well tolerated. In conclusion, ayahuasca, psilocybin and LSD may be useful pharmacological tools for the treatment of drug dependence, and anxiety and mood disorders, especially in treatment-resistant patients. These drugs may also be useful pharmacological tools to understand psychiatric disorders and to develop new therapeutic agents.

However, all studies reviewed had small sample sizes, and half of them were open-label, proof-of-concept studies. Randomized, double-blind, placebo-controlled studies with more patients are needed to replicate these preliminary findings.
Yhdiste:LSD, psilosybiini, ayahuasca
Aihe:Masennus, addiktio
Menetelmät:Kirjallisuuskatsaus
Otoskoko:0
Muuta:
Tagit:
DOI:10.1177/2045125316638008
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910400/


Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study (Carhart-Harris RL, Bolstridge M, Rucker J, Day CM, Erritzoe .., 2016)
Julkaisu:The Lancet Psychiatry
Tiivistelmä: Background

Psilocybin is a serotonin receptor agonist that occurs naturally in some mushroom species. Recent studies have assessed the therapeutic potential of psilocybin for various conditions, including end-of-life anxiety, obsessive-compulsive disorder, and smoking and alcohol dependence, with promising preliminary results. Here, we aimed to investigate the feasibility, safety, and efficacy of psilocybin in patients with unipolar treatment-resistant depression.

Methods

In this open-label feasibility trial, 12 patients (six men, six women) with moderate-to-severe, unipolar, treatment-resistant major depression received two oral doses of psilocybin (10 mg and 25 mg, 7 days apart) in a supportive setting. There was no control group. Psychological support was provided before, during, and after each session. The primary outcome measure for feasibility was patient-reported intensity of psilocybin's effects. Patients were monitored for adverse reactions during the dosing sessions and subsequent clinic and remote follow-up. Depressive symptoms were assessed with standard assessments from 1 week to 3 months after treatment, with the 16-item Quick Inventory of Depressive Symptoms (QIDS) serving as the primary efficacy outcome. This trial is registered with ISRCTN, number ISRCTN14426797.

Findings

Psilocybin's acute psychedelic effects typically became detectable 30–60 min after dosing, peaked 2–3 h after dosing, and subsided to negligible levels at least 6 h after dosing. Mean self-rated intensity (on a 0–1 scale) was 0·51 (SD 0·36) for the low-dose session and 0·75 (SD 0·27) for the high-dose session. Psilocybin was well tolerated by all of the patients, and no serious or unexpected adverse events occurred. The adverse reactions we noted were transient anxiety during drug onset (all patients), transient confusion or thought disorder (nine patients), mild and transient nausea (four patients), and transient headache (four patients). Relative to baseline, depressive symptoms were markedly reduced 1 week (mean QIDS difference −11·8, 95% CI −9·15 to −14·35, p=0·002, Hedges' g=3·1) and 3 months (−9·2, 95% CI −5·69 to −12·71, p=0·003, Hedges' g=2) after high-dose treatment. Marked and sustained improvements in anxiety and anhedonia were also noted.

Interpretation

This study provides preliminary support for the safety and efficacy of psilocybin for treatment-resistant depression and motivates further trials, with more rigorous designs, to better examine the therapeutic potential of this approach.

Funding

Medical Research Council.
Yhdiste:psilosybiini
Aihe:masennus, haitta-arvio
Menetelmät:open label, seuranta
Otoskoko:12
Muuta:
Tagit: masennus, pilotti, psilosybiini
DOI:10.1016/S2215-0366(16)30065-7
URL: http://www.sciencedirect.com/science/article/pii/S221503661630065...


Antidepressant Effects of a Single Dose of Ayahuasca in Patients With Recurrent Depression: A SPECT Study. (Sanches RF, de Lima Osório F, Dos Santos RG, Macedo LR, Mai.., 2016)
Julkaisu:Journal of Clinical Psychopharmacology
Tiivistelmä: Ayahuasca is an Amazonian botanical hallucinogenic brew which contains dimethyltryptamine, a 5-HT2A receptor agonist, and harmine, a monoamine-oxidase A inhibitor. Our group recently reported that ayahuasca administration was associated with fast-acting antidepressive effects in 6 depressive patients. The objective of the present work was to assess the antidepressive potentials of ayahuasca in a bigger sample and to investigate its effects on regional cerebral blood flow.

In an open-label trial conducted in an inpatient psychiatric unit, 17 patients with recurrent depression received an oral dose of ayahuasca (2.2 mL/kg) and were evaluated with the Hamilton Rating Scale for Depression, the Montgomery-Åsberg Depression Rating Scale, the Brief Psychiatric Rating Scale, the Young Mania Rating Scale, and the Clinician Administered Dissociative States Scale during acute ayahuasca effects and 1, 7, 14, and 21 days after drug intake. Blood perfusion was assessed eight hours after drug administration by means of single photon emission tomography.

Ayahuasca administration was associated with increased psychoactivity (Clinician Administered Dissociative States Scale) and significant score decreases in depression-related scales (Hamilton Rating Scale for Depression, Montgomery-Åsberg Depression Rating Scale, Brief Psychiatric Rating Scale) from 80 minutes to day 21. Increased blood perfusion in the left nucleus accumbens, right insula and left subgenual area, brain regions implicated in the regulation of mood and emotions, were observed after ayahuasca intake.

Ayahuasca was well tolerated. Vomiting was the only adverse effect recorded, being reported by 47% of the volunteers.

Our results suggest that ayahuasca may have fast-acting and sustained antidepressive properties. These results should be replicated in randomized, double-blind, placebo-controlled trials.
Yhdiste:Ayahuasca
Aihe:Masennus, yleiset vaikutukset, aivotutkimus
Menetelmät:Open label, seuranta, SPECT
Otoskoko:17
Muuta:
Tagit:
DOI:10.1097/JCP.0000000000000436
URL: https://www.ncbi.nlm.nih.gov/pubmed/26650973


Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial (Ross S, Bossis A, Guss J, Agin-Liebes G, Malone T, Cohen B, .., 2016)
Julkaisu:Journal of Psychopharmacology
Tiivistelmä: Tausta: Ahdistus ja masennusoireilu ovat yleisiä potilailla, joilla on pitkälle edennyt syöpäsairaus. Psykiatrinen oireilu on yhteydessä huonompaan hoidon ennusteeseen. Aiemmat tutkimustulokset viittaavat psilosybiinin soveltuvan syöpäsairauteen liittyvän ahdistuksen ja masennuksen hoitoon.

Metodit: Tässä satunnaistetussa plasebokontrolloidussa ristikkäistutkimuksessa 29 syöpää sairastavaa potilasta, joilla oli sairauteensa liittyvää ahdistusta ja masennusta saivat satunnaistetusti psykoterapian yhteydessä yhden annoksen joko psilosybiiniä (0.3mg/kg) tai niasiinia. Hoidon vaikuttavuutta arvioitiin ahdistus- ja masennusmittauksilla ennen koe- ja kontrolliryhmien yhdistämistä 7 viikkoa hoidon jälkeen.

Tulokset: Koehenkilöiden ahdistuneisuudessa ja mielialassa havaittiin tilastollisesti merkitseviä positiivisia muutoksia psilosybiinin jälkeen ennen koe- ja kontrolliryhmien yhdistämistä. Lisäksi syöpään liittyvässä toivottomuudessa ja demoralisaatiossa havaittiin laskua. Myös koehenkilöiden henkinen hyvinvointi ja elämänlaatu kohenivat. Kuuden kuukauden seurannassa psilosybiinin ahdistusta ja masentuneisuutta lieventävät vaikutukset säilyivät (60-80 % koehenkilöistä havaittiin kliinisesti merkitsevää vaikutusta ahdistukseen ja masentuneisuuteen). Seurannassa psilosybiini oli yhteydessä eksistentiaalisen ahdingon helpottumiseen, kohonneeseen elämänlaatuun ja muuntuneeseen asenteeseen kuolemaa kohtaan. Psilosybiinin terapeuttiset vaikutukset välittyivät sen tuottaman mystisen kokemuksen kautta.

Johtopäätökset: Kerta-annoksinen psilosybiiniavusteinen psykoterapia tuotti nopeita ja pysyviä muutoksia syöpää sairastavien potilaiden sairauteen liittyvässä masentuneisuudessa ja ahdistuneisuudessa.
Yhdiste:psilosybiini
Aihe:kuolemaan liittyvä ahdistus, masennus
Menetelmät:Kaksoissokkoutettu, lumekontrolloitu, vaihtovuoroinen
Otoskoko:29
Muuta:
Tagit: kuolemaan liittyvä ahdistus, masennus, psilosybiini
DOI:10.1177/0269881116675512
URL: http://journals.sagepub.com/doi/full/10.1177/0269881116675512


Antidepressive and anxiolytic effects of ayahuasca: a systematic literature review of animal and human studies.logical functioning, and neuroimaging. (Dos Santos RG, Osório FL, Crippa JA, Hallak JE, 2016)
Julkaisu:Revista brasileira de psiquiatria
Tiivistelmä: OBJECTIVE:
To conduct a systematic literature review of animal and human studies reporting anxiolytic or antidepressive effects of ayahuasca or some of its isolated alkaloids (dimethyltryptamine, harmine, tetrahydroharmine, and harmaline).

METHODS:
Papers published until 3 April 2015 were retrieved from the PubMed, LILACS and SciELO databases following a comprehensive search strategy and using a predetermined set of criteria for article selection.

RESULTS:
Five hundred and fourteen studies were identified, of which 21 met the established criteria. Studies in animals have shown anxiolytic and antidepressive effects of ayahuasca, harmine, and harmaline, and experimental studies in humans and mental health assessments of experienced ayahuasca consumers also suggest that ayahuasca is associated with reductions in anxiety and depressive symptoms. A pilot study reported rapid antidepressive effects of a single ayahuasca dose in six patients with recurrent depression.

CONCLUSION:
Considering the need for new drugs that produce fewer adverse effects and are more effective in reducing anxiety and depression symptomatology, the described effects of ayahuasca and its alkaloids should be further investigated.
Yhdiste:Ayahuasca
Aihe:Yleiset vaikutukset, masennus
Menetelmät:Kirjallisuuskatsaus
Otoskoko:0
Muuta:
Tagit:
DOI:10.1590/1516-4446-2015-1701
URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-4446...


Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: a preliminary report. (Osório Fde L, Sanches RF, Macedo LR, Santos RG, Maia-de-Oli.., 2015)
Julkaisu:Revista Brasileira de Psiquiatria
Tiivistelmä: OBJECTIVES:
Ayahuasca (AYA), a natural psychedelic brew prepared from Amazonian plants and rich in dimethyltryptamine (DMT) and harmine, causes effects of subjective well-being and may therefore have antidepressant actions. This study sought to evaluate the effects of a single dose of AYA in six volunteers with a current depressive episode.

METHODS:
Open-label trial conducted in an inpatient psychiatric unit.

RESULTS:
Statistically significant reductions of up to 82% in depressive scores were observed between baseline and 1, 7, and 21 days after AYA administration, as measured on the Hamilton Rating Scale for Depression (HAM-D), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Anxious-Depression subscale of the Brief Psychiatric Rating Scale (BPRS). AYA administration resulted in nonsignificant changes in Young Mania Rating Scale (YMRS) scores and in the thinking disorder subscale of the BPRS, suggesting that AYA does not induce episodes of mania and/or hypomania in patients with mood disorders and that modifications in thought content, which could indicate psychedelic effects, are not essential for mood improvement.

CONCLUSIONS:
These results suggest that AYA has fast-acting anxiolytic and antidepressant effects in patients with a depressive disorder.
Yhdiste:Ayahuasca
Aihe:Masennus
Menetelmät:Open label, seuranta
Otoskoko:6
Muuta:
Tagit:
DOI:10.1590/1516-4446-2014-1496
URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-4446...