Mertens Lea J, Preller Katrin H
Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Pharmaco-Neuroimaging and Cognitive-Emotional Processing, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry Zurich, Zurich, Switzerland.
Pharmacopsychiatry. 2021 Jul;54(4):176-190. doi: 10.1055/a-1341-1907. Epub 2021 Jan 20.
Classical psychedelics, primarily psilocybin and lysergic acid diethylamide (LSD), have been used and extensively studied in Western medicine as part of substance-assisted psychotherapy in the 1950s and 1960s. Modern clinical research is currently gaining momentum and provides new evidence for the safety and efficacy of classical psychedelics (primarily psilocybin, but also LSD and ayahuasca) in the treatment of different psychiatric conditions, including substance use and mood disorders.In this review article, we outline common pathological mechanisms of substance use disorders (SUD) and unipolar depression. Next, the current literature on the effects of psychedelics is summarized in order to generate hypotheses regarding their potential therapeutic mechanisms of action in treating these psychiatric conditions. Finally, we review and discuss clinical trials published since 2011 investigating the effects of psychedelics in SUD and depression.While results from those modern clinical trials are promising, most of them do not meet the methodological requirements to allow firm conclusions on the clinical efficacy of psychedelics. Larger, blinded, randomized controlled trials (RCT) with clearly defined patient groups and well-defined primary endpoints are needed. Additionally, the therapeutic mechanisms of classical psychedelics are currently unknown. This review presents hypotheses derived from preclinical and human studies that need to be tested in future trials to better understand the clinical potential of psychedelic substances in modern psychiatry.
经典致幻剂，主要是裸盖菇素和麦角酸二乙酰胺（LSD），在20世纪50年代和60年代曾作为物质辅助心理治疗的一部分在西方医学中被使用并得到广泛研究。现代临床研究目前正在兴起，并为经典致幻剂（主要是裸盖菇素，但也包括LSD和死藤水）在治疗包括物质使用障碍和情绪障碍在内的不同精神疾病方面的安全性和有效性提供了新证据。在这篇综述文章中，我们概述了物质使用障碍（SUD）和单相抑郁症的常见病理机制。接下来，总结了关于致幻剂作用效果的现有文献，以提出关于它们在治疗这些精神疾病中潜在治疗作用机制的假设。最后，我们回顾并讨论了自2011年以来发表的关于致幻剂对SUD和抑郁症影响的临床试验。虽然那些现代临床试验的结果很有前景，但其中大多数不符合方法学要求，无法就致幻剂的临床疗效得出确凿结论。需要开展更大规模、设盲、随机对照试验（RCT），明确界定患者群体并确定明确的主要终点。此外，经典致幻剂的治疗机制目前尚不清楚。本综述提出了源自临床前和人体研究的假设，这些假设需要在未来的试验中进行验证，以便更好地了解致幻物质在现代精神病学中的临床潜力。
