Kisely Steve, Connor Mark, Somogyi Andrew A, Siskind Dan
School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.
Addiction and Mental Health Services, Metro South Health Service, Woolloongabba, QLD, Australia.
Aust N Z J Psychiatry. 2023 Mar;57(3):362-378. doi: 10.1177/00048674221083868. Epub 2022 Mar 12.
There is an increasing interest in combining psilocybin or methylenedioxymethamphetamine with psychological support in treating psychiatric disorders. Although there have been several recent systematic reviews, study and participant numbers have been limited, and the field is rapidly evolving with the publication of more studies. We therefore conducted a systematic review of PubMed, MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, Embase, and CINAHL for randomised controlled trials of methylenedioxymethamphetamine and psilocybin with either inactive or active controls.
Outcomes were psychiatric symptoms measured by standardised, validated and internationally recognised instruments at least 2 weeks following drug administration, Quality was independently assessed using the Cochrane risk of bias assessment tool and Grading of Recommendations Assessment, Development and Evaluation framework.
There were eight studies on methylenedioxymethamphetamine and six on psilocybin. Diagnoses included post-traumatic stress disorder, long-standing/treatment-resistant depression, obsessive-compulsive disorder, social anxiety in adults with autism, and anxiety or depression in life-threatening disease. The most information and strongest association was for the change in methylenedioxymethamphetamine scores compared to active controls in post-traumatic stress disorder ( = 4; standardised mean difference = -0.86; 95% confidence interval = [-1.23, -0.50]; < 0.0001). There were also small benefits for social anxiety in adults with autism. Psilocybin was superior to wait-list but not niacin (active control) in life-threatening disease anxiety or depression. It was equally as effective as escitalopram in long-standing depression for the primary study outcome and superior for most of the secondary outcomes in analyses uncorrected for multiple comparisons. Both agents were well tolerated in supervised trials. Trial quality varied with only small proportions of potential participants included in the randomised phase. Overall certainty of evidence was low or very low using the Grading of Recommendations Assessment, Development and Evaluation framework.
Methylenedioxymethamphetamine and psilocybin may show promise in highly selected populations when administered in closely supervised settings and with intensive support.
将裸盖菇素或亚甲二氧基甲基苯丙胺与心理支持相结合用于治疗精神疾病，这一做法正引发越来越多的关注。尽管近期已有多项系统评价，但研究数量和参与人数有限，且随着更多研究的发表，该领域正在迅速发展。因此，我们对PubMed、MEDLINE、PsycINFO、Cochrane对照试验中央注册库、Embase和CINAHL进行了系统评价，以查找关于亚甲二氧基甲基苯丙胺和裸盖菇素与无效或有效对照的随机对照试验。
结局为在给药后至少2周通过标准化、经过验证且国际认可的工具测量的精神症状。使用Cochrane偏倚风险评估工具和推荐分级评估、制定与评价框架独立评估质量。
有8项关于亚甲二氧基甲基苯丙胺的研究和6项关于裸盖菇素的研究。诊断包括创伤后应激障碍、长期/难治性抑郁症、强迫症、自闭症成年患者的社交焦虑以及危及生命疾病中的焦虑或抑郁。与创伤后应激障碍中的有效对照相比，亚甲二氧基甲基苯丙胺评分变化的信息最多且关联最强（n = 4；标准化均数差 = -0.86；95%置信区间 = [-1.23, -0.50]；P < 0.0001）。对自闭症成年患者的社交焦虑也有小的益处。在危及生命疾病的焦虑或抑郁方面，裸盖菇素优于等待名单对照，但不优于烟酸（有效对照）。在长期抑郁症的主要研究结局方面，裸盖菇素与艾司西酞普兰效果相当，在未经多重比较校正的分析中，在大多数次要结局方面更优。在监督试验中，两种药物耐受性良好。试验质量各不相同，随机阶段纳入的潜在参与者比例很小。使用推荐分级评估、制定与评价框架时，证据的总体确定性为低或非常低。
亚甲二氧基甲基苯丙胺和裸盖菇素在密切监督的环境中并给予强化支持的情况下，对高度选择的人群可能显示出前景。
