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在临床实践中使用迷幻剂:比较治疗用途与潜在危害。

Using Psychedelics in Clinical Practice: Comparing Therapeutic Uses and Potential Harms.

作者信息

Tariq Rabeet

机构信息

Liaquat National Medical College, Karachi, Pakistan.

出版信息

Curr Rev Clin Exp Pharmacol. 2023;18(2):94-109. doi: 10.2174/2772432817666220321142707.

Abstract

Psychedelics might be the oldest psychoactive agents known to be used for inducing religious or mystical experiences. Their strong psychoactive effect was discovered accidentally in 1943 after the synthesis of Lysergic acid diethylamide (LSD) in 1937. These drugs became a mainstream area of research following the synthesis of LSD; however, several political and social factors led to their ban in 1966, after which research on psychedelics remained limited. These drugs became a major topic of scientific and ethical debate in the 1990's and the recent times have seen a 'Psychedelic renaissance' where the therapeutic value of psychedelics is being reconsidered. This article reports the historical perspective of psychedelics, pharmacologic action by 5-HT receptor agonism, and psychological effects and compares the proposed therapeutic uses, including uses in depression, PTSD, anxiety- related disorders, drug and alcohol addiction, neurodegenerative diseases, and auto-immune diseases to potential harms including the development of tolerance, hallucinogen persisting perception disorder, and potential psychosis. An analysis of history, pharmacology, and comparison of benefits and harms lead to the conclusion that the potential therapeutic benefits significantly outweigh the potential harms; thus, further research and clinical trials need to be conducted across different countries and cultures for their legal approval in clinical use.

摘要

迷幻剂可能是已知用于引发宗教或神秘体验的最古老的精神活性物质。1937年麦角酸二乙酰胺(LSD)合成后,其强大的精神活性作用于1943年被意外发现。LSD合成后,这些药物成为研究的一个主流领域;然而,一些政治和社会因素导致它们在1966年被禁止,此后对迷幻剂的研究仍然有限。这些药物在20世纪90年代成为科学和伦理辩论的一个主要话题,最近出现了一场“迷幻复兴”,迷幻剂的治疗价值正在被重新审视。本文报道了迷幻剂的历史背景、5-羟色胺受体激动作用的药理作用以及心理效应,并比较了其拟议的治疗用途,包括在抑郁症、创伤后应激障碍、焦虑相关疾病、药物和酒精成瘾、神经退行性疾病以及自身免疫性疾病中的用途,与潜在危害,包括耐受性的形成、致幻剂持续性感知障碍以及潜在的精神病。对历史、药理学的分析以及利弊比较得出结论,潜在的治疗益处显著超过潜在危害;因此,需要在不同国家和文化中进行进一步的研究和临床试验,以便其在临床使用中获得合法批准。

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