From the Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles.
Psychedelic Support, Santa Cruz, CA.
J Clin Psychopharmacol. 2022;42(5):464-469. doi: 10.1097/JCP.0000000000001595. Epub 2022 Aug 20.
Among the renewed applications of psychedelic medicines in psychiatry, 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for posttraumatic stress disorder (PTSD) has demonstrated the most promise in early small-scale studies. Recent exploratory analyses from prior clinical trials of MDMA-assisted therapy for PTSD have suggested that recent use of selective serotonin reuptake inhibitors (SSRIs)-the only medication class with United States Food and Drug Administration (FDA) approval to treat PTSD-can significantly dampen the efficacy of this novel therapy. Although psychedelic medicines are not yet FDA approved, MDMA is very likely to be the first to achieve FDA approval-perhaps within the next 2 years. Given this timeline, the field would benefit from more knowledge about potential interactions between this novel therapy and our current treatments.
This brief report reviews selected literature in the basic and clinical neurosciences relevant to the interaction of SSRIs and MDMA.
The possibility that SSRI use could dampen future responses to MDMA-assisted therapy for PTSD raises many important questions about the biological mechanisms as well as ethical implications around the most appropriate way to counsel patients. In this brief report, we compare the evidence for SSRIs and MDMA-assisted therapy in the treatment of PTSD and discuss what is known about the neurobiological interactions between these 2 medicines.
There is strong neurobiological plausibility for the hypothesis that chronic SSRI use dampens response to MDMA-assisted therapy, although current knowledge in the field is limited and primarily relates to acute pharmacodynamic interactions. Our commentary highlights the urgent need for future work dedicated to addressing this important clinical topic.
在精神药理学领域对迷幻药物的应用研究中，3,4-亚甲二氧基甲基苯丙胺（MDMA）辅助治疗创伤后应激障碍（PTSD）的疗效在早期小规模研究中表现出了最大的潜力。最近对 MDMA 辅助治疗 PTSD 的临床试验进行的探索性分析表明，近期使用选择性 5-羟色胺再摄取抑制剂（SSRIs）——唯一一种获得美国食品和药物管理局（FDA）批准用于治疗 PTSD 的药物类别——会显著降低这种新型治疗方法的疗效。尽管迷幻药物尚未获得 FDA 批准，但 MDMA 很可能是第一个获得 FDA 批准的药物——也许在未来 2 年内。鉴于这一时间表，该领域将受益于更多关于这种新型治疗方法与我们目前治疗方法之间潜在相互作用的知识。
本简要报告回顾了基础和临床神经科学中与 SSRIs 和 MDMA 相互作用相关的选定文献。
SSRIs 的使用可能会降低未来对 MDMA 辅助治疗 PTSD 的反应的可能性，这引发了许多关于生物机制以及围绕最适当的咨询患者方式的伦理问题。在本简要报告中，我们比较了 SSRI 和 MDMA 辅助治疗 PTSD 的证据，并讨论了我们对这两种药物之间神经生物学相互作用的了解。
尽管目前该领域的知识有限，主要与急性药效动力学相互作用有关，但慢性 SSRIs 使用会降低对 MDMA 辅助治疗的反应的假设具有很强的神经生物学合理性。我们的评论强调了未来致力于解决这一重要临床课题的迫切需要。
