Department of Psychiatry and Psychology, Mayo Clinic Health System, Eau Claire, WI, USA.
Behavioral Health Research Program, Department of Psychology and Psychiatry Research, Mayo Clinic, Rochester, MN, USA.
J Psychopharmacol. 2023 Sep;37(9):849-865. doi: 10.1177/02698811231190858. Epub 2023 Aug 31.
Hallucinogenic mushrooms have been used in religious and cultural ceremonies for centuries. Of late, psilocybin, the psychoactive compound in hallucinogenic mushrooms, has received increased public interest as a novel drug for treating mood and substance use disorders (SUDs). In addition, in recent years, some states in the United States have legalized psilocybin for medical and recreational use. Given this, clinicians need to understand the potential benefits and risks related to using psilocybin for therapeutic purposes so that they can accurately advise patients. This expert narrative review summarizes the scientific basis and clinical evidence on the safety and efficacy of psilocybin-assisted therapy for treating psychiatric disorders and SUDs. The results of this review are structured as a more extensive discussion about psilocybin's history, putative mechanisms of action, and recent legislative changes to its legal status. There is modest evidence of psilocybin-assisted therapy for treating depression and anxiety disorders. In addition, early data suggest that psilocybin-assisted therapy may effectively reduce harmful drinking in patients with alcohol use disorders. The evidence further suggests psilocybin, when administered under supervision (psilocybin-assisted therapy), the side effects experienced are mild and transient. The occurrence of severe adverse events following psilocybin administration is uncommon. Still, a recent clinical trial found that individuals in the psilocybin arm had increased suicidal ideations and non-suicidal self-injurious behaviors. Given this, further investigation into the safety and efficacy of psilocybin-assisted therapy is warranted to determine which patient subgroups are most likely to benefit and which are most likely to experience adverse outcomes related to its use.
致幻蘑菇在宗教和文化仪式中被使用了数个世纪。最近，致幻蘑菇中的精神活性化合物——裸盖菇素，作为一种治疗情绪和物质使用障碍（SUD）的新型药物受到了越来越多的关注。此外，近年来，美国的一些州已将裸盖菇素合法化，用于医疗和娱乐用途。鉴于此，临床医生需要了解使用裸盖菇素进行治疗的潜在益处和风险，以便能够准确地为患者提供建议。本专家叙述性综述总结了关于使用裸盖菇素辅助治疗精神疾病和 SUD 的安全性和疗效的科学依据和临床证据。本综述的结果以更广泛的讨论形式呈现，内容涉及裸盖菇素的历史、可能的作用机制，以及最近对其法律地位的立法变更。有一些关于使用裸盖菇素辅助治疗抑郁症和焦虑症的中度证据。此外，早期数据表明，裸盖菇素辅助治疗可能有效地减少酒精使用障碍患者的有害饮酒行为。有证据进一步表明，在监督下（裸盖菇素辅助治疗）使用裸盖菇素时，所经历的副作用是轻微且短暂的。使用裸盖菇素后发生严重不良事件的情况并不常见。尽管如此，一项最近的临床试验发现，接受裸盖菇素治疗的患者自杀意念和非自杀性自伤行为增加。因此，有必要进一步研究裸盖菇素辅助治疗的安全性和疗效，以确定哪些患者亚组最有可能受益，以及哪些患者最有可能因使用裸盖菇素而产生不良后果。
