Hashimoto Kenji
Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chiba, 260-8670, Japan.
Eur Arch Psychiatry Clin Neurosci. 2024 Feb 27. doi: 10.1007/s00406-024-01770-7.
The growing interest in the rapid and sustained antidepressant effects of the dissociative anesthetic ketamine and classic psychedelics, such as psilocybin, is remarkable. However, both ketamine and psychedelics are known to induce acute mystical experiences; ketamine can cause dissociative symptoms such as out-of-body experience, while psychedelics typically bring about hallucinogenic experiences, like a profound sense of unity with the universe or nature. The role of these mystical experiences in enhancing the antidepressant outcomes for patients with depression is currently an area of ongoing investigation and debate. Clinical studies have shown that the dissociative symptoms following the administration of ketamine or (S)-ketamine (esketamine) are not directly linked to their antidepressant properties. In contrast, the antidepressant potential of (R)-ketamine (arketamine), thought to lack dissociative side effects, has yet to be conclusively proven in large-scale clinical trials. Moreover, although the activation of the serotonin 5-HT receptor is crucial for the hallucinogenic effects of psychedelics in humans, its precise role in their antidepressant action is still under discussion. This article explores the importance of mystical experiences in enhancing the antidepressant efficacy of both ketamine and classic psychedelics.
对分离麻醉剂氯胺酮以及经典迷幻剂（如裸盖菇素）迅速且持续的抗抑郁作用的兴趣日益浓厚，这一点值得关注。然而，氯胺酮和迷幻剂都已知会引发急性神秘体验；氯胺酮会导致诸如离体体验等分离症状，而迷幻剂通常会带来致幻体验，比如与宇宙或自然的深刻合一感。这些神秘体验在增强抑郁症患者抗抑郁疗效方面的作用，目前是一个正在进行研究和辩论的领域。临床研究表明，服用氯胺酮或（S）-氯胺酮（艾氯胺酮）后出现的分离症状与其抗抑郁特性并无直接关联。相比之下，被认为缺乏分离副作用的（R）-氯胺酮（阿氯胺酮）的抗抑郁潜力，在大规模临床试验中尚未得到确凿证实。此外，尽管血清素5-HT受体的激活对迷幻剂在人体内的致幻作用至关重要，但其在抗抑郁作用中的精确角色仍在讨论之中。本文探讨了神秘体验在增强氯胺酮和经典迷幻剂抗抑郁疗效方面的重要性。
