Nina Schimmel1, Joost J Breeksema2, Sanne Y Smith-Apeldoorn2, Jolien Veraart2,3, Wim van den Brink4, Robert A Schoevers2. 1. Department of Psychiatry, University Medical Center, 9713 GZ, Hanzeplein 1 GroningenGroningen, Netherlands. n.schimmel@umcg.nl. 2. Department of Psychiatry, University Medical Center, 9713 GZ, Hanzeplein 1 GroningenGroningen, Netherlands. 3. PsyQ Haaglanden, Parnassia Psychiatric Institute, Mangostraat 1, 2552 KS, The Hague, The Netherlands. 4. Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Terminally ill patients may experience existential distress, depression, or anxiety, limiting quality of life in the final stage. Existing psychotherapeutic or pharmacological interventions have (time) limited efficacy. Psychedelic treatment may be a safe and effective alternative treatment option. AIM: Systematically review studies on psychedelic treatment with and without psychotherapy for existential distress, depression, and anxiety in terminally ill patients. METHODS: Medline, PsycINFO, and Embase were searched for original-data studies on the treatment of depression, anxiety, and existential distress with classical or a-typical psychedelics in patients with a terminal illness, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 1850 records were screened, and 33 articles were included in this review: 14 studies on classical psychedelics (DPT, LSD, and psilocybin) and 19 studies on atypical psychedelics (MDMA and ketamine). Results of early pre-post studies are promising but have serious methodological flaws. Recent (controlled) trials with LSD, psilocybin, ketamine, and MDMA are of higher methodological quality and indicate positive effects on existential and spiritual well-being, quality of life, acceptance, and reduction of anxiety and depression with few adverse and no serious adverse effects. CONCLUSIONS: Both classical and a-typical psychedelics are promising treatment options in patients with terminal illness. To draw final conclusions on effectiveness and safety of psychedelics, we need larger high-quality studies for classical psychedelics and MDMA. Ketamine studies should pay more attention to existential dimensions of well-being and the psychotherapeutic context of the treatment.
BACKGROUND: Terminally ill patients may experience existential distress, depression, or anxiety, limiting quality of life in the final stage. Existing psychotherapeutic or pharmacological interventions have (time) limited efficacy. Psychedelic treatment may be a safe and effective alternative treatment option. AIM: Systematically review studies on psychedelic treatment with and without psychotherapy for existential distress, depression, and anxiety in terminally ill patients. METHODS: Medline, PsycINFO, and Embase were searched for original-data studies on the treatment of depression, anxiety, and existential distress with classical or a-typical psychedelics in patients with a terminal illness, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 1850 records were screened, and 33 articles were included in this review: 14 studies on classical psychedelics (DPT, LSD, and psilocybin) and 19 studies on atypical psychedelics (MDMA and ketamine). Results of early pre-post studies are promising but have serious methodological flaws. Recent (controlled) trials with LSD, psilocybin, ketamine, and MDMA are of higher methodological quality and indicate positive effects on existential and spiritual well-being, quality of life, acceptance, and reduction of anxiety and depression with few adverse and no serious adverse effects. CONCLUSIONS: Both classical and a-typical psychedelics are promising treatment options in patients with terminal illness. To draw final conclusions on effectiveness and safety of psychedelics, we need larger high-quality studies for classical psychedelics and MDMA. Ketamine studies should pay more attention to existential dimensions of well-being and the psychotherapeutic context of the treatment.
Authors: Gabrielle I Agin-Liebes; Tara Malone; Matthew M Yalch; Sarah E Mennenga; K Linnae Ponté; Jeffrey Guss; Anthony P Bossis; Jim Grigsby; Stacy Fischer; Stephen Ross Journal: J Psychopharmacol Date: 2020-01-09 Impact factor: 4.153
Authors: Brian T Anderson; Alicia Danforth; Prof Robert Daroff; Christopher Stauffer; Eve Ekman; Gabrielle Agin-Liebes; Alexander Trope; Matthew Tyler Boden; Prof James Dilley; Jennifer Mitchell; Joshua Woolley Journal: EClinicalMedicine Date: 2020-09-24
Authors: William E Rosa; Zachary Sager; Megan Miller; Ilan Bernstein; Alden Doerner Rinaldi; Katie Addicott; Michael Ljuslin; Chris Adrian; Anthony L Back; Jamie Beachy; Anthony P Bossis; William S Breitbart; Mary P Cosimano; Stacy M Fischer; Jeffrey Guss; Emma Knighton; Janis Phelps; Brian D Richards; William A Richards; James A Tulsky; Monnica T Williams; Yvan Beaussant Journal: J Palliat Med Date: 2022-03-14 Impact factor: 2.947