Psychedelika in der Psychiatrie

 

 Buy Article Permissions and Reprints

ZUSAMMENFASSUNG

Psychedelika stoßen in der Psychiatrie auf ein erneut zunehmendes fachliches und wissenschaftliches Interesse. Nach einer intensiveren Phase des Einsatzes im psychotherapeutischen Kontext Mitte des letzten Jahrhunderts kam die Forschung in dem Bereich nach gesetzlichen Verboten weitestgehend zum Erliegen. Erst seit wenigen Jahren wird das klinische Potenzial wieder mit modernen wissenschaftlichen Methoden erforscht. Die Eigenschaft der Psychedelika, qualitativ veränderte Bewusstseinszustände mit auch psychodynamischen Erfahrungen und Erkenntnissen hervorzurufen, legt die Möglichkeit nahe, sie zur Unterstützung von psychotherapeutischen Prozessen zu nutzen. Bisherige Indikationsgebiete von klinischen Studien betreffen vor allem den Einsatz bei therapieresistenten Depressionen, aber auch bei posttraumatischen Belastungsstörungen und Alkoholabhängigkeit. Allerdings muss festgehalten werden, dass eine spezifische Psychedelika-Psychotherapie im engeren Sinnen noch nicht erforscht wird. Neben dem Ausbau der Evidenzlage ist in diesem Feld noch einiges vor einem eventuellen breiteren klinischen Einsatz zu erarbeiten.

Publication History

Article published online:
14 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• Literatur

• 1 Akers B, Ruiz JF, Piper A. et al A Prehistoric Mural in Spain Depicting Neurotropic Psilocybe Mushrooms. Economic Botany 2011; 65 (02) 121-128
  CrossrefGoogle Scholar
• 2 Beringer K.. Der Mescalinrausch. Seine Geschichte und Erscheinungsweise. Berlin: Julius Springer; 1927
  CrossrefGoogle Scholar
• 3 Herwig U, Mertens L, Perez Rosal S. et al Psychedelika in der Psychiatrie – Entwicklungen und die Stellung in Deutschland. Fortschr Neurol Psychiatr 2023; 91: 311-318
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Passie T, Guss J, Krähenmann R. Lower-dose psycholytic therapy – A neglected approach. Front Psychiatry 2022; 13: 1020505 DOI: 10.3389/fpsyt.2022.1020505.
  CrossrefPubMedGoogle Scholar
• 5 Mascher E.. Psycholytic therapy: statistics and indications. In: Brill, H. et al. eds. Neuro-Psychopharmacology. Amsterdam: Excerpta Medica Foundation 1967: 441-414
  PubMedGoogle Scholar
• 6 Holze F, Singh N, Liechti ME. et al Serotonergic Psychedelics – a Comparative review Comparing the Efficacy, Safety, Pharmacokinetics and Binding Profile of Serotonergic Psychedelics. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 30: S2451-9022 (24)00020-X DOI: 10.1016/j.bpsc.2024.01.007.
  CrossrefPubMedGoogle Scholar
• 7 Roth BL, Gumpper RH. Psychedelics as Transformative Therapeutics. Am J Psychiatry 2023; 180 (05) 340-347
  CrossrefPubMedGoogle Scholar
• 8 Vollenweider FX, Kometer M. The neurobiology of psychedelic drugs: implications for the treatment of mood disorders. Nat Rev Neurosci 2010; 11 (09) 642-651 DOI: 10.1038/nrn2884.
  CrossrefPubMedGoogle Scholar
• 9 Griffiths RR, Richards WA, McCann U. et al Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacol 2006; 187 (03) 268-283 DOI: 10.1007/s00213-006-0457-5.
  CrossrefPubMedGoogle Scholar
• 10 Leuner H.. Halluzinogene. Psychische Grenzzustände in Therapie und Forschung. Bern: Verlag Hans Huber; 1981
  Google Scholar
• 11 Dittrich A. The standardized psychometric assessment of altered states of consciousness (ASCs) in humans. Pharmacopsychiatry. 1998 Suppl 2 80-84 DOI: 10.1055/s-2007-979351
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Holze F, Ley L, Müller F. et al Direct comparison of the acute effects of lysergic acid diethylamide and psilocybin in a double-blind placebo-controlled study in healthy subjects. Neuropsychopharmacology 2022 DOI: 10.1038/s41386-022-01297-2
  CrossrefPubMedGoogle Scholar
• 13 Nutt DJ, King LA, Phillips LD. et al Drug harms in the UK: a multicriteria decision analysis. Lancet 2010; 376 9752 1558-1565 DOI: 10.1016/S0140-6736(10)61462-6.
  CrossrefPubMedGoogle Scholar
• 14 Griffiths RR, Johnson MW, Richards WA. et al Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects. Psychopharmacology 2011; 218 (04) 649-665 DOI: 10.1007/s00213-011-2358-5.
  CrossrefPubMedGoogle Scholar
• 15 Hendricks PS, Thorne CB, Clark CB. et al Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population. J Psychopharmacol 2015; 29 (03) 280-288 DOI: 10.1177/0269881114565653.
  CrossrefPubMedGoogle Scholar
• 16 Grob CS, Danforth AL, Chopra GS. et al Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Arch Gen Psychiatry 2011; 68 (01) 71-78 DOI: 10.1001/archgenpsychiatry.2010.116.
  CrossrefPubMedGoogle Scholar
• 17 Gasser P, Holstein D, Michel Y. et al Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases. J Nerv Ment Dis 2014; 202 (07) 513-520 DOI: 10.1097/NMD.0000000000000113.
  CrossrefPubMedGoogle Scholar
• 18 Carhart-Harris RL, Bolstridge M, Rucker J. et al Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 2016; 03 (07) 619-627 DOI: 10.1016/S2215-0366(16)30065-7.
  CrossrefPubMedGoogle Scholar
• 19 Carhart-Harris RL, Bolstridge M, Day CMJ. et al Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology (Berl). 2018; 235 (02) 399-408 DOI: 10.1007/s00213-017-4771-x.
  CrossrefPubMedGoogle Scholar
• 20 Davis AK, Barrett FS, May DG. et al Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2021; 78 (05) 481-489 DOI: 10.1001/jamapsychiatry.2020.3285. Erratum in: JAMA Psychiatry. 2021 Feb 10.
  CrossrefGoogle Scholar
• 21 Gukasyan N, Davis AK, Barrett FS. et al Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: Prospective 12-month follow-up. J Psychopharmacol 2022; 36 (02) 151-158 DOI: 10.1177/02698811211073759.
  CrossrefPubMedGoogle Scholar
• 22 Carhart-Harris R, Giribaldi B, Watts R. et al Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med 2021; 384 (15) 1402-1411 DOI: 10.1056/NEJMoa2032994.
  CrossrefPubMedGoogle Scholar
• 23 Weiss B, Erritzoe D, Giribaldi B. et al A critical evaluation of QIDS-SR-16 using data from a trial of psilocybin therapy versus escitalopram treatment for depression. J Psychopharmacol 2023; 37 (07) 717-732 DOI: 10.1177/02698811231167848.
  CrossrefPubMedGoogle Scholar
• 24 Goodwin GM, Aaronson ST, Alvarez O. et al Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression. N Engl J Med 2022; 387 (18) 1637-1648 DOI: 10.1056/NEJMoa2206443.
  CrossrefPubMedGoogle Scholar
• 25 Goodwin GM, Croal M, Feifel D. et al Psilocybin for treatment resistant depression in patients taking a concomitant SSRI medication. Neuropsychopharmacology 2023; 48 (10) 1492-1499 DOI: 10.1038/s41386-023-01648-7.
  CrossrefPubMedGoogle Scholar
• 26 von Rotz R, Schindowski EM, Jungwirth J. et al Single-dose psilocybin-assisted therapy in major depressive disorder: A placebo-controlled, double-blind, randomised clinical trial. EClinicalMedicine 2022; 56: 101809 DOI: 10.1016/j.eclinm.2022.101809. Erratum in: EClinicalMedicine 2023; 30; 56: 101841.
  CrossrefGoogle Scholar
• 27 Raison CL, Sanacora G, Woolley J. et al Single-Dose Psilocybin Treatment for Major Depressive Disorder: A Randomized Clinical Trial. JAMA 2023; 330 (09) 843-853 DOI: 10.1001/jama.2023.14530. Erratum in: JAMA. 2024 Jan 26.
  CrossrefGoogle Scholar
• 28 Roseman L, Nutt DJ, Carhart-Harris RL. Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression. Front Pharmacol 2018; 08: 974 DOI: 10.3389/fphar.2017.00974.
  CrossrefPubMedGoogle Scholar
• 29 Bogenschutz MP, Forcehimes AA, Pommy JA. et al Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. J Psychopharmacol 2015; 29 (03) 289-99 DOI: 10.1177/0269881114565144.
  CrossrefPubMedGoogle Scholar
• 30 Bogenschutz MP, Ross S, Bhatt S. et al Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79 (10) 953-962 DOI: 10.1001/jamapsychiatry.2022.2096. Erratum in: JAMA Psychiatry. 2022 Sep 14.
  CrossrefGoogle Scholar
• 31 Mithoefer MC, Wagner MT, Mithoefer AT. et al The safety and efficacy of { ± }3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. J Psychopharmacol 2011; 25 (04) 439-452 DOI: 10.1177/0269881110378371. Erratum in: J Psychopharmacol 2011; 25(6): 852.
  CrossrefGoogle Scholar
• 32 Mitchell JM, Bogenschutz M, Lilienstein A. et al MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 2021; 27 (06) 1025-1033 DOI: 10.1038/s41591-021-01336-3.
  CrossrefPubMedGoogle Scholar
• 33 Mitchell JM, Ot’alora G M, van der Kolk B. et al MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nat Med 2023; 29 (10) 2473-2480 DOI: 10.1038/s41591-023-02565-4.
  CrossrefPubMedGoogle Scholar
• 34 Reckweg JT, van Leeuwen CJ, Henquet C. et al A phase ½ trial to assess safety and efficacy of a vaporized 5-methoxy-N,N-dimethyltryptamine formulation (GH001) in patients with treatment-resistant depression. Front Psychiatry 2023; 14: 1133414 DOI: 10.3389/fpsyt.2023.1133414.
  CrossrefPubMedGoogle Scholar
• 35 Mash DC. IUPHAR – invited review – Ibogaine – A legacy within the current renaissance of psychedelic therapy. Pharmacol Res 2023; 190: 106620 DOI: 10.1016/j.phrs.2022.106620.
  CrossrefPubMedGoogle Scholar
• 36 Cherian KN, Keynan JN, Anker L. et al Magnesium-ibogaine therapy in veterans with traumatic brain injuries. Nat Med 2024 DOI: 10.1038/s41591-023-02705-w
  CrossrefPubMedGoogle Scholar
• 37 Holze F, Gasser P, Müller F. et al Lysergic Acid Diethylamide-Assisted Therapy in Patients With Anxiety With and Without a Life-Threatening Illness: A Randomized, Double-Blind, Placebo-Controlled Phase II Study. Biol Psychiatry 2023; 93 (03) 215-223 DOI: 10.1016/j.biopsych.2022.08.025.
  CrossrefPubMedGoogle Scholar
• 38 Gründer G, Brand M, Mertens LJ. et al Treatment with psychedelics is psychotherapy: beyond reductionism. Lancet Psychiatry. 2023 S2215-0366(23)00363–2. doi: 10.1016/S2215-0366(23)00363-2
  PubMedGoogle Scholar
• 39 Goodwin GM, Malievskaia E, Fonzo GA. et al Must Psilocybin Always “Assist Psychotherapy”?. Am J Psychiatry 2024; 181 (01) 20-25 DOI: 10.1176/appi.ajp.20221043.
  CrossrefPubMedGoogle Scholar
• 40 Aicher HD, Schmid Y, Gasser P.. Psychedelika-assistierte Psychotherapie. Psychotherapie 2024; 69: 98-106 DOI: 10.1007/s00278-024-00711-y.
  CrossrefGoogle Scholar
• 41 Ponomarenko P, Seragnoli F. Calder et al Can psychedelics enhance group psychotherapy? A discussion on the therapeutic factors. J Psychopharmacol 2023; 37 (07) 660-678 DOI: 10.1177/02698811231155117.
  CrossrefPubMedGoogle Scholar
• 42 Barber GS, Aaronson ST. The Emerging Field of Psychedelic Psychotherapy. Curr Psychiatry Rep 2022; 24 (10) 583-590 DOI: 10.1007/s11920-022-01363-y.
  CrossrefPubMedGoogle Scholar
• 43 Oehen P, Gasser P. Using a MDMA- and LSD-Group Therapy Model in Clinical Practice in Switzerland and Highlighting the Treatment of Trauma-Related Disorders. Front Psychiatry 2022; 13: 863552 DOI: 10.3389/fpsyt.2022.863552.
  CrossrefPubMedGoogle Scholar