Imported Top List

An even longer follow-up has been done by Jerome and colleagues on the results of the Phase 2 trials FDA trials led by MAPS. At twelve months later, 67% of participants in the double-blind study didn’t meet the criteria for PTSD. Of the participants in the study, more than half indicated that they experienced large benefits that continued or grown over time. This is another positive signal that psychedelics may become a treatment option for those suffering from mental health disorders. An analysis of the costs of this medical model by Marseille and colleagues optimistically models that MDMA-assisted psychotherapy for PTSD can add many good years (QALY) at lower costs than conventional treatments.

Who says that therapy assisted by psychedelics needs to be done one person at a time. Anderson and colleagues show, with this pilot study (n=18), that psilocybin can be useful in treating demoralization, it also has the potential to be used in a group setting. Although more studies are needed, doing the preparation and follow-up (or even the session with psychedelics) in a group setting shows the potential to improve the costs side of the equation even further.

Psychedelics as therapeutics have been catching headlines as treatments for PTSD, depression (TRD, MDD), addiction (see below), and many more mental health disorders/symptoms. Schindler and colleagues expand the reach of psychedelics with the first double-blind, placebo-controlled study (n=10) with a medium dose of psilocybin for migraines. The study found a significant reduction in migraines up to two weeks later. Via which mechanisms this happens is currently still up for debate, a recent review of psychedelics for cluster headaches identified changes in functional connectivity as a possible route.

Psychedelics are, well … psychedelic. They change someone’s consciousness during the acute psychedelic experience. In the long-term, they can be beneficial for a wide range of indications as already discussed. But what if you took out the acute psychedelic effects, whilst preserving the long-term outcomes? This is what Cameron and colleagues explored in their paper on tabernanthalog, an analog to ibogaine which (in mice) led to similar structural neural plasticity (something seen with other psychedelics too, e.g. Ly et al., 2018 or Barrett et al., 2020), reduction in addiction-like behavior, and antidepressant-like effects. If these results translate to humans, it could mean that this new type of psychedelics (without the acute effect and lower to no toxicity) a possible therapeutic for even more people.

A closer inspection of what happens inside the brain during a psychedelic experience was done by Mason and colleagues. This paper investigates the changes in the neurotransmitter glutamate in different brain areas. The authors conclude that psychedelics may increase neuroplasticity via glutamatergic activity. In the double-blind, placebo-controlled brain imaging study, lower levels of hippocampal glutamate were associated with a positively experienced ego dissolution. Many other studies in 2020 investigated the neuronal changes at the peak of a psychedelic experience. Alamia and colleagues provide further evidence of changed cortical waves under DMT. Whilst Varley and colleagues find that psilocybin and LSD increase fractal dimensions in brain areas related to spatial and temporal domains.

A final area of interest this year was the production of psychedelics itself. If they are to be available for thousands (upon thousands) of people, the production (and administration) of psychedelics needs to be done at scale and with lower costs. Kargbo and colleagues (primarily at Usona Institute) have made available a way of making psilocybin at scale (1kg, or >33.000 high dosages). This paper though wasn’t the only one to look at novel ways of producing psychedelics. Milne and colleagues were able to use brewer’s yeast to produce not only psilocybin, but also norbaeocystin, baeocystin, and aeruginascin. And co-authors on the paper of this section, Cozzi and Daley also synthesized DMT for clinical trials.

The studies above provide a glimpse into the brave new future of psychedelics research. They show the ways in which psychedelics can be beneficial, how they work in the brain, and even how we can produce them at scale. Looking back at the research, in the most often cited paper of the year, Reiff and colleagues summarize the current findings on psychedelics for psychedelic-assisted psychotherapy. They identify and celebrate the studies with MDMA for PTSD, the psilocybin trials for depression and cancer-related anxiety. This review looked only until the middle of 2019 and since then studies like the ones above have added more evidence for psychedelics as therapeutics. Another review by Goldberg and colleagues came to a similar conclusion, finding large positive effects on a variety of mental health symptoms.