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PTSD: National Center for PTSD

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Psychedelics are being increasingly researched as a novel method of augmenting the effectiveness of psychotherapies for the treatment of mental health conditions. The most studied psychedelics to date include psilocybin and 3,4-methylenedioxymethamphetamine MDMA. Despite the effectiveness of current evidence-based treatments for PTSD and depression, many people do not benefit enough from these treatments. One exciting area of research is examining psychotherapy augmentation strategies with psychedelic drugs, a subclass of hallucinogenic drugs that trigger non-ordinary states of consciousness. They 'alter perception and mood and affect numerous cognitive processes' 1. Two specific psychedelic compounds, MDMA often referred to as a non-classic psychedelic and psilocybin, have received most of the research attention to date. While these are both still Schedule I substances—drugs with high abuse potential and no currently accepted medical use—ongoing research efforts have found support for using these compounds in conjunction with therapy to treat various mental health conditions, including PTSD. MDMA is a monoamine releaser and re-uptake inhibitor with indirect effects on neurohormone release. The effects of MDMA include reduced fear 2 , increased social engagement 3 , increased openness 4 , increased receptiveness to positive affect 5 , increased empathy and compassion 6,7 , increased feelings of closeness 8 , and increased disclosure of emotional content 9. MDMA targets memory reconsolidation and fear extinction processes, allowing for expanded perspectives and positive, affirming experiences. The premise for MDMA-AT is that the therapeutic effects of MDMA are the result of an interaction between the medicine, the psychotherapy component, and the mindset of the participant and the therapists involved. These key areas help individuals with PTSD to overcome avoidance and better address their PTSD symptoms while working through their trauma under the guidance of a therapist. To date, the greatest evidence base is for the Lykos Therapeutics 'Lykos'; formerly MAPS Public Benefit Corporation protocol 26 , which includes twelve min therapy sessions plus three hour medicine sessions. The medication sessions are separated by at least 21 days, and each requires the engagement of 2 therapists. There are three minute preparation sessions prior to the first medicine session and each medicine session is followed by three minute integration sessions during which the patient has an opportunity to process their experience with the therapist s. Two recent randomized placebo-controlled phase 3 trials of the Lykos MDMA-AT protocol have demonstrated treatment efficacy with large effect sizes. In both trials, PTSD symptom severity significantly decreased more for participants who were administered MDMA-AT than for participants who received placebo and therapy, supporting the therapeutic value of MDMA itself as an addition to psychotherapy Four additional phase 2 studies focused on dose response, with all studies finding that participants in MDMA-AT were more likely to achieve clinically significant PTSD reductions than those in the control group Although MDMA-AT has historically been used with a non-directive therapy approach to help individuals process traumatic memories, as of February , several studies are underway to explore whether MDMA-AT could be further enhanced by augmenting established evidence-based trauma-focused therapies that have been rolled out in VA. These studies will inform next steps for larger clinical trials and implementation. Psilocybin is the active ingredient in a variety of hallucinogenic mushrooms. When ingested, psilocybin is converted to psilocin, which then acts as an agonist at several serotonergic and non-serotonergic receptors. Psilocybin has been shown to have low physiological toxicity i. Individuals who take psilocybin report a wide range of experiences for hours depending on the dose, including visual imagery of multicolored geometric shapes, vivid imaginative sequences, synesthesia i. These psychedelic experiences are often of great personal significance Of note, psilocybin remains a Schedule I drug, although as of February , Australia, the states of Oregon and Colorado, and the Canadian state of Alberta have legalized psilocybin for medicinal purposes in supervised settings. Similar bills are currently underway in the states of California, Washington, New Jersey, and Massachusetts. Although psilocybin has shown efficacy for treating depression, anxiety, and substance use , there has been minimal research on its impact on PTSD symptoms. Psychedelics can also decrease amygdala reactivity during emotion processing 49,50 , which may reverse the heightened amygdala reactivity typically seen in PTSD 51 , thereby increasing the ability to process traumatic memories. Psilocybin also increases emotional empathy 51 , mindfulness-related capacities 52,53 acceptance, and connectedness while reducing avoidance 54 , which may all facilitate PTSD treatment. Alongside sessions of supportive psychotherapy, psilocybin administration may help those with PTSD tolerate challenging emotions and address the traumas that they have experienced, while also finding new perspectives on unhelpful or negative thoughts. P-AT is showing promise as a powerful treatment for a variety of mental health conditions including treatment-resistant unipolar depression 39 , depression and anxiety secondary to serious medical illnesses like cancer 40,55,56 , and substance use disorders 41, Typical P-AT protocols include a non-directive psychotherapy component focused on preparation and integration of the psychedelic experience, with some including established cognitive behavioral therapeutic modalities, such as Acceptance and Commitment Therapy 58 , as part of integration. Protocols typically have about six minute therapy sessions and one to two 6- to 8-hour administration sessions A recent meta-analysis on the effects of P-AT on anxiety and depression showed large and statistically significant reductions of anxiety In the placebo-controlled studies included in the meta-analysis, these results were maintained, indicating the therapeutic potential of psilocybin for treating anxiety and depression. Although there is currently no published data on psilocybin use for treating PTSD, the strong impact of psilocybin on conditions that often co-occur with PTSD, such as depression and anxiety, indicates the potential beneficial impact of the psilocybin augmented PTSD treatment. While clinical trial data are lacking, anecdotal clinical data from the ss suggests that psychedelic therapy can help individuals deal with severe trauma 61, More recently, a survey of U. Finally, preliminary data suggests that a single administration of psilocybin along with group psychotherapy can decrease symptoms of PTSD in older long-term AIDS survivors For a review of psilocybin use for treating trauma-related disorders, please see Khan et al. There are ongoing trials of P-AT for alcohol use disorder, depression, and obsessive-compulsive disorder, among others. Although these studies are oriented toward preliminary evaluation and establishing feasibility and thus have small sample sizes, the results of this research will inform future research studies in P-AT for PTSD, which may include larger-scale trials. While the double-blind randomized controlled trial RCT is considered the gold standard design for identifying treatment-specific effects, the strong physical and psychological effects of psychedelics create difficulties effectively conducting blinded, controlled trials. Participants and investigators can typically tell if the person received the investigational product or a placebo thus breaking the blind. Failing to keep patients and researchers and staff uncertain of treatment condition assignment i. If participants know they have received the psychedelic treatment they already believe will improve their symptoms, this alone can improve clinical outcomes i. Conversely, if participants know they received a treatment they already believe is unlikely to improve their symptoms, e. Use of 'active' placebos that mimic aspects of the psychedelic experience is essential, as is the use of masked assessors. Study staff also should be masked to the extent possible. The adequacy of masking for both patients and providers should be assessed, along with patients' treatment expectations before treatment. Despite the large effects of expectancies on treatment outcomes in psychedelic RCTs, baseline treatment expectancies and masking efficacy typically go unmeasured Indeed, many researchers report their psychedelic studies as 'double-masked' without testing such claims There is a critical need for trial designs with psychedelics to better manage expectancy effects Many existing studies on MDMA-AT and P-AT also include small sample sizes and maintain some risk of bias, particularly with lack of randomization and unexpectedly high response to low dose control conditions 59,73, Therefore, there is an urgent need for additional studies with Veteran participants within the VA medical setting, as well as additional studies on P-AT for PTSD and studies with larger, more diverse samples. Both MDMA-AT and P-AT protocols emphasize 'set and setting', or the preparation of the patients for medicine administration as well as the creation of a safe and welcoming environment for dosage, as essential to safety and effective treatment There are 2 essential components of set and setting, both of which influence the individual's response to the drug and the overall experience during the medicine session. Set consists of the expectations and intentions that the patient comes in with, whereas setting refers to the physical, social, and cultural context in which the drug is taken Protocols also typically require the presence of 2 therapists for all medicine administration sessions, though only one is required to be present during other pre- and post-administration sessions in some cases It can be difficult to optimize both set and setting for a patient when attempting to implement psychedelic-assisted psychotherapy. Medicine sessions are optimal under specific physical settings, aspects of which may be hard to achieve if there is limited space available for private use for extended periods of time or restrictions on physical alterations that can be made to the space being used. It is important to note that current studies examining P-AT and MDMA-AT include rigorous medical and psychological eligibility criteria, with exclusion criteria preventing many individuals with PTSD from being eligible for the studies. While there will likely be fewer inclusion and exclusion criteria for clinical care, there will still be several medical conditions that would pose safety concerns if the patient were to take MDMA, such as uncontrolled hypertension, underlying cardiovascular or cerebrovascular disease 78 , and symptomatic liver disease. While P-AT protocols differ in some ways, administration sessions last an average of 7. The time demands of either treatment could serve as a barrier to patients with inflexible schedules due to work, childcare, other medical care, etc. It is also often required that 2 providers attend, at minimum, all medicine sessions with patients, which typically takes up the entire workday for both therapists. Information on the Lykos model and research can be found on the Lykos Therapeutics website. Veterans Crisis Line: Call: Press 1. Complete Directory. If you are in crisis or having thoughts of suicide, visit VeteransCrisisLine. Quick Links. Site Map.

Buying Ecstasy online in Ruse