Are Psychedelics Something New in Teaching Psychopharmacology?
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EDITORIAL
Are Psychedelics Something New in Teaching Psychopharmacology? Alan K. Louie 1 & Eugene V. Beresin 2 & John Coverdale 3 & Richard Balon 4 & Anthony P. S. Guerrero 5 & Mary K. Morreale 4 & Rashi Aggarwal 6 & Adam M. Brenner 7
# Academic Psychiatry 2020
These are interesting times for the practice and teaching of psychopharmacology. For instance, the repurposing of ketamine, the dissociative anesthetic, from anesthesiology into the practice of psychiatry, has garnered considerable interest as a potential innovation in the treatment of major depression [1]. Similarly attracting attention is the re-emergence of psychedelic drugs as potential treatments for a wide range of psychiatric disorders [2, 3]. Baby-boomer psychiatrists will remember the age of psychedelics in the 1960s [4], while subsequently trained generations of psychiatrists rarely, if ever, heard about them as potential treatments. A hiatus occurred for psychedelic research, from the mid-1970s into the mid-1990s [4]. Despite this hiatus, careful scientific studies with psychedelics began in the mid1990s, by a few investigators [2]. A July 31, 2020, ClinicalTrials.gov search using the term psychedelics [5] listed 268 National Institute of Health trials for the treatment of both medical and psychiatric conditions, the latter of which include depression, anxiety, obsessive compulsive disorder, posttraumatic stress disorder (PTSD), substance use disorders, and cognitive impairment. Psychedelic drugs [2, 3] include “classical” psychedelics like lysergic acid diethylamide (LSD), psilocybin, and ayahuasca, which are agonists at the serotonin 2A receptor, and empathogens like 3,4-methylenedioxymethamphetamine (MDMA), which release and inhibit the reuptake of serotonin * Alan K. Louie [email protected] 1
Stanford University, Stanford, CA, USA
2
Harvard Medical School, Boston, MA, USA
3
Baylor College of Medicine, Houston, TX, USA
4
Wayne State University, Detroit, MI, USA
5
University of Hawai’i John A. Burns School of Medicine, Honolulu, HI, USA
6
Rutgers New Jersey Medical School, Newark, NJ, USA
7
University of Texas Southwestern Medical Center, Dallas, TX, USA
and dopamine. Sometimes, other compounds, like ketamine, and atypical hallucinogens are also called psychedelics. Psilocybin, found in some mushrooms, and ayahuasca, consisting of two plant-based compounds, have been part of sacred ceremonies of ancient cultures and provide an interface between Western psychiatry and traditional indigenous healing approaches. State-of-the-art human studies with psychedelics are not easy to conduct given regulatory challenges and complex design issues, including providing an appropriate control group and blinding. Nevertheless, over the past couple decades, enough evidence has gradually accumulated to warrant Food and Drug Administration (FDA) trials. Psilocybin is currently in early phase 2 trials for the treatment of major depressive disorder [6] and treatment-resistant depression [7] under an FDA breakthrough therapy designation. MDMA is in
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