Apr 23, 2022
Welcome to PsychEd, the
psychiatry podcast for medical learners, by medical learners. This
episode covers psychedelic-assisted psychotherapy with Dr Emma
Hapke and Dr Daniel Rosenbaum, both of whom are psychiatrists at
the University Health Network in Toronto and co-founders of UHN’s
Nikean Psychedelic Psychotherapy Research Centre (in addition to
being lecturers in the Department of Psychiatry at the University
of Toronto).
The learning objectives for this
episode are as follows:
By the end of this episode, you
should be able to…
- Briefly describe the history of psychedelics in
psychiatry
- List the four classes of psychedelic drugs and
their mechanism of action
- Summarize the evidence regarding
psychedelic-assisted psychotherapy for various psychiatric
disorders
- Discuss patient selection considerations for
psychedelic-assisted psychotherapy
- Describe the safety, tolerability and possible
side effects of psychedelic-assisted psychotherapy
- Understand how a psychedelic-assisted
psychotherapy session is practically carried out
Guests: Dr Emma
Hapke and Dr Daniel Rosenbaum
Hosts: Dr Chase
Thompson (PGY4), Dr Nikhita Singhal (PGY3), Jake Johnston (CC4),
and Annie Yu (CC4)
Audio editing by: Nikhita Singhal
Show notes by: Nikhita Singhal
Interview Content:
- Introduction - 0:00
- Learning objectives - 02:47
- Definitions/categories of psychedelics -
03:24
- Classic psychedelics - 04:15
- Empathogens (e.g. MDMA) - 07:15
- Etymology of the term “psychedelic” -
09:30
- Ketamine - 12:24
- Iboga - 13:28
- Brief history of psychedelic medicine -
17:51
- Current evidence and ongoing trials -
27:38
- MDMA and PTSD - 29:26
- Psilocybin and treatment-resistant depression -
32:24
- A word of caution - 34:29
- End-of-life care - 38:47
- Practical aspects of psychedelic-assisted
psychotherapy sessions - 45:45
- Safety considerations - 01:04:04
- Future directions - 01:10:33
- Closing comments - 01:19:07
Resources:
References:
- 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. https://doi.org/10.1056/nejmoa2032994
- Carhart-Harris R, Nutt D. Serotonin and brain
function: a tale of two receptors. Journal of Psychopharmacology.
2017;31(9):1091-1120. https://doi.org/10.1177/0269881117725915
- 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(5):481–489. https://doi.org/10.1001/jamapsychiatry.2020.3285
- Griffiths RR, Johnson MW, Carducci MA, et al.
Psilocybin produces substantial and sustained decreases in
depression and anxiety in patients with life-threatening cancer: A
randomized double-blind trial. J Psychopharmacol.
2016;30(12):1181-1197. dhttps://dx.doi.org/10.1177%2F0269881116675513
- Griffiths RR, Johnson MW, Richards WA, et al.
Psilocybin-occasioned mystical-type experience in combination with
meditation and other spiritual practices produces enduring positive
changes in psychological functioning and in trait measures of
prosocial attitudes and behaviors. J Psychopharmacol.
2018;32(1):49-69. https://doi.org/10.1177/0269881117731279
- Johnson MW, Hendricks PS, Barrett FS, Griffiths
RR. Classic psychedelics: An integrative review of epidemiology,
therapeutics, mystical experience, and brain network function.
Pharmacol Ther. 2019;197:83-102. https://doi.org/10.1016/j.pharmthera.2018.11.010
- 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(6):1025-1033. https://doi.org/10.1038/s41591-021-01336-3
- Mithoefer MC, Mithoefer AT, Feduccia AA, et al.
3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for
post-traumatic stress disorder in military veterans, firefighters,
and police officers: a randomised, double-blind, dose-response,
phase 2 clinical trial. Lancet Psychiatry.
2018;5(6):486-497. https://doi.org/10.1016/s2215-0366(18)30135-4
- Nicholas CR, Henriquez KM, Gassman MC, et al.
High dose psilocybin is associated with positive subjective effects
in healthy volunteers. J Psychopharmacol.
2018;32(7):770-778. https://doi.org/10.1177/0269881118780713
- Reiff CM, Richman EE, Nemeroff CB, et al.
Psychedelics and Psychedelic-Assisted Psychotherapy. Am J
Psychiatry. 2020;177(5):391-410. https://doi.org/10.1176/appi.ajp.2019.19010035
- Rosenbaum D, Boyle AB, Rosenblum AM, Ziai S,
Chasen MR, Med MP. Psychedelics for psychological and existential
distress in palliative and cancer care. Curr Oncol.
2019;26(4):225-226. https://dx.doi.org/10.3747%2Fco.26.5009
- Swift TC, Belser AB, Agin-Liebes G, et al.
Cancer at the Dinner Table: Experiences of Psilocybin-Assisted
Psychotherapy for the Treatment of Cancer-Related Distress. Journal
of Humanistic Psychology. 2017;57(5):488-519. https://doi.org/10.1177/0022167817715966
CPA Note: The views expressed in
this podcast do not necessarily reflect those of the Canadian
Psychiatric Association.
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