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Recent years show an exponential increased interest (“renaissance”) in the use of psychedelics for the treatment of mental disorders and broader. Some of these treatments, such as psilocybin for depression, are in the process of formal regulation by regulatory bodies in the US (FDA) and Europe (EMA), and as such on the brink of real-world implementation. In the slipstream of these developments increasing commercial initiatives are taking shape. The European Psychiatric Association (EPA) acknowledges both the therapeutic potential of psychedelic substances and the challenges for both research and clinical implementation. Steps need to be taken toward a well-balanced policy based upon sound scientific evidence and research, aiming at safe, ethical responsible integration of psychedelic therapy available for all patients who can potentially benefit.
Methods
In this EPA policy paper, we highlight the potential benefits, and also the challenges of psychedelic treatments, which can be relevant for the future real-world implementation of these treatments.
Results
In addition to an overview of the current evidence and hypotheses of working mechanisms of psychedelic treatment, this policy paper specifically highlights the importance of the psychosocial components of the treatment as well as the ethical and professional aspects playing a role in real-world implementation.
Conclusions
Four recommendations are formulated for further research and clinical implementation.
Ayahuasca is an hallucinogenic tea prepared from the Amazonian vine Banisteriopsis caapi and the leaves of the plant Psychotria Viridis. Banisteriopsis caapi contains monoamine oxidase inhibitors (MAO) that render the N, N-dimethyltryptamine (DMT) of Psychotria Viridis active. This brew is being used as a sacrament in syncretic religions in urban areas of Brazil and worldwide with the purpose of enabling a spiritual experience as well as healing for a variety of conditions such as drug addiction, depression and anxiety disorders.
Objectives
This work aims to provide an understanding on the potential benefits of ayahuasca in psychiatric symptoms, as well as its neuropsychological functioning, neuroimaging and adverse events.
Methods
A non-systematic review was performed on PubMed database and Google Scholar, using the key words “Ayahuasca, Drug Addiction, Psychedelics, DMT, Neuroplasticity”. The review included experimental studies in humans, observational studies, systemic review articles and clinical trials.
Results
In a randomized placebo-controlled trial, ayahuasca had a significant antidepressant effect when compared to the placebo group. Long term ayahuasca usage was associated with structural alterations in the medial parts of the brain with no evidence of increased psychopathology or worse neuropsychological functioning. According to reviewed studies the incident of prolonged psychotic reaction among ayahuasca users is rare and the causal relation with ayahuasca is sometimes difficult to establish.
Conclusions
Despite the promising results, more controlled double-blinded studies with larger populations are necessary to better understand the therapeutic potentials and side effects of ayahuasca.
In chapter 6 we review recent work on psychedelics on brain function and on religious experiences. 5HT2A receptor signaling systems are covered as is the empirical evidence that transformative effects of psychdelics are linked to ego-dissolution and encounters with superntural agents during the experience.
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