[Psychedelic and dissociative agents in psychiatry: challenges in the treatment].

A review article examines the risks and methodological weaknesses of studies on psychedelic and dissociative agents for mental health treatment. While ketamine, esketamine, LSD, and psilocybin show promising results for conditions like treatment-resistant depression, leading to approvals of esketamine in the US, EU, and Switzerland, and psilocybin for compassionate use in Australia, Canada, and Switzerland, the authors caution that excessive expectations and insufficient risk-benefit estimation can harm patients and physician reputation. The article focuses specifically on treatment risks and study quality issues, emphasizing that careful assessment of challenges is crucial despite hopes for a paradigm shift in psychiatry.

Study at a glance

Abstract

With the discovery of the antidepressive effects of ketamine and the increasing withdrawal of the pharmaceutical industry from the development of new psychotropic drugs, the psychiatric research into the clinical application of hallucinogens in psychiatry has literally blossomed in the last two decades. Promising results for various treatment approaches with psychedelic agents, such lysergic acid diethylamide (LSD) and psilocybin, and dissociative agents, such as ketamine and esketamine, have raised great hopes among researchers, clinicians and patients in recent years, so that there was already talk of a new era in psychiatry. As one of the first of these substances, in December 2019 intranasal esketamine was approved in the USA and the EU for the treatment of treatment-resistant depression and Switzerland followed in 2020. Recently, psilocybin was approved in Australia, Canada and Switzerland for compassionate use in exceptional cases for the treatment of depression, while large approval studies with various psychedelic agents are currently ongoing worldwide. The medical application of psychedelic agents and ketamine/esketamine is considered to be safe; however, as with all new forms of treatment it is of crucial importance that, in addition to the hopes, the specific challenges of these new treatment approaches must also be carefully considered and assessed. Excessive expectations and an insufficient risk-benefit estimation are detrimental to the patients and the reputation of the treating physician. Although a possible paradigm shift in the care of mental health is already being discussed, this review article consciously concentrates on the possible risks of treatment and the methodological weaknesses of the studies carried out so far.