A Systematic Review of the efficacy, safety, and Tolerability of Psychedelics in the Treatment of post-traumatic Stress Disorder

A systematic review of 42 studies found that ketamine produced rapid symptom improvement for PTSD, though effects diminished in single-dose trials but persisted with repeated doses or when combined with psychotherapy. MDMA was associated with substantial and lasting symptom improvement in controlled settings. Data for ayahuasca, DMT, LSD, ibogaine, and psilocybin were preliminary but suggested potential benefits. Most studies assessed safety, and the treatments were generally well tolerated, with transient autonomic changes being the most common adverse effects. The evidence is strongest for MDMA and ketamine, but findings should be interpreted cautiously due to heterogeneity in study designs, sample sizes, and protocols.

Study at a glance

Abstract

Purpose A systematic review was conducted to synthesize the efficacy, safety, and tolerability of psychedelics including ketamine, MDMA, ayahuasca, LSD, DMT, ibogaine, and psilocybin in the treatment of PTSD. Recent Findings Among 5,155 studies identified, 42 studies met criteria and were included in our systematic review. Ketamine consistently produced rapid symptom improvement that attenuated in single-dose trials; but, persisted when repeated or in conjunction with psychotherapy. Studies using MDMA was associated with substantial and durable PTSD symptom improvement in controlled settings. Data for ayahuasca, DMT, LSD, ibogaine, and psilocybin were preliminary but suggested potential benefits. Safety was assessed in most studies and were overall well tolerated with transient autonomic changes being the most common adverse effects. Summary While MDMA and ketamine currently have the most developed evidence that supports their potential therapeutic roles in PTSD, findings should be interpreted cautiously given heterogeneity across study designs including sample size, sample make-up, protocols, and reporting. Other compounds show early promise but remain investigational. Large sample sizes and methodological rigorous studies with standardized objective endpoints and long-term safety follow-up are needed before these psychedelic-assisted interventions can be widely implemented or recommended in clinical practice.