Psychedelics for the treatment of end-of-life distress in patients with a life-threatening disease.

Patients with life-threatening disease often experience end-of-life distress—physical, psychological, emotional, and spiritual suffering linked to chronic illness and the prospect of death. Palliative care aims to improve quality of life, but current psychological and pharmacological interventions show inconclusive evidence with only short- to moderate effects and often require months to work. Over the past decade, psychedelic-assisted therapy has been investigated for addressing end-of-life distress, producing highly significant and sometimes sustained decreases in depression and death anxiety, along with improvements in meaning, spiritual well-being, optimism, life satisfaction, and attitudes toward disease. This chapter describes end-of-life distress, its prevalence, limitations of palliative interventions, the evidence for psychedelic-assisted therapy, why it may work for these patients, and future directions.

Study at a glance

Abstract

Patients with a life-threatening disease (LTD) sometimes suffer from end-of-life distress (EOLD) which refers to the physical, psychological, emotional, and spiritual suffering related to chronic illness and the possibility of death. Palliative care interventions seek to improve the quality of life of patients with EOLD and their significant others. Currently, a range of psychological and pharmacological palliative care interventions may be used to mitigate the various symptoms related to EOLD. However, the evidence for their efficacy is inconclusive with only short- to moderate effects. Another significant and relevant limitation in the context of LTDs is that palliative care interventions often require months to take effect. In the past decade, psychedelic-assisted therapy (PAT) has been increasingly investigated for its therapeutic potential in addressing EOLD in various LTDs characterized by highly significant and sometimes sustained decreases in symptoms of depression and (death) anxiety along with other EOLD-related improvements (e.g., meaning, spiritual well-being, optimism, life satisfaction, and change attitudes towards LTDs). The current chapter will provide a detailed description of the concept of EOLD followed by estimated prevalence rates in a range of LTDs. Next, the chapter provides a brief overview of palliative interventions and their limitations. The chapter then introduces a description of PAT, its evidence-base, and why it seems to work in particular for patients with EOLD. The chapter is concluded with future perspectives.