Nov 6, 2019
Andrew Penn, MS, NP, conducts a Masterclass lecture on
psychedelic-assisted psychotherapy from the
Psychopharmacology Update in Cincinnati. The meeting was
Global Academy for Medical Education and Current
Mr. Penn, a
psychiatric nurse practitioner, is associate clinical professor of
community health systems in the School of Nursing at the University
of California, San Francisco.
Later, Dr. Renee Kohanski is back – this time to discuss the
need to call out the truth when we see it.
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Reemergence of MDMA for PTSD and psilocybin for
- Psychedelic-assisted psychotherapy is currently being
investigated with 3,4-methylenedioxy-methamphetamine (MDMA)
for treatment-resistant post-traumatic stress disorder (PTSD) and
psilocybin for the treatment of major depressive disorder (MDD).
The use of these compounds would be highly regulated. These are not
medications that would be dispensed for a patient to take
- Both would be given in the clinical setting of one or more
psychotherapy sessions with two therapists who would continue to
work with the patient over time.
- MDMA was first patented by
Merck in 1912, synthesized again in the 1970s, and used by
psychotherapists to assist treatment. However, its recreational use
spread, leading to its classification as a Schedule I controlled
substance, thus prohibiting research or use in a medical
- Lobbying through the Multidisciplinary Association for
Psychedelic Studies, also known as MAPS, managed to bring MDMA into phase 3
clinical trials, and in 2017 the Food and Drug Administration
breakthrough therapy designation for its use with psychotherapy
- MDMA is a potent releaser of serotonin, oxytocin, and
prolactin, which in combination, allow the patient to feel less
fear, trust the psychotherapist more, and overcome the defenses
blocking them from talking about traumatic experiences. MDMA
permits patients to stay in the optimal arousal zone to discuss the
traumatic event. After the psychedelic-assisted session, patients
continue to process memories and sequelae of the event and
integrate changes into their lives to overcome trauma.
- If MDMA is approved by the FDA, it would be available only
under a REMS,
or Risk Evaluation and Mitigation Strategy, or drug safety
Psilocybin is a partial agonist on
5-HT2A serotonin receptors. The brain of a severely depressed
person is extremely rigid with limitations on the usual predictive
capacity of the human brain. Psilocybin facilitates plasticity to
“reset” and see a situation as it truly is, rather than through the
rigid cognitive distortions of depression.
- Although MDMA and psilocybin are controlled substances, we can
think of these medications like anesthetics, which are drugs that
can be prescribed in clinical settings under supervision only.
- These are old compounds used in a novel manner that can reduce
suffering for patients who have not responded to the current modes
of therapy for PTSD and MDD.
Mithoefer MC et al. MDMA-assisted psychotherapy for treatment of
PTSD: Study design and rationale for phase 3 trials based on pooled
analysis of six phase 3 randomized trials. Psychopharm
(Berl). 2019 Sep;236(9):2735-45.
Carhart-Harris RL et al. Psilocybin with psychological support
for treatment-resistant depression: An open-label feasibility
Lancet. 2016 Jul 1:3(7):619-21.
Pollan M. The Trip Treatment. New
Yorker. 2015 Feb 9.
Cooper A. Psilocybin sessions: Psychedelics could help people
with addiction and anxiety.
60 Minutes. 2019 Oct 13.
Sessa B. “The
Psychedelic Renaissance: Reassessing the Role of Psychedelic Drugs
in 21st Century Psychiatry and Society.” London: Muswell Hill
Usona Institute: News on Psychedelics
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