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Fortschr Neurol Psychiatr 2023; 91(07/08): 311-318
DOI: 10.1055/a-1981-3152
Übersichtsarbeit

Psychedelika in der Psychiatrie – Entwicklungen und die Stellung in Deutschland

Psychedelics in Psychiatry – Development and Current State in Germany
Uwe Herwig
1   Zentrum für Psychiatrie Reichenau, Akademisches Lehrkrankenhaus Universität Konstanz, Reichenau, Germany
2   Klinik für Psychiatrie und Psychotherapie III, Universität Ulm, Ulm, Germany
3   Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
,
Lea Mertens
4   Abteilung für Molekulares Neuroimaging, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
,
Sergio Pérez Rosal
5   Mind Foundation, Berlin, Germany
6   Ovid Health Systems, Berlin, Germany
,
Gabriele Koller
7   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München, Germany
,
Andrea Jungaberle
5   Mind Foundation, Berlin, Germany
6   Ovid Health Systems, Berlin, Germany
8   Charité Universitätsmedizin Mitte, Berlin, Germany
,
Stefan Borgwardt
9   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig Holstein, Universität zu Lübeck, Germany
,
Gerhard Gründer
4   Abteilung für Molekulares Neuroimaging, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
6   Ovid Health Systems, Berlin, Germany
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Zusammenfassung

In den letzten Jahren erlebte die klinische Forschung zur therapeutischen Wirksamkeit von Psychedelika eine Art Renaissance. Der aktuelle Stand wissenschaftlicher Erkenntnisse zur Wirksamkeit bei verschiedenen psychiatrischen Indikationen, wie auch die bereits unter bestimmten Voraussetzungen genehmigungsfähige Anwendung einiger psychedelischer Substanzen in der klinischen Praxis in manchen Ländern der Welt, legen die Möglichkeit einer zukünftigen Anwendung im klinischen Setting auch in Deutschland nahe. Dabei steht das Feld noch vor großen Herausforderungen inklusive der Notwendigkeit einer kritischen Gestaltung der Rahmenbedingungen für einen möglichen klinischen Einsatz. In diesem Artikel wird auf die historischen Hintergründe der klinischen Anwendung von Psychedelika eingegangen, um dann Aspekte wie Psychophänomenologie, Wirkmodelle, mögliche Indikationen und Pharmakosicherheit zu beleuchten. Anschließend wird der aktuelle Stand der Forschung und auch der Organisation von Fachgesellschaften in Deutschland im historischen und internationalen Kontext betrachtet, wie auch kritische Aspekte und noch zu klärende Fragen in dem Themenfeld.

Abstract

Clinical research on the therapeutic efficacy of psychedelics is currently experiencing a renaissance. Available scientific evidence on their efficacy in various psychiatric conditions, as well as their legally approved use in some countries of the world, show the possibility of their future application in clinical practice also in Germany. The field is facing substantial challenges that have to be addressed, such as defining and setting a suitable clinical frame. This manuscript deals with the historical background of the clinical application of psychedelics, as well as the psycho-phenomenology, modes of action, possible indications and aspects of safety. The current research status in Germany and the organization of professional societies are discussed in a historical and international context and attention is drawn to unresolved critical issues in the field.

Schlüsselwörter

Augmentierte Psychotherapie - Depression - PTSD - Psilocybin - LSD - MDMA

Key words

augmented psychotherapy - depression - PTSD - Psilocybin - LSD - MDMA


Publication History

Received: 04 July 2022

Accepted after revision: 11 October 2022

Article published online:
04 January 2023

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Davis AK, Barrett FS, May DG. et al. Effects of psilocybin-assisted therapy on major depressive disorder: a randomized clinical trial. JAMA Psychiatry 2021; 78: 481-489
    CrossrefPubMedGoogle Scholar
  • 2 Boldrini M, Canoll PD, Klein RS. How COVID-19 Affects the Brain. JAMA Psychiatry 2021; 78: 682-683
    CrossrefPubMedGoogle Scholar
  • 3 Altmetric – Effcts of Psilocybin-Assisted Therapy on Major Depressive Disorder
    PubMed
  • 4 Lewin Louis. Über Anhalonium Lewinii. Archiv für experimentelle Pathologie und Pharmakologie 1887; 24: 411
    PubMedGoogle Scholar
  • 5 Heffter A. Ueber Pellotin. Therapeutische Monatshefte 1896; 10: 327-328
    PubMedGoogle Scholar
  • 6 Lewin L. Phantastica – Die betäubenden und erregenden Genußmittel – Für Ärzte und Nichtärzte. Berlin. 1924
    PubMedGoogle Scholar
  • 7 Beringer K. Der Mescalinrausch. Seine Geschichte und Erscheinungsweise. Berlin. 1927
    PubMedGoogle Scholar
  • 8 Hofmann A. LSD – mein Sorgenkind. Stuttgart: Clett-Kotta,; 1979
    Google Scholar
  • 9 Stoll WA. Lysergsäure-Diäthylamid, ein Phantasticum aus der Mutterkorngruppe. Archiv für Neurologie und Psychiatrie 1947; 60: 279-323
    PubMedGoogle Scholar
  • 10 Leuner H. Halluzinogene. Psychische Grenzzustände in Therapie und Forschung. Bern: Verlag Hans Huber; 1981
    Google Scholar
  • 11 Rucker JJH, Iliff J, Nutt DJ. Psychiatry & the psychedelic drugs. Past, present & future. Neuropharmacology 2018; 142: 200-218
    CrossrefPubMedGoogle Scholar
  • 12 Passie T. The early use of MDMA (‚Ecstasy’) in psychotherapy (1977–1985). Drug, Science and Law 2018; 4: 1-19
    PubMedGoogle Scholar
  • 13 Nichols DE. Differences between the Mechanism of Action of MDMA, MDBD and the Classic Hallucinogens. Journal of Psychoactive Drugs 1986; 18: 305-313
    CrossrefPubMedGoogle Scholar
  • 14 Passie T, Benzenhöfer U. MDA, MDMA, and other "mescaline-like" substances in the US military’s search for a truth drug (1940s to 1960s). Drug Test Anal 2018; 72-80
    CrossrefPubMedGoogle Scholar
  • 15 Gasser P. Die psycholytische Psychotherapie in der Schweiz von 1988-1993. Eine katamnestische Erhebung. Schweizer Archiv für Neurologie und Psychiatrie 1996; 147: 59-65
    PubMedGoogle Scholar
  • 16 Vollenweider FX, Kometer M. The neurobiology of psychedelic drugs: implications for the treatment of mood disorders. Nat Rev Neurosci 2010; 11: 642-651
    CrossrefPubMedGoogle Scholar
  • 17 Gründer G, Brand M, Kärtner L. et al. Sind Psychedelika schnell wirksame Antidepressiva? [Are psychedelics fast acting antidepressant agents?]. Nervenarzt 2022; 93: 254-262
    CrossrefPubMedGoogle Scholar
  • 18 Mertens LJ, Koslowski M, Betzler F. et al. Methodological Challenges in Psychedelic Drug Trials: Efficacy and Safety of Psilocybin in Treatment-Resistant Major Depression (EPIsoDE) – Rationale and Study Design. Neurosci Applied 2022; 1: 100104 DOI: 10.1016/j.nsa.2022.100104.
    CrossrefPubMedGoogle Scholar
  • 19 Mitchell JM, Bogenschutz M, Lilienstein A. et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 2021; 27: 1025-1033
    CrossrefPubMedGoogle Scholar
  • 20 Majić T, Jungaberle H, Schmidt TT. et al. Psychotherapie mit adjuvanter Gabe von serotonergen psychoaktiven Substanzen – Möglichkeiten und Hindernisse [Psychotherapy with Adjuvant use of Serotonergic Psychoactive Substances: Possibilities and Challenges]. Fortschr Neurol Psychiatr 2017; 85: 383-392
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Sanacora G, Frye MA, McDonald W. et al. American Psychiatric Association (APA) Council of Research Task Force on Novel Biomarkers and Treatments. A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA Psychiatry 2017; 74: 399-405
    CrossrefPubMedGoogle Scholar
  • 22 Dore J, Turnipseed B, Dwyer S. et al. Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy. J Psychoactive Drugs 2019; 51: 189-198
    CrossrefPubMedGoogle Scholar
  • 23 Palhano-Fontes F, Soares BL, Galvão-Coelho NL, et al. Ayahuasca for the Treatment of Depression. Curr Top Behav Neurosci. 2021. 10.1007/7854_2021_277. Epub ahead of print
    PubMed
  • 24 Reiff CM, Richman EE, Nemeroff CB. et al. the Work Group on Biomarkers and Novel Treatments, a Division of the American Psychiatric Association Council of Research. Psychedelics and Psychedelic-Assisted Psychotherapy. Am J Psychiatry 2020; 177: 391-410
    CrossrefPubMedGoogle Scholar
  • 25 Dittrich A. The standardized psychometric assessment of altered states of consciousness (ASCs) in humans. Pharmacopsychiatry. 1998; 31: 80-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Schmidt TT, Berkemeyer H. The Altered States Database: Psychometric Data of Altered States of Consciousness. Front Psychol 2018; 9: 1028
    CrossrefPubMedGoogle Scholar
  • 27 Passie T, Scharfetter C. A taxonomy of ecstatic states in the context of psychotherapy with psychedelic substances. Journal of Consciousness Studies 2019; 256: 155-178
    PubMedGoogle Scholar
  • 28 Holze F, Vizeli P, Ley L. et al. Acute dose-dependent effects of lysergic acid diethylamide in a double-blind placebo-controlled study in healthy subjects. Neuropsychopharmacology 2021; 46: 537-544
    CrossrefPubMedGoogle Scholar
  • 29 Holze F, Ley L, Müller F, Becker AM. et al. Direct comparison of the acute effects of lysergic acid diethylamide and psilocybin in a double-blind placebo-controlled study in healthy subjects. Neuropsychopharmacology 2022; DOI: 10.1038/s41386-022-01297-2.
    CrossrefPubMedGoogle Scholar
  • 30 Hamill J, Hallak J, Dursun SM. et al. Ayahuasca: Psychological and Physiologic Effects, Pharmacology and Potential Uses in Addiction and Mental Illness. Curr Neuropharmacol 2019; 17: 108-128
    CrossrefPubMedGoogle Scholar
  • 31 Kraehenmann R, Preller KH, Scheidegger M. et al. Psilocybin-Induced Decrease in Amygdala Reactivity Correlates with Enhanced Positive Mood in Healthy Volunteers. Biol Psychiatry 2015; 78: 572-581
    CrossrefPubMedGoogle Scholar
  • 32 Müller F, Lenz C, Dolder PC. et al. Acute effects of LSD on amygdala activity during processing of fearful stimuli in healthy subjects. Transl Psychiatry 2017; 7: e1084
    CrossrefPubMedGoogle Scholar
  • 33 Mertens LJ, Wall MB, Roseman L. et al. Therapeutic mechanisms of psilocybin: Changes in amygdala and prefrontal functional connectivity during emotional processing after psilocybin for treatment-resistant depression. J Psychopharmacol 2020; 34: 167-180
    CrossrefPubMedGoogle Scholar
  • 34 Müller F, Lenz C, Dolder P. et al. Increased thalamic resting-state connectivity as a core driver of LSD-induced hallucinations. Acta Psychiatr Scand 2017; 136: 648-657
    CrossrefPubMedGoogle Scholar
  • 35 Müller F, Dolder PC, Schmidt A. et al. Altered network hub connectivity after acute LSD administration. Neuroimage Clin 2018; 18: 694-701
    CrossrefPubMedGoogle Scholar
  • 36 Vollenweider FX, Preller KH. Psychedelic drugs: neurobiology and potential for treatment of psychiatric disorders. Nat Rev Neurosci 2020; 21: 611-624
    CrossrefPubMedGoogle Scholar
  • 37 Carhart-Harris RL, Erritzoe D, Williams T, Stone JM. et al. Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proc Natl Acad Sci U S A 2012; 109: 2138-2143
    CrossrefPubMedGoogle Scholar
  • 38 Carhart-Harris RL, Muthukumaraswamy S, Roseman L. et al. Neural correlates of the LSD experience revealed by multimodal neuroimaging. Proc Natl Acad Sci U S A 2016; 113: 4853-4858
    CrossrefPubMedGoogle Scholar
  • 39 Palhano-Fontes F, Andrade KC, Tofoli LF. et al. The psychedelic state induced by ayahuasca modulates the activity and connectivity of the default mode network. PLoS One 2015; 10: e0118143
    CrossrefPubMedGoogle Scholar
  • 40 Smigielski L, Kometer M, Scheidegger M. et al. Characterization and prediction of acute and sustained response to psychedelic psilocybin in a mindfulness group retreat. Sci Rep 2019; 9: 14914
    CrossrefPubMedGoogle Scholar
  • 41 Carhart-Harris RL. How do psychedelics work?. Curr Opin Psychiatry 2019; 32: 16-21
    CrossrefPubMedGoogle Scholar
  • 42 Wolff M, Evens R, Mertens LJ. et al. Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance. Front Psychiatry 2020; 11: 5
    CrossrefPubMedGoogle Scholar
  • 43 Jungaberle H, Thal S, Zeuch A. et al. Positive psychology in the investigation of psychedelics and entactogens: A critical review. Neuropharmacology. 2018; 142: 179-199
    CrossrefPubMedGoogle Scholar
  • 44 Davis AK, Barrett FS, Griffiths RR. Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. J Contextual Behav Sci 2020; 15: 39-45
    CrossrefPubMedGoogle Scholar
  • 45 Guss J, Krause R, Sloshower J. Yale Manual for Psilocybin-assisted Therapy of Depression. 2020; DOI: 10.31234/osf.io/u6v9y.
    CrossrefPubMedGoogle Scholar
  • 46 Busch AK, Johnson WC. L.S.D. 25 as an aid in psychotherapy; preliminary report of a new drug. Dis Nerv Syst 1950; 11: 241-243
    PubMedGoogle Scholar
  • 47 Savage C. Lysergic acid diethylamide; a clinical-psychological study. Am J Psychiatry 1952; 108: 896-900
    CrossrefPubMedGoogle Scholar
  • 48 Sandison RA, Whitelaw JD. Further studies in the therapeutic value of lysergic acid diethylamide in mental illness. J Ment Sci 1957; 103: 332-343
    CrossrefPubMedGoogle Scholar
  • 49 Smith CM. A new adjunct to the treatment of alcoholism: the hallucinogenic drugs. Q J Stud Alcohol 1958; 19: 406-417
    CrossrefPubMedGoogle Scholar
  • 50 Mithoefer MC, Wagner MT, Mithoefer AT. et al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. J Psychopharmacol 2013; 27: 28-39
    CrossrefPubMedGoogle Scholar
  • 51 De Gregorio D, Comai S, Posa L. et al. d-Lysergic Acid Diethylamide (LSD) as a Model of Psychosis: Mechanism of Action and Pharmacology. Int J Mol Sci 2016; 17: 1953
    CrossrefPubMedGoogle Scholar
  • 52 Carhart-Harris RL, Bolstridge M, Rucker J. et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 2016; 3: 619-627
    CrossrefPubMedGoogle Scholar
  • 53 Carhart-Harris R, Giribaldi B, Watts R, Baker-Jones M. et al. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med 2021; 384: 1402-1411
    CrossrefPubMedGoogle Scholar
  • 54 Bogenschutz MP, Forcehimes AA, Pommy JA. et al. Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. J Psychopharmacol 2015; 29: 289-299
    CrossrefPubMedGoogle Scholar
  • 55 Krediet E, Bostoen T, Breeksema J. et al. Reviewing the Potential of Psychedelics for the Treatment of PTSD. Int J Neuropsychopharmacol 2020; 23: 385-400
    CrossrefPubMedGoogle Scholar
  • 56 Bird CIV, Modlin NL, Rucker JJH. Psilocybin and MDMA for the treatment of trauma-related psychopathology. Int Rev Psychiatry 2021; 33: 229-249
    CrossrefPubMedGoogle Scholar
  • 57 Nichols DE. Psychedelics. Pharmacol Rev. 2016; 68(2): 264-355. doi: 10.1124/pr.115.011478. Erratum in: Pharmacol Rev. 2016; 68(2): 356
    PubMed
  • 58 Han B, Compton WM, Jones CM. et al. Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths Among US Adults. JAMA Psychiatry 2021; 78: 1329-1342
    CrossrefPubMedGoogle Scholar
  • 59 Dos Santos RG, Bouso JC, Alcázar-Córcoles MÁ. et al. Efficacy, tolerability, and safety of serotonergic psychedelics for the management of mood, anxiety, and substance-use disorders: a systematic review of systematic reviews. Expert Rev Clin Pharmacol 2018; 11: 889-902
    CrossrefPubMedGoogle Scholar
  • 60 NIDA (National Institute on Drug Abuse): Hallucinogens. April 22, 2019 https://www.drugabuse.gov/publications/drugfacts/hallucinogens
    PubMed
  • 61 Müller F, Kraus E, Holze F. et al. Flashback phenomena after administration of LSD and psilocybin in controlled studies with healthy participants. Psychopharmacology (Berl). 2022
    PubMedGoogle Scholar
  • 62 Anderson BT, Danforth AL, Grob CS. Psychedelic medicine: safety and ethical concerns. Lancet Psychiatry 2020; 10: 829-830
    CrossrefPubMedGoogle Scholar
  • 63 Gründer G, Jungaberle H. The Potential Role of Psychedelic Drugs in Mental Health Care of the Future. Pharmacopsychiatry 2021; 54: 191-199
    Article in Thieme ConnectPubMedGoogle Scholar
  • 64 Tai SJ, Nielson EM, Lennard-Jones M. et al. Development and Evaluation of a Therapist Training Program for Psilocybin Therapy for Treatment-Resistant Depression in Clinical Research. Front Psychiatry 2021; 12: 586682
    CrossrefPubMedGoogle Scholar