Ptsd

Post-traumatic stress disorder (PTSD) is an anxiety disorder that often presents after exposure to a traumatic, life-threatening event.

While psilocybin has shown potential for the treatment of PTSD, the gap in research does not provide enough evidence to indicate whether psilocybin as a co-therapy with psychotherapy, is useful in the treatment of PTSD. Additionally, the current legal stance on psilocybin creates several hurdles for researchers to overcome. It should aim to assess the depth by which these psychedelics impact the neural connectivity and neuroanatomy of patients with PTSD. Additionally, future research should study and analyze the long-term effects of these treatments. With these current limitations in mind, psilocybin may still be a promising treatment for PTSD. While the exact pathophysiology of PTSD is not fully elucidated, it is thought that a dysregulated fear response is one facet of the disease state [26]. fMRI studies of participants’ brains after dosing psilocybin show decreased cerebral blood flow (CBF) and decreased reactivity in the amygdala [56, 62]. Decreased reactivity of the amygdala is associated with a decreased fear response. Despite the lack of studies on the efficacy of psilocybin in the treatment of PTSD, evidence collected before the controlled substance ban showed that it is safe to use with few long-term adverse events [54]. In addition, a single-arm, open-label pilot study showed that psilocybin treatment for demoralization in AIDS patients showed few acute adverse events [58]. In a double-blind study by Grob et al. proceeded to determine the therapeutic response and durability of six infusions of ketamine to veterans with comorbid PTSD and TRD in a different study [54]. In comparison to single-infusion regimens, this regimen resulted in a longer period of symptom reduction. The ketamine infusion was well-tolerated, and no adverse effects were reported [50]. Later, a larger cohort study consisting of participants diagnosed with PTSD, showed that a single infusion of 0.5 mg/kg of ketamine over 40 min led to significant improvement in chronic PTSD symptoms 24 hours post-infusion compared to midazolam, a standardized anxiolytic [51]. Dissociative symptoms and physical adverse effects during infusion were noted as being transient and well-tolerated [51]. PTSD symptoms were assessed using CAPS-IV scoring one to two months following the last active MDMA session and 12 months after the last active session [41]. The majority of the patients in the trial reported that their symptoms were reduced after one to two months and remained lower 12 months following the treatment [41]. The study showed no reduction in cognitive performance and in fact, cognitive assessments were predictive of a positive response to ketamine treatment [53]. With these results, Albott et al. In 2021, a randomized-controlled clinical trial showed that repeated intravenous ketamine infusions demonstrated sustained improvement in chronic PTSD patients [52]. The participants suffered from severe-to-chronic PTSD determined by the CAPS-5 (Clinician-Administered PTSD Scale for DSM-5), MADRS (Montgomery-Asberg Depression Rating Scale), and other parameters such as duration of PTSD and source of primary trauma (i.e. sexual assault, molestation, physical assault, combat exposure) [52]. The participants experienced PTSD for a median duration of 15 years, half of whom were taking concomitant psychotropic medications. evaluated whether CBT would change the activation of these neural areas involved in the physiology of social cognition (the ability to forgive and empathize) in individuals with PTSD [35, 36]. The participants underwent fMRI before and after treatment to evaluate for social cognition changes. used the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality in patients from baseline, primary endpoint, treatment exit, and 12-month follow-up [46]. At all points where patients' sleep quality was measured after either MDMA or placebo treatment, the MDMA group showed increased sleep quality compared to the placebo group reported at the 12-month follow-up [47]. Among the drugs being researched for this purpose are psychedelics including ketamine, psilocybin, and MDMA. These psychoactive drugs have been shown to be capable of facilitating structural and functional reorganization of neural circuits to produce positive behavioral effects, which may be of great benefit in many mental health disorders [25]. While there is a lot of research addressing the therapeutic and curative abilities of psychedelic drugs, not all have found that there is much benefit to the utilization of these drugs.