Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review

Probably not a substantial claim: may not pass S3 (load-bearing).

The review's search and selection strategy followed PRISMA guidelines.

“The search and selection strategy was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009).”

• cites Moher et al., 2009 sourceSupported

May combine two claims.

Existing psychotherapeutic and pharmacological interventions for these symptoms have limited efficacy, often time-limited.

“Existing psychotherapeutic or pharmacological interventions have (time) limited efficacy.”

• cites Rosenstein, 2011 sourcePartly supported

  The Treatment of depression in end-of-life cancer care section says antidepressant trials in cancer patients have yielded mixed results and that the effectiveness of established treatments for patients with end-stage cancer is unknown. It does not establish that psychotherapeutic interventions have limited efficacy or that either type of intervention is time-limited; it describes several psychosocial approaches as promising. Page numbers are unavailable in our copy. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites Bauereiss et al., 2018 sourceNot checked — no full text of the source

May combine two claims.

In Falk et al. (2020), there was a significant group effect on anxiety with a larger reduction in the ketamine group, but no significant group effects on depression or pain.

“They found a significant group effect on anxiety with a larger reduction of anxiety in the ketamine group, but no significant group effects on depression or pain.”

• cites Falk et al., 2020 sourceSupported

May combine two claims.

In Kolp et al. (2007), the other patient, a heavy polysubstance user, had a very negative experience, noted no positive results, and declined further treatment.

“The other patient, who was reported to be a heavy polysubstance user, had a'very negative experience,' noted no positive results, and declined further (psychotherapeutic) treatment.”

• cites Kolp et al., 2007 sourceSupported

May combine two claims.

In Griffiths et al. (2016), high-dose psilocybin produced significantly larger anxiety response and remission rates than active placebo after 5 weeks.

“Griffiths et al. (2016)(n = 51) reported significantly larger response (92% versus 32%) and remission (60% versus 1%) on depression and anxiety (76% vs. 24%; 52% vs. 12%, respectively) in the high-dose group compared to active placebo after 5 weeks.”

• cites Griffiths et al., 2016 sourcePartly supported

  Table 6 (Results > Outcome measures; page not provided) supports the anxiety claim: at five weeks, response was 76% versus 24% and remission was 52% versus 12%, with significant between-group differences. The citing sentence also gives depression remission as 60% versus 1%, but Table 6 reports 60% versus 16%. The comparator was a very low, placebo-like dose of psilocybin. (LLM, conf=0.91)

  Experimental — accuracy not yet measured

May combine two claims.

In Ross et al. (2016), participants and their friends and family reported positive effects on attitude toward life and self, spiritual well-being, social contacts, quality of life, acceptance of death, and optimism.

“Both participants and their friends and family reported positive effects on attitude towards life and the self, spiritual well-being, social contacts, quality of life, acceptance of death, and optimism (Ross et al., 2016).”

• cites Ross et al., 2016 sourcePartly supported

  The Results (Secondary outcomes; page not supplied) report participants’ positive ratings of attitudes toward life and self, social effects, and spirituality, as well as improvements in spiritual well-being, quality of life, and later attitudes toward death. The passages do not report ratings from friends or family, and they do not specifically establish improved social contacts or optimism. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

In Anderson et al. (2020), two unexpected events occurred: one patient vividly re-experienced a traumatic event 2 days after treatment, and another reported severe anxiety due to feeling rejected by the group after 1 week.

“Two unexpected events were reported: one patient vividly re-experienced a traumatic event (not psilocybinrelated) 2 days after treatment, and another reported severe anxiety due to feeling rejected by the group after 1 week.”

• cites Anderson et al., 2020 sourcePartly supported

  The Results report two unexpected reactions: a participant vividly re-experienced a past sexual assault two days after the medication visit, and another reported severe anxiety associated with feeling rejected by the group. The second report was ten days after the visit, not one week. The flashback’s content was unrelated to the psilocybin experience, but the paper classifies the flashback itself as an unexpected psilocybin reaction. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

In Wang et al. (2020), the decrease was highest for the high-dose S-ketamine group, with no significant difference between the racemic and low-dose S-ketamine groups.

“This decrease was highest for the high-dose S-ketamine group, while no significant difference was found between the racemic and low-dose S-ketamine groups.”

• cites Wang et al., 2020 sourceSupported

May combine two claims.

In Iglewicz et al. (2015), the effect was maintained in 80% of patients after 4 to 7 days and in 60% after 8 days to 3 weeks.

“This effect was maintained in 80% of the patients after 4 to 7 days, and in 60% after 8 days to 3 weeks.”

• cites Iglewicz et al., 2015 sourceSupported

May combine two claims.

In Wang et al. (2020), after 5 and 7 days, depression scores were low in all four groups with no significant between-group differences.

“After 5 and 7 days, depression scores were low in all four groups with no significant between-group differences.”

• cites Wang et al., 2020 sourcePartly supported

  The Results section, “Comparison of HAMD-17 scores” (page not provided), reports no significant difference among the four groups at day 5. The copy does not establish that depression scores were low at days 5 and 7; its statement that there was no difference at one week appears in the abstract, not in the full-text Results passage on HAMD-17 scores. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

In Fan et al. (2017), on day three, the effect on suicidality remained significant, but no difference was found on depression.

“On day three, the effect on suicidality remained significant, whereas no difference was found on depression.”

• cites Fan et al., 2017 sourceSupported

May combine two claims.

In Griffiths et al. (2016), six months after crossover, 78% of all participants showed clinical response on depression and 83% on anxiety compared to baseline.

“Six months after crossover, 78% and 83% of all participants showed clinical responses on depression and anxiety compared to baseline.”

• cites Griffiths et al., 2016 sourceSupported

May combine two claims.

All psychedelics exert effects rapidly and are known to induce mystical-type, peak, or transcendental effects that are correlated with therapeutic outcomes.

“Since all psychedelics exert effects rapidly and are known to induce mystical-type, peak, or transcendental effects that are correlated with therapeutic outcomes (Dore et al., 2019;Johnson et al., 2019;Barrett and Griffiths, 2018), these treatments may be especially helpful in the context of existential distress (Rosenbaum et al., 2019).”

• cites Dore et al., 2019 sourcePartly supported

  The Introduction (page unavailable) reports an association between psychedelic or mystical experiences and treatment outcomes for ketamine and psilocybin. It does not establish that all psychedelics rapidly exert effects or induce such experiences, so the citing sentence extends the source’s point beyond those medicines. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites Johnson et al., 2019 sourceNot checked — no full text of the source
• cites Barrett and Griffiths, 2018 sourcePartly supported

  The 'Mystical Experiences, Classic Hallucinogens, and Therapeutic Interventions' section reports a correlation between mystical-experience scores and later anxiety and depression outcomes after high-dose psilocybin. The Conclusion says classic hallucinogens can occasion mystical experiences with high probability under appropriate conditions, but not every experience is mystical. The paper does not establish that all psychedelics act rapidly or that the stated relationship applies to all psychedelics. Page numbers were not available in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

MDMA treatment efficacy has so far mainly been assessed in PTSD patients, indicating moderate to large effects.

“To our knowledge, MDMA treatment efficacy is so far mainly assessed in PTSD patients, indicating moderate to large effects (Krediet et al., 2020;Bahji et al., 2020).”

• cites Krediet et al., 2020 sourceSupported
• cites Bahji et al., 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

About half of the participants in the studies by Griffiths et al. (2016) and Ross et al. (2016) reported former experience with psychedelics.

“About half of the participants in the studies by Griffiths et al. (2016) and Ross et al. (2016) reported to have former experience with psychedelics.”

• cites Griffiths et al., 2016 sourceSupported
• cites Ross et al., 2016 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Thirty-three articles were included in the review.

“Ultimately, 33 articles were included in this review”

The quote only partly states this claim.

Later controlled trials using LSD, psilocybin, ketamine, and MDMA had better methodological quality than earlier studies.

“Recent (controlled) trials with LSD, psilocybin, ketamine, and MDMA are of higher methodological quality”

May combine two claims.

The included studies comprised 9 RCTs, 7 pre-post studies, 2 retrospective chart reviews, 11 case studies, and 4 qualitative studies, with 1130 unique patients.

“9 RCTs (n = 11-417), seven pre-post studies (n = 14-50), two retrospective chart reviews (n = 23-31), 11 case studies (n ≤ 2), and four qualitative studies (n = 4-13), with a total of 1130 unique patients.”

May combine two claims.

The DPT study found significant gains in depression, anxiety, and social isolation, tied to mystical or peak experiences.

“Significant therapeutic effects on depression, anxiety, and social isolation were found, which correlated with mystical or peak experiences.”

• cites Richards et al.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The included articles consisted of 14 studies on classical psychedelics (DPT, LSD, psilocybin) and 19 studies on atypical psychedelics (MDMA, ketamine).

“14 studies on classical psychedelics (DPT, LSD, and psilocybin) and 19 studies on atypical psychedelics (MDMA and ketamine).”

May combine two claims.

Those reports found 29% dramatic, 42% moderate, and 29% unchanged.

“Post-treatment, patients showed 'dramatic improvement' (29%) and 'moderate improvement' (42%), or remained 'essentially unchanged' (29%).”

• cites Richards et al., 1972Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Grof et al., 1973 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The review identified 1850 records after removing duplicates and adding records from other sources.

“After removing duplicates, 1842 records remained.Eight records were obtained through other sources including cross-references, resulting in a total of 1850 records.”

May combine two claims.

Pahnke et al. (1969) reported 64% improvement after treatment, including 27% dramatic.

“After treatment, 64% showed improvement, of which 27% 'dramatic.'”

• cites Pahnke et al., 1969Not checked — no full text of the source

May combine two claims.

Recent controlled trials reported few adverse effects and no serious adverse effects.

“with few adverse and no serious adverse effects.”

May combine two claims.

In Gasser et al. (2015), all participants reported benefiting from treatment and feeling more relaxed and patient.

“all stated to have profited from the treatment and felt more relaxed and patient (Gasser et al., 2015).”

• cites Gasser et al., 2015 sourceNot checked — no full text of the source

May combine two claims.

Later controlled trials showed benefits for existential and spiritual well-being, quality of life, acceptance, and less anxiety and depression.

“indicate positive effects on existential and spiritual well-being, quality of life, acceptance, and reduction of anxiety and depression”

May combine two claims.

Pahnke et al. (1969) reported reductions in depression, anxiety, and fear of death, along with more relaxation and closer relationships.

“Improvements included decreased depression, anxiety, and fear of death, increased relaxation, and closer relationships.”

• cites Pahnke et al., 1969Not checked — no full text of the source

May combine two claims.

The review included 14 articles on classical psychedelics: one on DPT, six on LSD (including one qualitative study), and seven on psilocybin (including three qualitative studies).

“We included 14 articles on classical psychedelics: DPT (one), LSD (six, including one qualitative study), and psilocybin (seven, including three qualitative studies).”

May combine two claims.

Early pre-post studies had promising results but serious methodological flaws.

“Results of early pre-post studies are promising but have serious methodological flaws.”

May combine two claims.

Those reports also noted gains in anxiety, depression, and social isolation.

“Overall, improvements were reported on anxiety, depression, and social isolation.”

• cites Richards et al., 1972Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Grof et al., 1973 sourceNot checked — no full text of the source

May combine two claims.

The 1960-1970s studies had no control groups; most later studies were double-blind RCTs, many using crossover.

“None of the 1960-1970s studies used control groups, whereas most of the more recent studies were double blind randomized controlled trials (RCTs), many with a crossover design.”

May combine two claims.

In that second crossover RCT, treatment reduced demoralization and hopelessness and improved spiritual well-being and quality of life both short term (2 weeks) and longer term (6 months).

“Moreover, treatment reduced demoralization and hopelessness, and improved spiritual well-being and quality of life, both short term (after 2 weeks) and longer term (after 6 months).”

May combine two claims.

In Irwin et al. (2013), there was no significant effect on pain, functional status, cognition, suicidal ideation, or quality of life.

“There was no significant effect on pain (not all participants had pain pre-treatment), functional status, cognition, suicidal ideation, and quality of life.”

• cites Irwin et al., 2013 sourceNot checked — no full text of the source

May combine two claims.

In Liu et al. (2020), after 3 days, 1 week, and 1 month, depression scores were significantly lower in the ketamine groups compared to control, with significantly larger effects for S-ketamine than racemic ketamine.

“After 3 days, 1 week, and 1 month, depression scores were significantly lower in the ketamine groups compared to control, with significantly larger effects for S-ketamine than racemic ketamine.”

• cites Liu et al., 2020 sourceNot checked — no full text of the source

May combine two claims.

In that second crossover RCT, six months after crossover there were significant decreases in anxiety (60%) and depression (80%).

“Six months after crossover, there were significant decreases in anxiety (60%) and depression (80%).”

May combine two claims.

Several case studies suggest rapid effects of ketamine on anxiety and depression in patients with a potentially terminal illness, but this effect is transient in single-dose treatment regimens.

“Several case studies suggest rapid effects of ketamine on anxiety and depression in patients with a (potentially) terminal illness, but this effect is transient in single-dose treatment regimens (Smith-Apeldoorn et al., 2020).”

• cites Smith-Apeldoorn et al., 2020Not checked — no full text of the source

May combine two claims.

The review included 19 studies on atypical psychedelics, mostly ketamine (n=18, including 11 case studies) and one recent study on MDMA.

“We included a total of 19 studies on atypical psychedelics, mostly on ketamine (n = 18, including 11 case studies) and one recent study on MDMA.”

May combine two claims.

In Irwin et al. (2013), significant treatment effects emerged after 3 days for anxiety and after 14 days for depression, and remained significant until the final treatment day.

“Significant treatment effects emerged after 3 days for anxiety and after 14 days for depression, which remained significant until the final treatment day.”

• cites Irwin et al., 2013 sourceNot checked — no full text of the source

May combine two claims.

In that second crossover RCT, death anxiety did not significantly decrease short term, but the high-dose group had significant improvement in attitude toward death after 26 weeks.

“Death anxiety did not significantly decrease on the short term, but in the high-dose group a significant improvement in attitude towards death was found after 26 weeks.”

May combine two claims.

In follow-ups of that study, after 3 years there were still reductions in anxiety, depression, hopelessness, and demoralization; death anxiety was significantly lower; and spiritual well-being was improved compared to baseline.

“After 3 years, there were still reductions in anxiety, depression, hopelessness, and demoralization, death anxiety was significantly lower, and spiritual well-being was improved compared to baseline.”

May combine two claims.

In that second crossover RCT, before crossover at 7 weeks, anxiety response was 58% versus 14% and depression response was 83% versus 14%.

“After 7 weeks (before crossover), anxiety response was 58% versus 14%, and depression response was 83% versus 14%.”

The quote only partly states this claim.

In Irwin et al. (2013), all patients in a pre-post study of 28 daily oral ketamine administrations showed statistically significant responses on anxiety.

“In this pre-post study, all patients showed statistically significant responses on anxiety.”

• cites Irwin et al., 2013 sourceNot checked — no full text of the source

May combine two claims.

In Grob et al. (2011), participants reported improved social interactions, new insights about illness influence, and a more positive attitude toward limited life expectancy.

“Participants further reported improved social interactions, new insights regarding the influence of the illness on their lives, and a more positive attitude towards their limited life expectancy.”

• cites Grob et al., 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In terminal cancer patients with emotional and physical distress, brief intensive psychotherapy with LSD or DPT produced dramatic or moderate improvement in emotional distress (36%) and physical distress (36%), with condition unchanged in 19% and decreased in 8%.

“Brief intensive psycho-therapy PT: dramatic and moderate improvement of emo-tional (36%) and physical (36%) distress. Condi-tion unchanged (19%) or decreased (8%)”

• cites Kurland et al. 1972; Pahnke et al. 1969Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims. The quote only partly states this claim.

In terminal cancer patients with existential distress, DPT combined with integrative psychotherapy reduced observer-rated depression and anxiety (ECRS p < .03 and p < .01) and raised POI self-regard, self-acceptance and capacity for intimate contact (p < .02, < .005, < .02).

“Integrative psycho-therapy 1 PT: decrease in observer-rated depression and anxiety (ECRS: p < .03 and p < .01), increase in POI self-regard, self-acceptance, and capacity for intimate contact (p < .02, < .005, p p < .02)”

• cites Richards et al. 1979Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In (pre)terminal cancer patients with depression, anxiety and pain, LSD psychedelic peak therapy reduced observer-rated depression, anxiety and fear of death and increased relaxation, ease of medical management, pain tolerance and family closeness; 14 of 22 showed meaningful positive change, 6 of them dramatic.

“Psychedelic peak therapy PT: decrease in observer-rated depression, anxiety and fear of death; increased relaxation, ease in medical management, pain tolerance, closeness of family relation-ships. Meaningful positive change (n = 14), of which dramatic change (n = 6)”

• cites Pahnke et al. 1969Not checked — no full text of the source

May combine two claims.

In most ketamine studies, treatment was aimed at depression or anxiety, while other psychedelic treatments were usually offered to patients with varying types of psychological distress in the face of life-threatening illness.

“In most ketamine studies, treatment was aimed at (symptoms of) depression or anxiety, while the other psychedelic treatments were usually offered to patients with varying types of psychological distress in the face of life-threatening illness.”

May combine two claims.

While some qualitative studies detailed patient experiences with classical psychedelics, no qualitative studies on ketamine treatment in terminally ill patients were encountered in the literature.

“Additionally, while we found some qualitative studies detailing patient experiences with classical psychedelics (Grof et al., 1973;Agin-Liebes et al., 2020;Belser et al., 2017), no qualitative studies on ketamine treatment in terminally ill patients were encountered in the literature.”

• cites Grof et al., 1973 sourceNot checked — no full text of the source
• cites Agin-Liebes et al., 2020 sourceNot checked — no full text of the source
• cites Belser et al., 2017 sourceNot checked — no full text of the source

May combine two claims.

Terminally ill patients can experience existential distress, depression, or anxiety that limits quality of life in the final stage.

“As such, depression, anxiety, and existential distress greatly limit one's possibilities of experiencing a meaningful final stage of life (LeMay and Wilson, 2008).”

• cites LeMay and Wilson, 2008 sourceNot checked — no full text of the source

May combine two claims.

Existential distress shares many symptoms with anxiety, depression, and adjustment disorders, and their relationship is not clear.

“There is a significant overlap between symptoms of existential distress and anxiety, depression, and adjustment disorders.The nature of the relationship between existential distress and these disorders remains unclear”

• cites Nierop-van Baalen et al., 2020 sourceNot checked — no full text of the source
• cites Bobevski et al., 2018 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Titles and abstracts were screened independently by two reviewers.

“Titles and abstracts were independently screened by JJB and NS.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The prevalence of anxiety disorders in patients with cancer is estimated at 14-21%.

“The prevalence of psychiatric symptoms or disorders in patients with cancer is estimated at 14-21% for anxiety 1 3 disorders (Wilson et al., 2007)”

• cites Wilson et al., 2007 sourceNot checked — no full text of the source

May combine two claims.

In Kast's 1967 report, 128 pre-terminal patients given LSD showed less pain, better mood, more positive life attitudes, and less distress about illness and death.

“After LSD treatment, patients experienced less pain, a better mood, more positive attitudes towards life, and less illness-and death-related distress (1967).”

• cites Kast, 1967 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Advanced cancer patients have about double the suicide rate of the age-matched general population.

“Suicide is twice as prevalent in advanced cancer patients compared to the general population of the same age (Chochinov et al., 1998).”

• cites Chochinov et al., 1998 sourceNot checked — no full text of the source

May combine two claims.

The early studies did not report whether patients had psychiatric comorbidities, and they used no formal instruments to assess therapeutic effects.

“It is unclear whether psychiatric comorbidities were present in the studied patients and no formal assessment instruments were used to measure therapeutic effects.”

Classified as probably not a substantial claim. May combine two claims.

Reviews of 1960-2018 trials of classical psychedelics for psychiatric problems in life-threatening illness reported benefits for anxiety, depression, and existential distress, with few side effects.

“Findings of clinical trials on classical psychedelics for the treatment of psychiatric problems secondary to (life-threatening) illness between 1960 and 2018 were reviewed by Ross et al. (Ross, 2018;Reiche et al., 2018) and by Reiche et al. (28), indicating positive effects on anxiety, depression, and existential distress with little side effects.”

• cites Ross, 2018 sourceNot checked — no full text of the source
• cites Reiche et al., 2018 sourceNot checked — no full text of the source

May combine two claims.

Kast and Collins (1964) tested LSD against pethidine and hydromorphone for pain in 50 terminally ill patients and found LSD's pain relief was slower but lasted longer.

“Kast and Collins (Kast and Collins, 1964) conducted a trial that compared the analgesic effect of LSD with the effect of the opioids pethidine and hydromorphone in 50 patients with a terminal disease and severe pain.They concluded that while LSDinduced pain reduction came about slower, its effects lasted longer.”

• cites Kast and Collins, 1964 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The prevalence of adjustment disorders in patients with cancer is estimated at 6-19%.

“6-19% for adjustment disorders (Mitchell et al., 2011;Singer et al., 2013;Hernandez Blazquez and Cruzado, 2016).”

• cites Mitchell et al., 2011 sourceNot checked — no full text of the source
• cites Singer et al., 2013 sourceNot checked — no full text of the source

May combine two claims.

Only mianserin beat placebo for cancer-related depression; the SSRIs fluoxetine and paroxetine had low response rates despite reported antidepressant effects.

“While antidepressant effects are reported regarding mianserin and the selective serotonin reuptake inhibitors fluoxetine and paroxetine, generally low response rates are reported, and only mianserin was found to be more effective compared to placebo in treating cancerrelated depression (Riblet et al., 2014).”

• cites Riblet et al., 2014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In a cross-sectional study, 12% of cancer patients had a serious yearning for death, and 52% of those met criteria for an anxiety or depressive disorder.

“A cross-sectional study found that 12% of patients with cancer (n = 377) had a serious yearning for death, and of those, 52% met criteria for an anxiety and/or depressive disorder (Wilson et al., 2016).”

• cites Wilson et al., 2016 sourceNot checked — no full text of the source

May combine two claims.

Newer psychotherapies for existential distress in terminal cancer focus on meaning and dignity; they improve existential well-being, hope, and self-reliance for up to 3 months but do not affect depression or anxiety.

“Recently developed psychotherapies for the treatment of existential distress in patients with terminal cancer (Bauereiss et al., 2018) emphasize the importance of meaning and dignity.These therapies yield significant but time-limited (up to 3 months) positive effects on existential well-being, hope, and self-reliance, but no effects on depression and anxiety.”

• cites Bauereiss et al., 2018 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Each review said that larger, better-designed studies are needed to settle effectiveness for this indication.

“In all reviews, it was reported that larger and methodologically better studies are needed to draw definite conclusions on effectiveness for this indication.”

• cites Ross, 2018 sourceNot checked — no full text of the source
• cites Reiche et al., 2018 sourceNot checked — no full text of the source
• cites Goldman et al., 2019 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The prevalence of major depression in patients with cancer is estimated at 15%.

“15% for major depression (Mitchell et al., 2011)”

• cites Mitchell et al., 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Estimates of existential distress among terminal cancer patients range from 3% to 29%, depending on how the concept is defined.

“prevalence rates of existential distress in patients with terminal cancer vary from 3 to 29%, depending on the operationalization of the concept”

• cites Pelletier et al., 2002 sourceNot checked — no full text of the source
• cites De Faye et al., 2006 sourceNot checked — no full text of the source
• cites Wilson et al., 2007 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The prevalence of minor depression in patients with cancer is estimated at 20-25%.

“20-25% for minor depression”

• cites Mitchell et al., 2011 sourceNot checked — no full text of the source

May combine two claims.

Classical and atypical psychedelics both show promise as treatments for terminal illness.

“Both classical and a-typical psychedelics are promising treatment options in patients with terminal illness.”

May combine two claims.

Most study designs were limited by small sample sizes and lack of a control group.

“However, it is important to note that most of the study designs were limited by small sample sizes and lack of a control group.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The 0.125 mg-kg dose of racemic ketamine in Liu et al. might have been too low for optimal treatment efficacy.

“although the 0.125 mg-kg dose of racemic ketamine in the study by Liu et al. might have been too low for optimal treatment efficacy.”

• cites Liu et al., 2020 sourceNot checked — no full text of the source

May combine two claims.

Classical psychedelics administered in a psychotherapeutic context appear well-tolerated and effective in the short and longer term, with beneficial effects on depression, anxiety, existential distress, and psychological domains such as quality of life and well-being.

“Classical psychedelics, administered in a psychotherapeutic context, appear to be well-tolerated and effective in both the short and longer term, with beneficial effects on depression, anxiety, existential distress, and a variety of psychological domains such as quality of life and well-being.”

May combine two claims.

It may take weeks to months before patients respond to antidepressants, and half of patients do not achieve symptom remission.

“It may take weeks to months before patients respond to treatment with an antidepressant, and half of the patients do not achieve symptom remission, taking time that these patients may not have or cannot bear (Trivedi et al., 2006).”

• cites Trivedi et al., 2006 sourceNot checked — no full text of the source

May combine two claims.

Adverse effects reported in clinical trials with ketamine are mild and usually resolve within an hour of administration.

“Furthermore, adverse effects reported in clinical trials with ketamine are mild and usually resolve within an hour of administration (Van Amsterdam and Van den Brink 2021).”

• cites Van Amsterdam and Van den Brink 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable).

Given the importance of spiritual and existential well-being in palliative care, psychedelics may play a unique role in enabling patients to address these critical issues in the last stage of their lives.

“Given the importance of spiritual and existential well-being in palliative care, psychedelics may play a unique role in enabling patients to address these critical issues in the last stage of their lives (Bauereiss et al., 2018;Rosa et al., 2019).”

• cites Bauereiss et al., 2018 sourceNot checked — no full text of the source
• cites Rosa et al., 2019 sourceNot checked — no full text of the source

May combine two claims.

Studies that administered ketamine to anesthetized patients, thereby canceling out acute psychedelic effects, reported short-term effects on depression, indicating that the psychedelic experience is not necessary for its effect on depression.

“Interestingly, studies that administered ketamine to anesthetized patients-thereby canceling out acute psychedelic effects-reported short-term effects on depression, indicating that the psychedelic experience is not necessary for its effect on depression.”

May combine two claims.

Conventional pharmacological interventions may decrease symptoms of anxiety and depression, which can improve quality of life to an important degree.

“Conventional pharmacological interventions may decrease symptoms of anxiety and depression, which can improve patients' quality of life to an important degree.”

Probably not a substantial claim: may not pass S3 (load-bearing).

This may explain why no non-clinical psychological measures such as quality of life, meaningfulness, and existential issues were reported for ketamine.

“This may explain why no non-clinical psychological measures such as quality of life, meaningfulness, and existential issues were reported for ketamine.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Pathological disease-related distress may be seen as an adjustment disorder given its stressor-related nature.

“Given the stressor-related nature of the phenomenon, pathological disease-related distress may be seen as an adjustment disorder (Vehling and Kissane, 2018).”

• cites Vehling and Kissane, 2018 sourceNot checked — no full text of the source