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Psychiatry & the psychedelic drugs. Past, present & future
Open accessAbstract
The classical psychedelic drugs, including psilocybin, lysergic acid diethylamide and mescaline, were used extensively in psychiatry before they were placed in Schedule I of the UN Convention on Drugs in 1967. Experimentation and clinical trials undertaken prior to legal sanction suggest that they are not helpful for those with established psychotic disorders and should be avoided in those liable to develop them. However, those with so-called 'psychoneurotic' disorders sometimes benefited considerably from their tendency to 'loosen' otherwise fixed, maladaptive patterns of cognition and behaviour, particularly when given in a supportive, therapeutic setting. Pre-prohibition studies in this area were sub-optimal, although a recent systematic review in unipolar mood disorder and a meta-analysis in alcoholism have both suggested efficacy. The incidence of serious adverse events appears to be low. Since 2006, there have been several pilot trials and randomised controlled trials using psychedelics (mostly psilocybin) in various non-psychotic psychiatric disorders. These have provided encouraging results that provide initial evidence of safety and efficacy, however the regulatory and legal hurdles to licensing psychedelics as medicines are formidable. This paper summarises clinical trials using psychedelics pre and post prohibition, discusses the methodological challenges of performing good quality trials in this area and considers a strategic approach to the legal and regulatory barriers to licensing psychedelics as a treatment in mainstream psychiatry. This article is part of the Special Issue entitled 'Psychedelics: New Doors, Altered Perceptions'.
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“Although considerable stigma is associated with this class of drugs, very few studies have reported long-term adverse effects as a result of psychedelic administration, and in almost all cases where adverse reactions were reported, they were attributed to the unsupportive context in which they were administered (34, 41, 160).”
From Examining the Potential Synergistic Effects Between Mindfulness Training and Psychedelic-Assisted Therapy (2021) · cites this paper as [34]
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“Most of these studies however suffer from low methodological validity and are mostly open-label, yet they have yielded preliminary evidence for the capacity of psychedelic substances for treating addiction, depression, anxiety, and eating disorders (29–35).”
From Examining the Potential Synergistic Effects Between Mindfulness Training and Psychedelic-Assisted Therapy (2021) · cites this paper as [34]
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Trial of Psilocybin versus Escitalopram for Depression
Carhart-Harris, R., Giribaldi, B., Watts, R., Baker-Jones, M., Murphy-Beiner, A., Murphy, R., Martell, J., Blemings, A., Erritzoe, D., & Nutt, D. J. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2032994 · Cited by 1,391
Self-citationREBUS and the anarchic brain: Toward a unified model of the brain action of psychedelics
Carhart-Harris, R. L., & Friston, K. J. (2019) · Pharmacological Reviews · doi:10.1124/pr.118.017160 · Cited by 1,180
Johnson, M. W., Griffiths, R. R., Hendricks, P. S., & Henningfield, J. E. (2018) · Neuropharmacology · doi:10.1016/j.neuropharm.2018.05.012 · Cited by 354
Andersen, K. A. A., Carhart‐Harris, R., Nutt, D. J., & Erritzoe, D. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13249 · Cited by 347
Self-citationAdverse effects of psychedelics: From anecdotes and misinformation to systematic science
Schlag, A. K., Aday, J. S., Salam, I., Neill, J. C., & Nutt, D. (2022) · Journal of Psychopharmacology · doi:10.1177/02698811211069100 · Cited by 359
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Metadata
- Authors
- Rucker, J. J. H., Iliff, J., & Nutt, D. J.
- Affiliations
- King's College London (GB)
- University College London (GB)
- Imperial College London (GB)
- Corresponding author
- Rucker, James J.H.
- Venue
- Neuropharmacology
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 142
- Pages
- 200-218
- ISSN
- 0028-3908 (ISSN-L)
- OpenAlex
- W2781316183
- Cited by
- 343
- References
- 137
- Citations by year
- 2026: 38 · 2025: 40 · 2024: 59 · 2023: 49 · 2022: 50 · 2021: 50 · 2020: 36 · 2019: 14 · 2018: 7
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Neuropharmacology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Funders
- National Institute for Health Research (NIHR) Biomedical Research Centre at South London
- Maudsley NHS Foundation Trust
- King's College London
- UK Medical Research Council (MR/J00460X/1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- psychedelics, psilocybin, lysergic acid diethylamide, mescaline, psychedelic-assisted psychotherapy, unipolar mood disorders, alcoholism, adverse events, psychosis risk
- MeSH terms
- Animals, Mental Disorders, Clinical Trials as Topic, Hallucinogens, Humans, Psychiatry
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