Therapeutic Applications of Classic Hallucinogens
Therapeutic Applications of Classic Hallucinogens
复制标题
DOI：
10.1007/7854_2016_464
复制
发表时间：
2018-01-01
期刊：
影响因子：
--
通讯作者：
Ross, Stephen
中科院分区：
文献类型：
--
作者：
Bogenschutz, Michael P.;Ross, Stephen
本章综述了已知的5-羟色胺能或经典致幻剂的治疗用途，即精神活性药物，如LSD和裸盖菇素，它们主要通过5-羟色胺2A(5HT2A)受体的激动剂发挥作用。在回顾了人类使用这些药物的历史和科学研究之后，总结了来自临床研究的数据，包括在治疗酒精中毒和其他成瘾中使用经典迷幻剂的广泛工作，使用LSD和裸盖菇素来缓解死亡痛苦的研究，特别是在晚期或晚期癌症患者中，以及关于使用经典迷幻剂治疗情绪和焦虑症的更有限的数据。对临床相关效应的可能机制进行了综述。回顾了经典致幻剂公认的安全性。为了提供临床视角，提供了在最近的裸盖菇素对照试验中接受治疗的两个人的病例摘要：一个人正在接受酒精中毒的治疗，另一个人患有与癌症诊断导致的死亡恐惧有关的焦虑和抑郁。虽然从20世纪50年代到70年代初进行的有希望的早期研究在就任何传统迷幻剂对任何临床疾病的疗效得出确定结论之前就停止了，但在那个时代进行的研究强烈表明，传统迷幻剂具有临床相关效果，特别是在LSD治疗酒精中毒的情况下。在过去的十年里，临床试验已经恢复，研究经典致幻剂在治疗癌症面前的生存苦恼方面的效果，以及在治疗包括酒精中毒和尼古丁成瘾在内的成瘾方面的效果。到目前为止已经完成的研究不足以确定疗效，但结果非常令人鼓舞，目前正在进行或计划进行更大规模的试验，直到并包括第三阶段。尽管研究已经阐明了经典致幻剂对人类、动物和体外系统的许多急性神经生物学和心理影响，但临床上相关的持久效应的机制仍然知之甚少。
This chapter reviews what is known about the therapeutic uses of the serotonergic or classic hallucinogens, i.e., psychoactive drugs such as LSD and psilocybin that exert their effects primarily through agonist activity at serotonin 2A (5HT2A) receptors. Following a review of the history of human use and scientific study of these drugs, the data from clinical research are summarized, including extensive work on the use of classic hallucinogens in the treatment of alcoholism and other addictions, studies of the use of LSD and psilocybin to relieve distress concerning death, particularly in patients with advanced or terminal cancer, and more limited data concerning the use of classic hallucinogens to treat mood and anxiety disorders. A survey of possible mechanisms of clinically relevant effects is provided. The well-established safety of classic hallucinogens is reviewed. To provide a clinical perspective, case summaries are provided of two individuals who received treatment in recent controlled trials of psilocybin: one being treated for alcoholism, the other suffering from anxiety and depression related to fear of death due to a cancer diagnosis. Although promising early phase research conducted from the 1950s through the early 1970s was discontinued before firm conclusions could be reached concerning the efficacy of any of the classic hallucinogens for any clinical condition, the research that was conducted in that era strongly suggests that classic hallucinogens have clinically relevant effects, particularly in the case of LSD treatment of alcoholism. In the past decade, clinical trials have resumed investigating the effects of classic hallucinogens in the treatment of existential distress in the face of cancer, and in the treatment of addictions including alcoholism and nicotine addiction. The studies that have been completed to date are not sufficient to establish efficacy, but the outcomes have been very encouraging, and larger trials, up to and including phase 3, are now underway or being planned. Although research has elucidated many of the acute neurobiological and psychological effects of classic hallucinogens on humans, animals, and in vitro systems, the mechanisms of clinically relevant persisting effects remain poorly understood.