The emerging role of psilocybin and MDMA in the treatment of mental illness

ABSTRACT

Introduction

Mental illness has a chronic course of illness with a number of clinical manifestations. Affected individuals experience significant functional, emotional, cognitive, and/or behavioral impairments. The growing prevalence of mental illness has been associated with significant social and economic costs. Indeed, the economic burden of mental illness is estimated to exceed $1.8 trillion USD over the next 30 years. A significant number of individuals affected by mental illness fail to respond to first-line treatment options. Therefore, there remains an unmet need for rapidly attenuating therapeutic options for mental health disorders with minimal social and economic burden.

Areas covered

The paucity of novel treatment options warrants a renewed investigation of psychedelic-based psychotherapy. Herein, the authors will evaluate the therapeutic potential of traditional psychedelics, psilocybin, and MDMA, in the treatment of mental illness with a narrative review of available literature.

Expert opinion

Psychedelics, such as psilocybin and MDMA, offer an alternative avenue of therapy for many mental health disorders. Available evidence indicates that psychedelics may offer a single-dose, rapid effect model that have robust effects with treatment-resistant mental disorders and a unique advantage as a possible monotherapy for mental illness. Novel clinical trials that evaluate the safety, tolerability, and efficacy in clinically representative populations are warranted.

Key words:

• psilocybin
• MDMA
• major depressive disorder
• anxiety
• post-traumatic stress disorder
• psychiatric disorders
• mood disorders

Article highlights

• There is a significant unmet need for single-dose, rapidly attenuating therapeutic options for mental illness.

• Psychedelics, such as psilocybin and MDMA, may offer an alternative treatment option for mental health disorders.

• Herein, the therapeutic potential of psilocybin and MDMA for the treatment of major depressive disorder, post-traumatic stress disorder and anxiety is evaluated.

• Psilocybin- and MDMA-based psychotherapy options should be explored as a possible monotherapy for mental health disorders.

• Dose–response studies in placebo-controlled settings with a real-world clinical population are required as an important next step.

Acknowledgments

The want to extend our appreciation to all team members and co-authors for their contributions to this manuscript.

Declaration of interests

RS McIntryre has received research grant support from Stanley Medical Research Institute, CIHR/GACD/National Natural Science Foundation of China; speaker/consultation fees from Lundbeck, Janssen, Shire, Purdue, Pfizer, Otsuka, Allergan, Takeda, Neurocrine, Sunovion, and Minerva. J Daniel Rosenblat has received research grant support from the Canadian Cancer Society, Canadian Psychiatric Association, American Psychiatric Association, American Society of Psychopharmacology, University of Toronto, University Health Network Centre for Mental Health, Joseph M. West Family Memorial Fund and Timeposters Fellowship and industry funding for speaker/consultation/research fees from Allergan, Lundbeck, and COMPASS.

J Daniel Rosenblat is the medical director of a private clinic providing intravenous ketamine infusions and intranasal esketamine for depression. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.