Integrating psychotherapy and psychopharmacology: psychedelic-assisted psychotherapy and other combined treatments

ABSTRACT

Introduction

Combinations of psychotherapy with antidepressants are gold-standard psychiatric treatments. They operate through complex and interactional mechanisms, not unlike the reemergent paradigm of psychedelic-assisted psychotherapy, which promising research suggests may also be highly effective in even challenging populations.

Areas covered

We review the therapeutic mechanisms behind both conventional and psychedelic paradigms, including the evolution of this knowledge and the associated explanatory frameworks. We explore how psychedelics have provided insights about psychiatric illnesses and treatments over the past decades. We discuss limitations to early explanatory models while highlighting and comparing the psychological and biological mechanisms underlying many psychiatric treatments.

Methods

A narrative review was conducted based on a search in Medline/Pubmed up to January 1^st, 2020, and iterative retrieval of references from recent reviews and clinical trials.

Expert opinion

The contextual model of the common factors of psychotherapy provides a powerful perspective on psychotherapy, antidepressants, and psychedelics, as well as 3,4-methylenedioxymethamphetamine (MDMA) and ketamine. It aligns well with key tenets of psychedelic-assisted psychotherapy. Conventional antidepressants and especially psychedelics may improve the efficacy of psychotherapy via neurochemical changes and increased environmental sensitivity. Combined treatments hold significant promise for advancing the knowledge and treatment of many forms of psychopathology.

KEYWORDS:

• Psychedelics
• mdma
• lsd
• psilocybin
• psychotherapy
• antidepressants
• psychiatry
• psychedelic-assisted psychotherapy
• mdma-assisted psychotherapy
• ketamine
• ketamine-assisted psychotherapy

Article highlights

• Psychiatric treatments, including psychotherapy and antidepressants, act both biologically and psychologically.

• Combinations of antidepressants with psychotherapy act through interactional and potentially synergistic mechanisms.

• Though operating with greater acuity, similar mechanisms underly the combinations of psychotherapy with psychedelics, MDMA, or ketamine.

• This acuity presents significant therapeutic opportunities and challenges.

• Research on conventional combinations can inform the optimal use of these novel combinations, and vice versa.

Declaration of interest

L. Jerome is an employee of the Multidisciplinary Association for Psychedelics Studies (MAPS) Public Benefit Corporation, as was A. Feduccia during the preparation of the manuscript. A. Feduccia is an owner and employee of Psychedelic.Support and consultant for Project New Day, a 501(c)(3) not-for-profit organization. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers disclosures

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

Additional information

Funding

This paper was not funded