Background/Significance: Anxiety is a common psychiatric symptom secondary to life-threatening disease, and is associated decreased quality of life, poor treatment compliance, existential distress, and an impaired ability to make medical decisions, manage symptoms, and pursue appropriate care (Brown, Kroenke, Theobald, Wu, & Tu, 2010; Kolva et al., 2011; Smith, Gomm, Dickens & 2003; Stark et al., 2002). Conventional pharmacological management of anxiety includes antidepressants and benzodiazepines. Antidepressants require at least three to six weeks of use to reach clinical efficacy (Frazer & Benmansour, 2002); an ineffective timeframe for individuals with life-threatening disease. Benzodiazepines can worsen lethargy and concentration, and result in addiction or paradoxical symptoms in the elderly (Traeger et al., 2012). Clinical trials studying the efficacy of psychedelics in the treatment of anxiety in adults with life-threatening diseases have recently re-emerged in an effort to find alternative, more effective treatment methods.
Analysis: A literature search was conducted using PsycINFO, CINAHL, and PubMed databases. Inclusion criteria include publication years of 2008 to 2018, English language, adult participants with life-threatening diseases and secondary anxiety, administration of serotonergic psychedelics (LSD or psilocybin), and research article or systematic review. Key search terms included, “psychedelics,” “hallucinogen,” “anxiety,” and “life-threatening.” The search yielded 184 articles and 153 were excluded based on content. Thirty-one articles were further evaluated from which six were selected for review and synthesis; four double-blind crossover RCTs (Gasser et al., 2014a, Griffiths et al., 2016; Grob et al., 2011; Ross et al., 2016), one follow-up qualitative study (Gasser, Kirchner & Passie, 2014b), and one systematic review (Reiche et al., 2018).
Discussion: All four clinical trials found statistically significant improvements in anxiety that were maintained at three months (Grob et al., 2011), six months (Griffiths et al., 2016; Ross et al., 2016), and 12 months (Gasser et al., 2014a; Gasser et al., 2014b), after one or two experimental doses of psychedelics in adult participants with life-threatening diseases. Participants reported improved quality of life (Gasser et al., 2014b; Ross et al., 2016), spirituality (Ross et al., 2016), access to emotions, introspection, relaxation, reductions in fear of death (Gasser et al., 2014b), and reduced diagnosis-related hopelessness and demoralization (Ross et al., 2016). Some participants called for added experimental sessions, believing that they would improve further with additional doses (Gasser et al., 2014b; Grob et al., 2011). No serious medical complications or lasting adverse effects were experienced, however, moderate increases in blood pressure were noted during experimental sessions in all four RCTs (Gasser et al., 2014a; Griffiths et al., 2016; Grob et al., 2011; Ross et al., 2016) with no medical interventions required. In conclusion, the typical adverse psychological reaction to life-threatening disease appears to be essentially altered by the treatment effects of psychedelics. Considering their limited side-effect profile when administered in a supportive environment with safety guidelines in place, psychedelic-assisted psychotherapy could be an effective treatment model for anxiety in adult patients with life-threatening disease. This treatment may address existential distress, a core determinant of poor quality of life in patients with life-threatening disease (Breitbart et al., 2010), for which there are no current pharmacological treatment options.
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