Thread by @ee_schenberg

1/16 THREAD🧵3 years ago I proposed that #Psychedelic-Assisted Psychotherapy (PAP) is a #ParadigmShift in psychiatry. The paper has been viewed almost 80k times around the globe and sits at the top 1% views/downloads and top 8% citations of the whole @FrontiersIn journal series.

2/16 Published in the special issue “Psychedelic Drug Research in the 21st Century” it has 82 citations at Google Scholar and was included in one slide by Javier Muñiz, from the FDA’s division of psychiatry, at his ISRP lecture in Oct/2019 frontiersin.org/articles/10.33…

3/16 My perspective on the psychedelic impact on psychiatric research and development was based on Prof. @rose_nikolas useful critique of the current situation in psychiatry as a triple crisis
cambridge.org/core/journals/…

4/16 The first axis of the crisis is the most obvious: #therapeutics. There have been very few pharmaceutical innovations since Prozac (1980’s) and investments are decreasing while mental health is likely deteriorating worldwide.

5/16 Furthermore, psychiatric medications have the highest rate of postmarketing safety events in medicine, reaching 80% of medications 10 years after approval, twice as high as neurology.
jamanetwork.com/journals/jama/…

6/16 The second axis of the psychiatric crisis is hotly debated: #diagnostics. In 7 decades, the number of categories increased five-fold, the DSM went from 132 to 947 pages annualreviews.org/doi/abs/10.114… but robust neuroscientific support for this expansion is still lacking.

7/16 The third axis is related to #explanatory models in psychiatry, which moved from a more psychoanalytic and psychosocial past into a current dominance of biological, neurocentric reductionism.

8/16 Given this - brief and simplified - panorama, I summarized in a single table all clinical trials registered in the US and EU databases until then, with Ketamine, MDMA, psilocybin and LSD: 95 planned studies for a total of more than 5k patients.

9/16 Thus PAP seemed a very promising #therapeutic innovation: supervised-only use of psychoactive drugs very few times could solve many safety issues now affecting large scale use of psychiatric medications: treatment adherence, polypharmacy, overdoses and withdrawal symptoms.

10/16 However, I argued that more than a simple innovation in the #therapeutic axis of the psychiatric crisis, PAP also has consequences for the #diagnostics and #explanatory axes as well.

11/16 Observing the indications summarized in the table quickly reveals a lack of molecule-diagnostic specificity. Eg. Ketamine for 6 different diagnoses, MDMA 4 and psilocybin 5, while alcohol dependence appeared for Ketamine, MDMA and psilocybin.
frontiersin.org/files/Articles…

12/16 Therefore the growing success of PAP studies challenges the prevailing categorical diagnostic specificity, perhaps corroborating concepts such as multidimensional spectra. Still, regulatory demands limit studies to focus on symptom-reductions in specific diagnosis.

13/16 Finally, and perhaps more importantly, PAP treatments includes experiences in non-ordinary states of consciousness, which for long psychiatry has mostly conceived of as #pathological, referring to these as “drugs of abuse”.

14/16 PAP then also challenges current psychiatric explanations about the etiology of mental disorders, with the PAP model being more supportive of biopsychosocial understandings where trauma and life adversities, aka “mental injuries”, play a central role.

15/16 Especially meaningful is the impact that psychedelics can have in the whole field as a fresh approach to non-ordinary states of consciousness, their content, phenomenology and impacts on human psychology and well being.

16/16 Want to know more? Check the paper and/or stay tuned for some upcoming articles where I explore some very important aspects of the current landscape in psychedelic research and therapeutics!