Skip to main content
Erschienen in: Current Geriatrics Reports 3/2023

27.07.2023 | REVIEW

The Potential for Psychedelics to Improve Coping Skills and Resilience in Persons With Newly Diagnosed Mild Cognitive Impairment or Early Alzheimer’s Disease

verfasst von: Martin Steinberg, Paul Rosenberg, Albert Garcia-Romeu

Erschienen in: Current Geriatrics Reports | Ausgabe 3/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Mild Cognitive Impairment and mild Alzheimer’s disease are associated with depression and existential distress, but high quality evidence supporting psychotropic or psychotherapeutic intervention is lacking. There is encouraging research suggesting benefit of psychedelic compounds such as psilocybin in treating depression, as well as existential distress in terminal illness. This article will summarize research to date of psychedelic use in depression and terminal illness and discuss pre-clinical evidence suggesting that these benefits may also extend to Mild Cognitive Impairment and mild Alzheimer’s disease as well as important safety caveats in older patients.

Recent Findings

From the early 1950s to the 1960s, and then since the mid 2000s, hundreds of studies have suggested benefit of psychedelics in treating numerous psychiatric conditions, including depression and existential distress in terminal illness. Psychedelics appear to be well tolerated, and the use of careful screening and pre-, peri-, and post-administration psychological support can minimize the risk of psychological adverse effects, such as hallucinogen persisting perception disorder. Several strains of pre-clinical and neuroimaging research also suggest that psychedelics may be helpful in early Alzheimer’s disease and Mild Cognitive Impairment. Despite encouraging findings, caveats remain regarding psychedelic use in the elderly population, including limited inclusion in research and potential cardiovascular risks.

Summary

Mild Cognitive Impairment and mild Alzheimer’s disease are associated with depression and existential distress, and evidence supporting psychotropic or psychotherapeutic treatment is limited. Encouraging research has suggested benefit of psychedelics in treating depression, as well as existential distress in terminal illness. Pre-clinical research and neuroimaging data suggest potential benefit of psychedelics in Mild Cognitive Impairment and mild Alzheimer’s disease. Safety concerns include limited research in the elderly and potential cardiovascular events. Further research is indicated to determine whether benefit extends to those with Mild Cognitive Impairment or mild Alzheimer’s disease.
Literatur
2.
Zurück zum Zitat Low LF, Swaffer K, McGrath M, Brodaty H. Do people with early stage dementia experience Prescribed Disengagement®? A systematic review of qualitative studies. Int Psychogeriatr. 2018 un;30(6):807–831. https://doi.org/10.1017/S1041610217001545. Epub 2017 Aug 22. PMID: 28828999. Low LF, Swaffer K, McGrath M, Brodaty H. Do people with early stage dementia experience Prescribed Disengagement®? A systematic review of qualitative studies. Int Psychogeriatr. 2018 un;30(6):807–831. https://​doi.​org/​10.​1017/​S104161021700154​5. Epub 2017 Aug 22. PMID: 28828999.
4.
Zurück zum Zitat Peel E. 'The living death of Alzheimer's' versus 'Take a walk to keep dementia at bay': representations of dementia in print media and carer discourse. Sociol Health Illn 2014:36:885–901. https://doi.org/10.1111/1467-9566.12122. Epub 2014 Jun 17. PMID: 24935028; PMCID: PMC4145707. Peel E. 'The living death of Alzheimer's' versus 'Take a walk to keep dementia at bay': representations of dementia in print media and carer discourse. Sociol Health Illn 2014:36:885–901. https://​doi.​org/​10.​1111/​1467-9566.​12122. Epub 2014 Jun 17. PMID: 24935028; PMCID: PMC4145707.
9.
Zurück zum Zitat Schimmel N, Breeksema JJ, Smith-Apeldoorn SY, Veraart J, van den Brink W, Schoevers RA. Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review. Psychopharmacology. 2022;239(1):15–33.CrossRef Schimmel N, Breeksema JJ, Smith-Apeldoorn SY, Veraart J, van den Brink W, Schoevers RA. Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review. Psychopharmacology. 2022;239(1):15–33.CrossRef
17.
Zurück zum Zitat Pahnke WN, Kurland AA, Unger S, Savage C, Wolf S, Goodman LE. Psychedelic therapy (utilizing LSD) with cancer patients. J Psychedelic Drugs. 1970;3(1):63–75.CrossRef Pahnke WN, Kurland AA, Unger S, Savage C, Wolf S, Goodman LE. Psychedelic therapy (utilizing LSD) with cancer patients. J Psychedelic Drugs. 1970;3(1):63–75.CrossRef
19.
Zurück zum Zitat Ross S, Bossis A, Guss J, Agin-Liebes G, Malone T, Cohen B, Mennenga SE, Belser A, Kalliontzi K, Babb J, Su Z, Corby P, Schmidt BL. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165–80. https://doi.org/10.1177/0269881116675512. PMID:27909164; PMCID:PMC5367551.CrossRefPubMedPubMedCentral Ross S, Bossis A, Guss J, Agin-Liebes G, Malone T, Cohen B, Mennenga SE, Belser A, Kalliontzi K, Babb J, Su Z, Corby P, Schmidt BL. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165–80. https://​doi.​org/​10.​1177/​0269881116675512​. PMID:27909164; PMCID:PMC5367551.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Hofmann, A. LSD: my problem child. Oxford University Press: 2013. Hofmann, A. LSD: my problem child. Oxford University Press: 2013.
27.
Zurück zum Zitat Baumeister RF, Placidi KS. A social history and analysis of the LSD controversy. J Humanist Psychol. 1983;23(4):25–58.CrossRef Baumeister RF, Placidi KS. A social history and analysis of the LSD controversy. J Humanist Psychol. 1983;23(4):25–58.CrossRef
32.
Zurück zum Zitat Andersen KAA, Carhart-Harris R, Nutt DJ, Erritzoe D. Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern-era clinical studies. Acta Psychiatr Scand 2021: Feb;143(2):101–118. https://doi.org/10.1111/acps.13249. Epub 2020 Dec 1. PMID: 33125716. Andersen KAA, Carhart-Harris R, Nutt DJ, Erritzoe D. Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern-era clinical studies. Acta Psychiatr Scand 2021: Feb;143(2):101–118. https://​doi.​org/​10.​1111/​acps.​13249. Epub 2020 Dec 1. PMID: 33125716.
33.
Zurück zum Zitat Bogenschutz MP, Ross S, Bhatt S, Baron T, Forcehimes AA, Laska E, et al. Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: a randomized clinical trial. JAMA Psychiat. 2022;79(10):953–62. https://doi.org/10.1001/jamapsychiatry.2022.2096. Erratum In: JAMA Psychiatry. 2022 Sep 14; PMID:36001306; PMCID:PMC9403854.CrossRef Bogenschutz MP, Ross S, Bhatt S, Baron T, Forcehimes AA, Laska E, et al. Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: a randomized clinical trial. JAMA Psychiat. 2022;79(10):953–62. https://​doi.​org/​10.​1001/​jamapsychiatry.​2022.​2096. Erratum In: JAMA Psychiatry. 2022 Sep 14; PMID:36001306; PMCID:PMC9403854.CrossRef
34.
Zurück zum Zitat Johnson MW, Garcia-Romeu A, Griffiths RR. Long-term follow-up of psilocybin-facilitated smoking cessation. Am J Drug Alcohol Abuse 2017:43(1):55–60. https://doi.org/10.3109/00952990.2016.1170135. Epub 2016 Jul 21. Erratum in: Am J Drug Alcohol Abuse. 2017 Jan;43(1):127. PMID: 27441452; PMCID: PMC5641975. Johnson MW, Garcia-Romeu A, Griffiths RR. Long-term follow-up of psilocybin-facilitated smoking cessation. Am J Drug Alcohol Abuse 2017:43(1):55–60. https://​doi.​org/​10.​3109/​00952990.​2016.​1170135. Epub 2016 Jul 21. Erratum in: Am J Drug Alcohol Abuse. 2017 Jan;43(1):127. PMID: 27441452; PMCID: PMC5641975.
36.
Zurück zum Zitat Reiff CM, Richman EE, Nemeroff CB, Carpenter LL, Widge AS, Rodriguez CI, Kalin NH, McDonald WM; the Work Group on Biomarkers and Novel Treatments, a Division of the American Psychiatric Association Council of Research. Psychedelics and psychedelic-assisted psychotherapy. Am J Psychiatry 2020: May 1;177(5):391–410. https://doi.org/10.1176/appi.ajp.2019.19010035. Epub 2020 Feb 26. PMID: 32098487. Reiff CM, Richman EE, Nemeroff CB, Carpenter LL, Widge AS, Rodriguez CI, Kalin NH, McDonald WM; the Work Group on Biomarkers and Novel Treatments, a Division of the American Psychiatric Association Council of Research. Psychedelics and psychedelic-assisted psychotherapy. Am J Psychiatry 2020: May 1;177(5):391–410. https://​doi.​org/​10.​1176/​appi.​ajp.​2019.​19010035. Epub 2020 Feb 26. PMID: 32098487.
37.
Zurück zum Zitat •• Goodwin GM, Aaronson ST, Alvarez O, Arden PC, Baker A, Bennett JC, et al. Single-dose psilocybin for a treatment-resistant episode of major depression. N Engl J Med. 2022;387(18):1637–48. https://doi.org/10.1056/NEJMoa2206443. PMID: 36322843. The largest clinical study of psilocybin conducted to date showing antidepressant effects of a single high (25 mg) dose of psilocybin lasting up to 3 weeks post treatment. •• Goodwin GM, Aaronson ST, Alvarez O, Arden PC, Baker A, Bennett JC, et al. Single-dose psilocybin for a treatment-resistant episode of major depression. N Engl J Med. 2022;387(18):1637–48. https://​doi.​org/​10.​1056/​NEJMoa2206443. PMID: 36322843. The largest clinical study of psilocybin conducted to date showing antidepressant effects of a single high (25 mg) dose of psilocybin lasting up to 3 weeks post treatment.
41.
Zurück zum Zitat von Rotz R, Schindowski EM, Jungwirth J, Schuldt A, Rieser NM, Zahoranszky K, et. al. Single-dose psilocybin-assisted therapy in major depressive disorder: A placebo-controlled, double-blind, randomised clinical trial. E Clinical Medicine. 2022:28:56:101809. https://doi.org/10.1016/j.eclinm.2022.101809. Erratum in: E Clinical Medicine. 2023:56:101841. PMID: 36636296; PMCID: PMC9830149. von Rotz R, Schindowski EM, Jungwirth J, Schuldt A, Rieser NM, Zahoranszky K, et. al. Single-dose psilocybin-assisted therapy in major depressive disorder: A placebo-controlled, double-blind, randomised clinical trial. E Clinical Medicine. 2022:28:56:101809. https://​doi.​org/​10.​1016/​j.​eclinm.​2022.​101809. Erratum in: E Clinical Medicine. 2023:56:101841. PMID: 36636296; PMCID: PMC9830149.
42.
Zurück zum Zitat Rosenbaum D, Boyle AB, Rosenblum AM, Ziai S, Chasen MR, Med MP. Psychedelics for psychological and existential distress in palliative and cancer care. Curr Oncol 2019:26(4):225–226. https://doi.org/10.3747/co.26.5009. Epub 2019 Aug 1. PMID: 31548800; PMCID: PMC6726261. Rosenbaum D, Boyle AB, Rosenblum AM, Ziai S, Chasen MR, Med MP. Psychedelics for psychological and existential distress in palliative and cancer care. Curr Oncol 2019:26(4):225–226. https://​doi.​org/​10.​3747/​co.​26.​5009. Epub 2019 Aug 1. PMID: 31548800; PMCID: PMC6726261.
43.
Zurück zum Zitat Maia LO, Beaussant Y, Garcia ACM. The therapeutic potential of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness: a systematic review. J Pain Symptom Manage. 2022;63(6):e725–38.CrossRefPubMed Maia LO, Beaussant Y, Garcia ACM. The therapeutic potential of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness: a systematic review. J Pain Symptom Manage. 2022;63(6):e725–38.CrossRefPubMed
44.
Zurück zum Zitat Richards WA, Rhead JC, DiLeo FB, Yensen R, Kurland AA. The peak experience variable in DPT-assisted psychotherapy with cancer patients. J Psychedelic Drugs. 1977;9(1):1–10.CrossRef Richards WA, Rhead JC, DiLeo FB, Yensen R, Kurland AA. The peak experience variable in DPT-assisted psychotherapy with cancer patients. J Psychedelic Drugs. 1977;9(1):1–10.CrossRef
45.
Zurück zum Zitat • Agin-Liebes GI, Malone T, Yalch MM, Mennenga SE, Ponté KL, Guss J, et. al. Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer. J Psychopharmacol 2020:34(2):155–166. https://doi.org/10.1177/0269881119897615. Epub 2020 Jan 9. PMID: 31916890. Among the first studies to show durability of psilocybin effects for reducing anxiety, depression, hopelessness, demoralization, and death anxiety in patients with cancer-related existential distress on average 3 to 5 years after treatment with a single moderately high dose of 0.3 mg/kg psilocybin. • Agin-Liebes GI, Malone T, Yalch MM, Mennenga SE, Ponté KL, Guss J, et. al. Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer. J Psychopharmacol 2020:34(2):155–166. https://​doi.​org/​10.​1177/​0269881119897615​. Epub 2020 Jan 9. PMID: 31916890. Among the first studies to show durability of psilocybin effects for reducing anxiety, depression, hopelessness, demoralization, and death anxiety in patients with cancer-related existential distress on average 3 to 5 years after treatment with a single moderately high dose of 0.3 mg/kg psilocybin.
50.
51.
Zurück zum Zitat •• Garcia-Romeu A, Darcy S, Jackson H, White T, Rosenberg P. Psychedelics as novel therapeutics in Alzheimer’s disease: rationale and potential mechanisms. Curr Top Behav Neurosci. 2022;56:287–317. A comprehensive review outlining biological and psychological mechanisms and rationale for studying classic psychedelics as potential therapeutics in Alzheimer’s Disease. •• Garcia-Romeu A, Darcy S, Jackson H, White T, Rosenberg P. Psychedelics as novel therapeutics in Alzheimer’s disease: rationale and potential mechanisms. Curr Top Behav Neurosci. 2022;56:287–317. A comprehensive review outlining biological and psychological mechanisms and rationale for studying classic psychedelics as potential therapeutics in Alzheimer’s Disease.
57.
Zurück zum Zitat Zhang G, Ásgeirsdóttir HN, Cohen SJ, Munchow AH, Barrera MP, Stackman RW Jr. Stimulation of serotonin 2A receptors facilitates consolidation and extinction of fear memory in C57BL/6J mice. Neuropharmacology 2013: 64(1):403–13. https://doi.org/10.1016/j.neuropharm.2012.06.007. Epub 2012 Jun 18. PMID: 22722027; PMCID: PMC3477617. Zhang G, Ásgeirsdóttir HN, Cohen SJ, Munchow AH, Barrera MP, Stackman RW Jr. Stimulation of serotonin 2A receptors facilitates consolidation and extinction of fear memory in C57BL/6J mice. Neuropharmacology 2013: 64(1):403–13. https://​doi.​org/​10.​1016/​j.​neuropharm.​2012.​06.​007. Epub 2012 Jun 18. PMID: 22722027; PMCID: PMC3477617.
62.
Zurück zum Zitat Lee ES, Yoo K, Lee YB, Chung J, Lim JE, Yoon B, et al. Alzheimer’s Disease Neuroimaging Initiative. Default Mode Network functional connectivity in early and late Mild Cognitive Impairment: Results From the Alzheimer's Disease Neuroimaging Initiative. Alzheimer Dis Assoc Disord. 2016:30(4):289–296. https://doi.org/10.1097/WAD.0000000000000143. PMID: 26840545. Lee ES, Yoo K, Lee YB, Chung J, Lim JE, Yoon B, et al. Alzheimer’s Disease Neuroimaging Initiative. Default Mode Network functional connectivity in early and late Mild Cognitive Impairment: Results From the Alzheimer's Disease Neuroimaging Initiative. Alzheimer Dis Assoc Disord. 2016:30(4):289–296. https://​doi.​org/​10.​1097/​WAD.​0000000000000143​. PMID: 26840545.
63.
Zurück zum Zitat Carhart-Harris RL, Erritzoe D, Williams T, Stone JM, Reed LJ, Colasanti A, et. al. Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proc Natl Acad Sci U S A. 2012:109(6):2138–43. https://doi.org/10.1073/pnas.1119598109. Epub 2012 Jan 23. PMID: 22308440; PMCID: PMC3277566. Carhart-Harris RL, Erritzoe D, Williams T, Stone JM, Reed LJ, Colasanti A, et. al. Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proc Natl Acad Sci U S A. 2012:109(6):2138–43. https://​doi.​org/​10.​1073/​pnas.​1119598109. Epub 2012 Jan 23. PMID: 22308440; PMCID: PMC3277566.
66.
67.
Zurück zum Zitat Anderson BT, Danforth A, Daroff PR, Stauffer C, Ekman E, Agin-Liebes G, et al. Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: An open-label safety and feasibility pilot study EClinicalMedicine. 2020:27:100538. https://doi.org/10.1016/j.eclinm.2020.100538. PMID: 33150319; PMCID: PMC7599297. Anderson BT, Danforth A, Daroff PR, Stauffer C, Ekman E, Agin-Liebes G, et al. Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: An open-label safety and feasibility pilot study EClinicalMedicine. 2020:27:100538. https://​doi.​org/​10.​1016/​j.​eclinm.​2020.​100538. PMID: 33150319; PMCID: PMC7599297.
Metadaten
Titel
The Potential for Psychedelics to Improve Coping Skills and Resilience in Persons With Newly Diagnosed Mild Cognitive Impairment or Early Alzheimer’s Disease
verfasst von
Martin Steinberg
Paul Rosenberg
Albert Garcia-Romeu
Publikationsdatum
27.07.2023
Verlag
Springer US
Erschienen in
Current Geriatrics Reports / Ausgabe 3/2023
Elektronische ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-023-00395-3

Weitere Artikel der Ausgabe 3/2023

Current Geriatrics Reports 3/2023 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Blutdrucksenkung könnte Uterusmyome verhindern

Frauen mit unbehandelter oder neu auftretender Hypertonie haben ein deutlich erhöhtes Risiko für Uterusmyome. Eine Therapie mit Antihypertensiva geht hingegen mit einer verringerten Inzidenz der gutartigen Tumoren einher.

„Jeder Fall von plötzlichem Tod muss obduziert werden!“

17.05.2024 Plötzlicher Herztod Nachrichten

Ein signifikanter Anteil der Fälle von plötzlichem Herztod ist genetisch bedingt. Um ihre Verwandten vor diesem Schicksal zu bewahren, sollten jüngere Personen, die plötzlich unerwartet versterben, ausnahmslos einer Autopsie unterzogen werden.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Schlechtere Vorhofflimmern-Prognose bei kleinem linken Ventrikel

17.05.2024 Vorhofflimmern Nachrichten

Nicht nur ein vergrößerter, sondern auch ein kleiner linker Ventrikel ist bei Vorhofflimmern mit einer erhöhten Komplikationsrate assoziiert. Der Zusammenhang besteht nach Daten aus China unabhängig von anderen Risikofaktoren.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.