Abstracts
Abstract
Recent evidence shows significant potential for therapies involving psychedelic substances such as psilocybin and MDMA to improve clinical outcomes for patients experiencing various mental disorders. However, research to date focuses almost exclusively on adults. I argue that adolescents should be included in research into psychedelic therapies. First, I demonstrate the pressing need for novel interventions to address the growing mental health burden of adolescents, and I draw on empirical evidence to show that research into psychedelic therapies presents an opportunity to address this shortfall. Secondly, I argue that psychedelics pose low risk to young patients, particularly relative to existing psychiatric medications. I then address two major concerns specific to adolescent contexts. First, I address the risks of using psychedelic substances at earlier stages of physiological and cognitive development. I note that the lack of understanding of the risks underscores the need for including adolescents in research. I then address the added complexity of consent in the adolescent context. I highlight some additional concerns that should be addressed in an “enhanced” informed consent process for adolescents and defend the view that capable adolescents should be able to consent to psychedelic interventions. I ultimately hold that including adolescents in emerging psychedelic research has the potential to substantiate innovative treatments that could improve their clinical outcomes, long-term mental health and quality of life.
Keywords:
- psychedelic therapy,
- psychedelic research,
- adolescent mental health,
- adolescent psychiatry,
- psilocybin,
- ketamine,
- MDMA,
- LSD
Résumé
Des données récentes montrent que les thérapies faisant appel à des substances psychédéliques telles que la psilocybine et la MDMA ont un potentiel important pour améliorer les résultats cliniques des patients souffrant de divers troubles mentaux. Cependant, les recherches menées à ce jour se concentrent presque exclusivement sur les adultes. Je soutiens que les adolescents devraient être inclus dans la recherche sur les thérapies psychédéliques. Tout d’abord, je démontre le besoin urgent de nouvelles interventions pour répondre au fardeau croissant de la santé mentale des adolescents, et je m’appuie sur des preuves empiriques pour montrer que la recherche sur les thérapies psychédéliques offre une opportunité de répondre à ce manque. Deuxièmement, je soutiens que les psychédéliques présentent un faible risque pour les jeunes patients, en particulier par rapport aux médicaments psychiatriques existants. J’aborde ensuite deux préoccupations majeures spécifiques aux contextes adolescents. Premièrement, j’aborde les risques liés à l’utilisation de substances psychédéliques à des stades précoces du développement physiologique et cognitif. Je note que le manque de compréhension de ces risques souligne la nécessité d’inclure les adolescents dans la recherche. J’aborde ensuite la complexité supplémentaire du consentement dans le contexte des adolescents. Je souligne certaines préoccupations supplémentaires qui devraient être abordées dans un processus de consentement éclairé « amélioré » pour les adolescents, et je défends l’idée que les adolescents capables devraient être en mesure de consentir à des interventions psychédéliques. Je soutiens finalement que l’inclusion des adolescents dans la recherche émergente sur les psychédéliques a le potentiel de justifier des traitements innovants qui pourraient améliorer leurs résultats cliniques, leur santé mentale à long terme et leur qualité de vie.
Mots-clés :
- thérapie psychédélique,
- recherche sur les psychédéliques,
- santé mentale des adolescents,
- psychiatrie des adolescents,
- psilocybine,
- kétamine,
- MDMA,
- LSD
Appendices
Bibliography
- 1. Tupper KW, Wood E, Yensen R, et al. Psychedelic medicine: a re-emerging therapeutic paradigm. Canadian Medical Association Journal. 2015;187(14):1054-59.
- 2. Sacks D. Age limits and adolescents. Paediatr Child Health. 2003;8(9):577.
- 3. Lifshitz M, Sheiner E, Kirmayer LJ. Cultural Neurophenomenology of psychedelic thought: guiding the “unconstrained” mind through ritual context In: Fox KCK, editor. The Oxford Handbook of Spontaneous Thought: Mind-Wandering, Creativity, and Dreaming Oxford: Oxford University Press; 2018.
- 4. dos Santos RG, Hallak JEC. Therapeutic use of serotoninergic hallucinogens: A review of the evidence and of the biological and psychological mechanisms. Neuroscience & Biobehavioral Reviews. 2020;108:423-34.
- 5. Canady VA. FDA approves esketamine treatment for MDD, suicidal ideation. Mental Health Weekly. 2020;30(31):6-7.
- 6. Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine. 2021;27(6):1025-33.
- 7. Chiu M. et al. Deconstructing the rise in mental health–related ED visits among children and youth in Ontario, Canada. Health Affairs. 2020;39(10):1728-36.
- 8. Statistics Canada. Health at a glance: Mental and substance use disorders in Canada. 2015.
- 9. Ontario Ministry of Children and Youth Services. Mental Health Services. 2015.
- 10. Wiens K, Bhattarai A, Pedram P, et al. A growing need for youth mental health services in Canada: examining trends in youth mental health from 2011 to 2018. Epidemiol Psychiatr. 2020;29:e115.
- 11. Kalb LG, Stapp EK, Ballard ED, et al. Trends in psychiatric emergency department visits among youth and young adults in the US. Pediatrics. 2019;143(4):e20182192.
- 12. Gunnell D, Kidger J, Elvidge H. Adolescent mental health in crisis. BMJ 2018;361:k2608.
- 13. Kieling C, Baker-Henningham H, Belfer M, et al. Child and adolescent mental health worldwide: evidence for action. Lancet 2011;378(9801):1515-25.
- 14. Racine N, Cooke JE, Eirich R, et al. Child and adolescent mental illness during COVID-19: A rapid review. Psychiatry Res 2020;292:113307.
- 15. Malla A, Shah J, Iyer S, et al. Youth mental health should be a top priority for health care in Canada. The Canadian Journal of Psychiatry 2018;63(4):216-22.
- 16. Schenberg EE. Psychedelic-assisted psychotherapy: a paradigm shift in psychiatric research and development. Frontiers in Pharmacology. 2018;9:733.
- 17. Davis AK, Barrett FS, May DG, et al. Effects of psilocybin-assisted therapy on major depressive disorder: a randomized clinical trial. JAMA Psychiatry 2021;78(5):481-89.
- 18. Goldberg SB, Pace BT, Nicholas CR, Raison CL, Hutson PR. The experimental effects of psilocybin on symptoms of anxiety and depression: A meta-analysis. Psychiatry Res. 2020;284:112749.
- 19. Marcantoni WS, Akoumba BS, Wassef M, et al. A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 – January 2019. Journal of Affective Disorders. 2020;277:831-41.
- 20. Jerome L, Feduccia AA, Wang JB, et al. Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials. Psychopharmacology 2020;237(8):2485-97.
- 21. Tedesco S, Gajaram G, Chida S, Ahmad A, Pentak M, Kelada M, et al. The efficacy of MDMA (3,4-Methylenedioxymethamphetamine) for post-traumatic stress disorder in humans: a systematic review and meta-analysis. Cureus. 2021;13(5):e15070.
- 22. DiVito AJ, Leger RF. Psychedelics as an emerging novel intervention in the treatment of substance use disorder: a review. Molecular Biology Reports. 2020;47(12):9791-9.
- 23. Morgan C, McAndrew A, Stevens T, et al. Tripping up addiction: the use of psychedelic drugs in the treatment of problematic drug and alcohol use. Current Opinion in Behavioral Sciences 2017;13:71-76.
- 24. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology. 2016;30(12):1181-97.
- 25. Ross S, Bossis A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. Journal of Psychopharmacology. 2016;30(12):1165-80.
- 26. Gasser P, Holstein D, Michel Y, et al. Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases. J Nerv Ment Dis 2014;202(7):513-20.
- 27. Hendricks PS, Thorne CB, Clark CB, et al. Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population. Journal of Psychopharmacology 2015;29(3):280-88.
- 28. Witt K, Potts J, Hubers A, et al. Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. Australian & New Zealand Journal of Psychiatry. 2020;54(1):29-45.
- 29. Nutt D. Drugs – Without the Hot Air: Minimising the Harms of Legal and Illegal Drugs. Cambridge University Press; 2012.
- 30. Johansen P-Ø, Krebs TS. Psychedelics not linked to mental health problems or suicidal behavior: A population study. Journal of Psychopharmacology 2015;29(3):270-79.
- 31. Nutt D, King L, Phillips L. Drug harms in the UK: A multi-criterion decision analysis. Lancet 2010;376(9752):1558-65.
- 32. Roxburgh A, Sam B, Kriikku P, et al. Trends in MDMA-related mortality across four countries. Addiction 2021;116(11):3094-3103.
- 33. Smith WR, Sisti D. Ethics and ego dissolution: the case of psilocybin. Journal of Medical Ethics 2020. Epub: medethics-2020-106070.
- 34. Carbonaro TM, Bradstreet MP, Barrett FS, et al. Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology. 2016;30(12):1268-78.
- 35. National Institute on Drug Abuse. Overdose Death Rates. 2020.
- 36. Ray WA, Stein CM, Murray KT, et al. Association of antipsychotic treatment with risk of unexpected death among children and youths. JAMA Psychiatry 2019;76(2):162-71.
- 37. Read J, Williams J. Adverse effects of antidepressants reported by a large international cohort: emotional blunting, suicidality, and withdrawal effects. Current Drug Safety 2018;13(3):176-86.
- 38. Moonzwe LS, Schensul JJ, Kostick KM. The role of MDMA (Ecstasy) in coping with negative life situations among urban young adults. J Psychoactive Drugs 2011;43(3):199-210.
- 39. Mason NL, Kuypers KP. Mental health of a self-selected sample of psychedelic users and self-medication practices with psychedelics. Journal of Psychedelic Studies 2018;2(1):45-52.
- 40. Laing MK, Tupper KW, Fairbairn N. Drug checking as a potential strategic overdose response in the fentanyl era. International Journal of Drug Policy 2018;62:59-66.
- 41. Neitzke-Spruill L. Race as a component of set and setting: How experiences of race can influence psychedelic experiences. Journal of Psychedelic Studies 2020;4(1):51.
- 42. Vardy MM, Kay SR. LSD psychosis or LSD-induced schizophrenia? A multimethod inquiry. Archives of General Psychiatry. 1983;40(8):877-83.
- 43. Meruelo AD, Castro N, Cota CI, et al. Cannabis and alcohol use, and the developing brain. Behavioural Brain Research 2017;325:44-50.
- 44. Hilt RJ et al. Side effects from use of one or more psychiatric medications in a population-based sample of children and adolescents. Journal of Child and Adolescent Psychopharmacology 2014;24(2):83-89.
- 45. Coughlin KW, Canadian Paediatric Society Bioethics Committee. Medical decision-making in paediatrics: Infancy to adolescence. Paediatr Child Health 2018;23(2):138-46.