DOCSLIB.ORG

Ketamine Psychedelic Psychotherapy: Focus on Its Pharmacology, Phenomenology, and Clinical Applications Eli Kolp Private Practice

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ketamine Psychedelic Psychotherapy: Focus on Its Pharmacology, Phenomenology, and Clinical Applications Eli Kolp Private Practice International Journal of Transpersonal Studies Volume 33 | Issue 2 Article 8 7-1-2014 Ketamine Psychedelic Psychotherapy: Focus on its Pharmacology, Phenomenology, and Clinical Applications Eli Kolp Private Practice Harris L. Friedman University of Florida Evgeny Krupitsky St. Petersburg State Pavlov Medical University Karl Jansen Auckland Hospital Mark Sylvester Private Practice See next page for additional authors Follow this and additional works at: https://digitalcommons.ciis.edu/ijts-transpersonalstudies Part of the Philosophy Commons, Psychiatry and Psychology Commons, and the Religion Commons Recommended Citation Kolp, E., Friedman, H. L., Krupitsky, E., Jansen, K., Sylvester, M., Young, M. S., & Kolp, A. (2014). Kolp, E., Friedman, H. L., Krupitsky, E., Jansen, K., Sylvester, M., Young, M. S., & Kolp, A. (2014). Ketamine psychedelic psychotherapy: Focus on its pharmacology, phenomenology, and clinical applications. International Journal of Transpersonal Studies, 33(2), 84–140.. International Journal of Transpersonal Studies, 33 (2). http://dx.doi.org/10.24972/ijts.2014.33.2.84 This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This Special Topic Article is brought to you for free and open access by the Journals and Newsletters at Digital Commons @ CIIS. It has been accepted for inclusion in International Journal of Transpersonal Studies by an authorized administrator of Digital Commons @ CIIS. For more information, please contact [email protected]. Ketamine Psychedelic Psychotherapy: Focus on its Pharmacology, Phenomenology, and Clinical Applications Authors Eli Kolp, Harris L. Friedman, Evgeny Krupitsky, Karl Jansen, Mark Sylvester, M. Scott ounY g, and Anna Kolp This special topic article is available in International Journal of Transpersonal Studies: https://digitalcommons.ciis.edu/ijts- transpersonalstudies/vol33/iss2/8 Ketamine Psychedelic Psychotherapy: Focus on its Pharmacology, Phenomenology, and Clinical Applications Eli Kolp Harris L. Friedman Privare Practice University of Florida Sarasota, FL, USA Gainesville, FL, USA Evgeny Krupitsky Karl Jansen St. Petersburg State Pavlov Medical University Auckland Hospital St. Petersburg, Russia Auckland, New Zealand Mark Sylvester M. Scott Young Private Practice University of South Florida Sarasota, FL, USA Tampa, FL, USA Anna Kolp University of Florida Gainesville, FL, USA Meant to be an authoritative guide for psychiatrists and others interested in understanding and applying ketamine psychedelic psychotherapy (KPP), this paper focuses on its pharmacology, phenomenology, and clinical applications. Ketamine is a dissociative anesthetic widely used by physicians and veterinarians in the United States. In addition to its anesthetic and dissociative properties, ketamine also has a multitude of other psychological and pharmacological properties, which include analgesic, sedative, neuroprotective, anxiolytic, antidepressant, stimulant, euphoriant, and hallucinogenic effects. The literature on the clinical application of KPP is comprehensively reviewed, practical advice for using KPP is given, and the pharmacology and phenomenology of ketamine-induced psychedelic experiences are explored, including in relationship to transpersonal healing and possible iatrogenic consequences of misuse of KPP. Keywords: psychedelic, ketamine, psychotherapy, transpersonal, consciousness etamine is an extremely interesting substance, Arylcyclohexylamines: especially from a transpersonal healing perspec- Ketamine’s Family Tree tive, as it not only has a wide range of potential he arylcyclohexylamines (also known as arylcyclo- Kclinical applications, including through what is here Thexamines or arylcyclohexanamines) were originally called ketamine psychedelic psychotherapy (KPP), but developed as anesthetics by Parke-Davis. Unlike all it is the only legally-available (i.e., through a physician’s other anesthetic agents, except perhaps nitrous oxide, off-label prescription without having to go through the arylcyclohexylamines do not generally extinguish regulatory hurdles) substance within the United States consciousness, but instead appear to “dissociate” mind that can reliably produce psychedelic experiences. from body (thus the name of “dissociative anesthetics”). Consequently, we review the literature on the clinical The arylcyclohexylamines predominantly block the application of KPP, and focus on the phenomenology N-methyl-D-aspartate (NMDA) receptor, a target for of ketamine-induced psychedelic experiences in terms the neurotransmitter glutamate in the brain, and prevent of possible clinical applications within a transpersonal the NMDA receptor from being activated by glutamate context. (Ahmadi & Mahmoudi, 2005; Ahmadi, Khalili, 84 International Journal of Transpersonal Studies , 33(2), 2014, pp. 84-140 Kolp et al. Hajikhani, & Naserbakht, 2011). In addition to NMDA distorted sense of time and space, visual and auditory antagonism, the arylcyclohexylamines produce µ opioid hallucinations). receptor agonism (Itzhak & Simon, 1984) and cause PCP use spread in the 1970s. When PCP is dopamine reuptake inhibition (Chaudieu et al., 1989). snorted or smoked (for example, users dipped tobacco Some of the arylcyclohexylamines also produce sigma or cannabis cigarettes in the liquid form of PCP or receptor agonistic (He et al., 1993), nACh receptor sprinkled its powder form on a leafy material like antagonistic (Eterović et al., 1999), and D2 receptor tobacco or cannabis), the effects are felt within 4 to 5 agonistic (Seeman, Ko, & Tallerico, 2005) actions. minutes and last from 4 to 6 hours. PCP can also be Antagonism of the NMDA receptor generates injected, although this appears to be a less common dissociative (hallucinogenic), anesthetic, neuroprotective route of administration. and anticonvulsant effects; stimulation of the sigma PCP use may have peaked around 1978, when and D2 receptors contributes to hallucinogenic People magazine called it the country’s “number one” (psychomimetic) effects; activation of the µ-opioid drug problem. PCP became infamous for its recurrent receptor causes analgesic and anxiolytic effects; blockade binges (so-called “runs”), when chronic users would of the dopamine transporter mediates stimulant and take PCP repeatedly for 2 to 3 consecutive days at a euphoriant effects (as well as adding to psychomimetic time without eating or sleeping. It was estimated that effects in higher doses); the combination of the two last at least 7 million Americans used PCP on at least qualities confers a strong antidepressant effect; and the one occasion between 1975 and 1983. The American combination of all the above pharmacological properties Psychiatric Association (APA) Diagnostic and Statistical make the arylcyclohexylamines powerful psychedelic Manual (DSM)-IV-TR (APA, 2000) devoted a separate drugs. chapter to this substance entitled Phencyclidine-Related The first member of the arylcyclohexylamine class Disorder. By the mid-1980s, PCP use began declining, to be discovered was phencyclidine. It was synthesized in perhaps partly as a result of the increased popularity of 1926, eventually patented in 1953 by the Parke-Davis ketamine and crack cocaine. Eventually, PCP use slowly pharmaceutical company for use as an anesthetic agent faded away, although there is still some manufacture for humans and animals, and was marketed under the by clandestine chemists. Today PCP is classified as a brand name Sernyl® (referring to serenity). By 1965, its hallucinogen and the new APA (2013) DSM-5 places its use with humans was discontinued as clinical studies effects in the Hallucinogen-Related Disorder category, revealed that patients experienced what was then seen as with classical hallucinogens. “psychotic” symptoms when emerging from the drug’s The second compound from the arylcyclo- effects (so-called “emergence delirium”). Today, it is hexylamines class, eticyclidine, was also developed by rarely used even in the veterinary community. However, Parke-Davis and evaluated for anesthetic potential it continues to be legally available for research purposes under the code name CI-400. Eticlydine is very similar in the United States, but as a Schedule II controlled in effects to phencyclidine and is slightly more potent. substance. Parke-Davis did not continue its research of eticyclidine Phencyclidine re-emerged as a drug of abuse after the development of ketamine, a similar drug with in the mid-1960s due to its strong euphoriant and more favorable properties. Nevertheless, eticyclidine psychedelic qualities. The drug was relatively easy and (under the name of PCE) did make its way to the inexpensive to manufacture in clandestine laboratories streets and was briefly abused in the 1970s and 1980s. and it quickly became popular on the streets, with names It did not become popular with recreational users due such as “Angel Dust” and PCP. PCP can be pressed into to its unpleasant taste and tendency to cause nausea. pills or put in capsules and swallowed. When ingested Eticyclidine was placed into the U.S. Schedule I list of orally, effects are felt in 30 to 45 minutes and last from 6 illegal drugs in the 1970s and its use is unknown today. to 24 hours. Doses of less than 5 mg produce euphoriant Ketamine was the third compound from the effects (feelings of elation and joy, relaxation, feelings of class of arylcyclohexylamines that Parke-Davis developed unreality and mild dissociation from the environment), as part of an effort to find
Load more

Recommended publications
  • Dextromethorphan Attenuates Sensorineural Hearing Loss in an Animal Model and Population-Based Cohort Study
    International Journal of Environmental Research and Public Health Article Dextromethorphan Attenuates Sensorineural Hearing Loss in an Animal Model and Population-Based Cohort Study Hsin-Chien Chen 1,* , Chih-Hung Wang 1,2 , Wu-Chien Chien 3,4 , Chi-Hsiang Chung 3,4, Cheng-Ping Shih 1, Yi-Chun Lin 1,2, I-Hsun Li 5,6, Yuan-Yung Lin 1,2 and Chao-Yin Kuo 1 1 Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; [email protected] (C.-H.W.); [email protected] (C.-P.S.); [email protected] (Y.-C.L.); [email protected] (Y.-Y.L.); [email protected] (C.-Y.K.) 2 Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan 3 School of Public Health, National Defense Medical Center, Taipei 114, Taiwan; [email protected] (W.-C.C.); [email protected] (C.-H.C.) 4 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan 5 Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; [email protected] 6 School of Pharmacy, National Defense Medical Center, Taipei 114, Taiwan * Correspondence: [email protected]; Tel.: +886-2-8792-7192; Fax: +886-2-8792-7193 Received: 31 July 2020; Accepted: 28 August 2020; Published: 31 August 2020 Abstract: The effect of dextromethorphan (DXM) use in sensorineural hearing loss (SNHL) has not been fully examined. We conducted an animal model and nationwide retrospective matched-cohort study to explore the association between DXM use and SNHL.
    [Show full text]
  • Module Two the Clinical Neurotoxicology of Chemical Terrorism
    Chemical Agents of Opportunity for Terrorism: TICs & TIMs! Module Two The Clinical Neurotoxicology of Chemical Terrorism Training Support Package 1 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Goals and Objectives • Recognize toxic syndromes that effect the nervous system – Sedation – Convulsions – Hallucinations • Know unique clinical effects of toxins that cause sedation syndromes • List examples of agents of opportunity for each syndrome • Know initial treatment strategy Module Two - The Clinical Neurotoxicology of Chemical Terrorism 2 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Central Nervous System • The CNS is immensely complex – Great target for terrorism • The CNS is central to both our function and our thinking Module Two - The Clinical Neurotoxicology of Chemical Terrorism 3 Chemical Agents of Opportunity for Terrorism: TICs & TIMs The Balance of the Brain • The brain is a fine balance of excitatory and inhibitory influences – Slight alterations in either direction are significant Excitation Inhibition Glutamate Gamma-aminobutyric acid Catecholamines (GABA) Module Two - The Clinical Neurotoxicology of Chemical Terrorism 4 Chemical Agents of Opportunity for Terrorism: TICs & TIMs The Balance of the Brain • In addition, other neurotransmitters influence our mood, our ability to think, remember, etc. Excitation Inhibition Modulators of Thought Processes Serotonin Acetylcholine Module Two - The Clinical Neurotoxicology of Chemical Terrorism 5 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Clinical
    [Show full text]
  • 4/23/2015 1 •Psychedelics Or Hallucinogens
    4/23/2015 Hallucinogens •Psychedelics or This “classic” hallucinogen column The 2 groups below are quite different produce similar effects From the classic hallucinogens Hallucinogens Drugs Stimulating 5HT Receptors Drugs BLOCKING ACH Receptors • aka “psychotomimetics” LSD Nightshade(Datura) Psilocybin Mushrooms Jimsonweed Morning Glory Seeds Atropine Dimethyltryptamine Scopolamine What do the very mixed group of hallucinogens found around the world share in common? •Drugs Resembling NE Drugs BLOCKING Glutamate Receptors •Peyote cactus Phencyclidine (PCP) •Mescaline Ketamine All contain something that resembles a •Methylated amphetamines like MDMA High dose dextromethorphan •Nutmeg neurotransmitter •New synthetic variations (“bath salts”) •5HT-Like Hallucinogens •LSD History • Serotonin • created by Albert Hofmann for Sandoz Pharmaceuticals LSD • was studying vasoconstriction produced by ergot alkaloids LSD • initial exposure was accidental absorption thru skin • so potent ED is in millionths of a gram (25-250 micrograms) & must be delivered on something else (sugar cube, gelatin square, paper) Psilocybin Activate 5HT2 receptors , especially in prefrontal cortex and limbic areas, but is not readily metabolized •Characteristics of LSD & Other “Typical” •Common Effects Hallucinogens • Sensory distortions (color, size, shape, movement), • Autonomic (mostly sympathetic) changes occur first constantly changing (relatively mild) • Vivid closed eye imagery • Sensory/perceptual changes follow • Synesthesia (crossing of senses – e.g. hearing music
    [Show full text]
  • Protabase Record Display Datura Stramonium L
    Protabase Record display www.prota.org Datura stramonium L. Protologue Sp. pl. 1: 179 (1753). Family Solanaceae Chromosome number 2n = 24 Vernacular names Thorn apple, green thorn apple, Jimson weed, Jamestown weed, devil’s apple, devil’s trumpet, stramonium (En). Pomme épineuse, stramoine, datura, feuille du diable, herbe du diable (Fr). Figueira do inferno, pomo espinhoso, erva dos bruxos, palha verde, estramonio (Po). Muranha (Sw). Origin and geographic distribution Datura stramonium is native to the Americas and has been introduced in many tropical, subtropical and even temperate regions. It is a naturalized weed in many African countries, but is probably seriously under-reported. Uses Datura stramonium and Datura metel L. have largely similar medicinal uses throughout the world. The most widely known use of Datura stramonium and of other Datura species is for relieving asthma, cough, tuberculosis and bronchitis by smoking the dried leaves, roots or flowers. ‘Asthma cigarettes’ have been shown to be very effective in some cases, but in other cases they had little or no effect. Cigarettes made with the leaves are also used to treat Parkinson’s disease. A decoction or infusion of leaves is given as a sedative to mental and schizophrenic patients. The leaves are applied as a dressing to cure rheumatic pain, swellings, wounds, gout, burns, ingrown toe-nails, fungal infections, tumours and ulcers. Dried pulverized leaves are dusted on wounds or applied after mixing the powder with fat or Vaseline. In DR Congo pounded fresh root and fresh leaves are soaked in water and the liquid is given in enema as an abortifacient.
    [Show full text]
  • Cyclopropane Anaesthesia by JOHN BOYD, M.D., D.A
    Cyclopropane Anaesthesia By JOHN BOYD, M.D., D.A. TLHIS paper is based on my experience of one thousand cases of cyclopropane anaesthesia personally conducted by me since October, 1938, both in hospital and in private. But before discussing these it might be convenient for me to mention here something about the drug itself. HISTORY. Cyclopropane was first isolated in Germany in 1882 by Freund, who also demonstrated its chemical structure, C3H6. He did not, however, describe its anaesthetic properties. Following its discovery it seems to have been forgotten until 1928, when Henderson and Lucas of Toronto, in investigating contaminants of propylene, another anesthetic with undesirable side-effects, and itself'an isomer of cyclopropane, found that the supposed cause of the cardiac disturbances was in reality a better and less toxic anaesthetic. They demonstrated its anaesthetic properties first on animals, and then, before releasing it to the medical profession for clinical trial, they anaesthetised each other, and determined the quantities necessary for administration to man. In 1933 the first clinical trials of cyclopropane were made by Waters and his associates of the University of Wisconsin. In October of that year Waters presented a preliminary report on its anaesthetic properties in man,1 confirming the findings of Henderson and Lucas. Rowbotham introduced it to England first in 1935, and since then its use has spread rapidly throughout the country. PREPARATION. Cyclopropane is prepared commercially by the reduction of trimethylene bromide in the presence of metallic zinc in ethyl alcohol. It is also made commercially from propane in natural gas by progressive thermal chlorination.
    [Show full text]
  • Unnamed Document
    Mutations M287L and Q266I in the Glycine Receptor ␣1 Subunit Change Sensitivity to Volatile Anesthetics in Oocytes and Neurons, but Not the Minimal Alveolar Concentration in Knockin Mice Cecilia M. Borghese, Ph.D.,* Wei Xiong, Ph.D.,† S. Irene Oh, B.S.,‡ Angel Ho, B.S.,§ S. John Mihic, Ph.D.,ʈ Li Zhang, M.D.,# David M. Lovinger, Ph.D.,** Gregg E. Homanics, Ph.D.,†† Edmond I. Eger 2nd, M.D.,‡‡ R. Adron Harris, Ph.D.§§ ABSTRACT What We Already Know about This Topic • Inhibitory spinal glycine receptor function is enhanced by vol- Background: Volatile anesthetics (VAs) alter the function of atile anesthetics, making this a leading candidate for their key central nervous system proteins but it is not clear which, immobilizing effect if any, of these targets mediates the immobility produced by • Point mutations in the ␣1 subunit of glycine receptors have been identified that increase or decrease receptor potentiation VAs in the face of noxious stimulation. A leading candidate is by volatile anesthetics the glycine receptor, a ligand-gated ion channel important for spinal physiology. VAs variously enhance such function, and blockade of spinal glycine receptors with strychnine af- fects the minimal alveolar concentration (an anesthetic What This Article Tells Us That Is New EC50) in proportion to the degree of enhancement. • Mice harboring specific mutations in their glycine receptors Methods: We produced single amino acid mutations into that increased or decreased potentiation by volatile anesthetic in vitro did not have significantly altered changes in anesthetic the glycine receptor ␣1 subunit that increased (M287L, third potency in vivo transmembrane region) or decreased (Q266I, second trans- • These findings indicate that this glycine receptor does not me- membrane region) sensitivity to isoflurane in recombinant diate anesthetic immobility, and that other targets must be receptors, and introduced such receptors into mice.
    [Show full text]
  • Hallucinogens - LSD, Peyote, Psilocybin, and PCP
    Information for Behavioral Health Providers in Primary Care Hallucinogens - LSD, Peyote, Psilocybin, and PCP What are Hallucinogens? Hallucinogenic compounds found in some plants and mushrooms (or their extracts) have been used— mostly during religious rituals—for centuries. Almost all hallucinogens contain nitrogen and are classified as alkaloids. Many hallucinogens have chemical structures similar to those of natural neurotransmitters (e.g., acetylcholine-, serotonin-, or catecholamine-like). While the exact mechanisms by which hallucinogens exert their effects remain unclear, research suggests that these drugs work, at least partially, by temporarily interfering with neurotransmitter action or by binding to their receptor sites. This InfoFacts will discuss four common types of hallucinogens: LSD (d-lysergic acid diethylamide) is one of the most potent mood-changing chemicals. It was discovered in 1938 and is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains. Peyote is a small, spineless cactus in which the principal active ingredient is mescaline. This plant has been used by natives in northern Mexico and the southwestern United States as a part of religious ceremonies. Mescaline can also be produced through chemical synthesis. Psilocybin (4-phosphoryloxy-N, N-dimethyltryptamine) is obtained from certain types of mushrooms that are indigenous to tropical and subtropical regions of South America, Mexico, and the United States. These mushrooms typically contain less than 0.5 percent psilocybin plus trace amounts of psilocin, another hallucinogenic substance. PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Its use has since been discontinued due to serious adverse effects. How Are Hallucinogens Abused? The very same characteristics that led to the incorporation of hallucinogens into ritualistic or spiritual traditions have also led to their propagation as drugs of abuse.
    [Show full text]
  • Medical Review Officer Manual
    Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention Medical Review Officer Manual for Federal Agency Workplace Drug Testing Programs EFFECTIVE OCTOBER 1, 2010 Note: This manual applies to Federal agency drug testing programs that come under Executive Order 12564 dated September 15, 1986, section 503 of Public Law 100-71, 5 U.S.C. section 7301 note dated July 11, 1987, and the Department of Health and Human Services Mandatory Guidelines for Federal Workplace Drug Testing Programs (73 FR 71858) dated November 25, 2008 (effective October 1, 2010). This manual does not apply to specimens submitted for testing under U.S. Department of Transportation (DOT) Procedures for Transportation Workplace Drug and Alcohol Testing Programs (49 CFR Part 40). The current version of this manual and other information including MRO Case Studies are available on the Drug Testing page under Medical Review Officer (MRO) Resources on the SAMHSA website: http://www.workplace.samhsa.gov Previous Versions of this Manual are Obsolete 3 Table of Contents Chapter 1. The Medical Review Officer (MRO)........................................................................... 6 Chapter 2. The Federal Drug Testing Custody and Control Form ................................................ 7 Chapter 3. Urine Drug Testing ...................................................................................................... 9 A. Federal Workplace Drug Testing Overview..................................................................
    [Show full text]
  • Hallucinogens and Dissociative Drugs
    Long-Term Effects of Hallucinogens See page 5. from the director: Research Report Series Hallucinogens and dissociative drugs — which have street names like acid, angel dust, and vitamin K — distort the way a user perceives time, motion, colors, sounds, and self. These drugs can disrupt a person’s ability to think and communicate rationally, or even to recognize reality, sometimes resulting in bizarre or dangerous behavior. Hallucinogens such as LSD, psilocybin, peyote, DMT, and ayahuasca cause HALLUCINOGENS AND emotions to swing wildly and real-world sensations to appear unreal, sometimes frightening. Dissociative drugs like PCP, DISSOCIATIVE DRUGS ketamine, dextromethorphan, and Salvia divinorum may make a user feel out of Including LSD, Psilocybin, Peyote, DMT, Ayahuasca, control and disconnected from their body PCP, Ketamine, Dextromethorphan, and Salvia and environment. In addition to their short-term effects What Are on perception and mood, hallucinogenic Hallucinogens and drugs are associated with psychotic- like episodes that can occur long after Dissociative Drugs? a person has taken the drug, and dissociative drugs can cause respiratory allucinogens are a class of drugs that cause hallucinations—profound distortions depression, heart rate abnormalities, and in a person’s perceptions of reality. Hallucinogens can be found in some plants and a withdrawal syndrome. The good news is mushrooms (or their extracts) or can be man-made, and they are commonly divided that use of hallucinogenic and dissociative Hinto two broad categories: classic hallucinogens (such as LSD) and dissociative drugs (such drugs among U.S. high school students, as PCP). When under the influence of either type of drug, people often report rapid, intense in general, has remained relatively low in emotional swings and seeing images, hearing sounds, and feeling sensations that seem real recent years.
    [Show full text]
  • (19) United States (12) Patent Application Publication (10) Pub
    US 20130289061A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2013/0289061 A1 Bhide et al. (43) Pub. Date: Oct. 31, 2013 (54) METHODS AND COMPOSITIONS TO Publication Classi?cation PREVENT ADDICTION (51) Int. Cl. (71) Applicant: The General Hospital Corporation, A61K 31/485 (2006-01) Boston’ MA (Us) A61K 31/4458 (2006.01) (52) U.S. Cl. (72) Inventors: Pradeep G. Bhide; Peabody, MA (US); CPC """"" " A61K31/485 (201301); ‘4161223011? Jmm‘“ Zhu’ Ansm’ MA. (Us); USPC ......... .. 514/282; 514/317; 514/654; 514/618; Thomas J. Spencer; Carhsle; MA (US); 514/279 Joseph Biederman; Brookline; MA (Us) (57) ABSTRACT Disclosed herein is a method of reducing or preventing the development of aversion to a CNS stimulant in a subject (21) App1_ NO_; 13/924,815 comprising; administering a therapeutic amount of the neu rological stimulant and administering an antagonist of the kappa opioid receptor; to thereby reduce or prevent the devel - . opment of aversion to the CNS stimulant in the subject. Also (22) Flled' Jun‘ 24’ 2013 disclosed is a method of reducing or preventing the develop ment of addiction to a CNS stimulant in a subj ect; comprising; _ _ administering the CNS stimulant and administering a mu Related U‘s‘ Apphcatlon Data opioid receptor antagonist to thereby reduce or prevent the (63) Continuation of application NO 13/389,959, ?led on development of addiction to the CNS stimulant in the subject. Apt 27’ 2012’ ?led as application NO_ PCT/US2010/ Also disclosed are pharmaceutical compositions comprising 045486 on Aug' 13 2010' a central nervous system stimulant and an opioid receptor ’ antagonist.
    [Show full text]
  • The Effect of Opioids on Emotional Reactivity
    The Effect of Opioids on Emotional Reactivity Steven M. Savvas, BHSc (Hons) Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences University of Adelaide August, 2013 A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy i Steven M. Savvas, PhD Thesis, 2013 TABLE OF CONTENTS Abstract .................................................................................................................................... xi Declaration ............................................................................................................................ xiii Acknowledgements ............................................................................................................... xiv CHAPTER 1 - INTRODUCTION ...................................................................................... 1 1.1 OPIOIDS AND OPIOID MAINTENANCE TREATMENT ...................................... 1 1.1.1 A BRIEF HISTORY OF OPIOIDS .......................................................................... 1 1.1.2 OPIOID RECEPTORS ............................................................................................ 1 1.1.3 ADAPTATION TO OPIOIDS.................................................................................. 3 1.1.3.1 Tolerance ........................................................................................................ 4 1.1.3.2 Withdrawal ...................................................................................................... 4 1.1.3.3 Dependence
    [Show full text]
  • SPRAVATO® Esketamine Hydrochloride DATA SHEET
    SPRAVATO® esketamine hydrochloride DATA SHEET 1. PRODUCT NAME SPRAVATO® esketamine hydrochloride 32.3mg (equivalent to 28mg esketamine) nasal spray 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each single use nasal spray device delivers two sprays, one spray into each nostril. Total volume of drug product per device to be delivered is 0.2 mL containing a total of 32.3 mg of esketamine hydrochloride (equivalent to 28 mg of esketamine). For the full list of excipients, see Section 6.1 List of Excipients. 3. PHARMACEUTICAL FORM Nasal spray, solution. Clear, colourless, aqueous solution. 4. CLINICAL PARTICULARS 4.1 Therapeutic Indications SPRAVATO in conjunction with an oral antidepressant, is indicated for: - treatment resistant depression (Major Depressive Disorder in adults who have not responded adequately to at least two different antidepressants of adequate dose and duration to treat the current depressive episode). - rapid reduction of depressive symptoms in patients with Major Depressive Disorder who have acute suicidal ideation or behaviour. SPRAVATO is not indicated to prevent suicide or in reducing suicidal ideation or behaviour (see section 4.4. Special Warnings And Precautions For Use) 4.2 Dose and method of administration In patients with TRD, SPRAVATO should be administered in conjunction with a newly initiated oral antidepressant (AD) therapy. In patients with MDSI, SPRAVATO should be administered in conjunction with standard of care therapy. During the Phase III MDSI clinical program, standard of care oral AD treatment (either AD monotherapy or AD plus augmentation therapy) was initiated or optimised. Important Considerations Prior to Initiating and During Therapy SPRAVATO must be administered under the direct supervision of a healthcare provider.
    [Show full text]