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Ketamine As a Rapid Antidepressant
BJPsych Advances (2016), vol. 22, 222–233 doi: 10.1192/apt.bp.114.014274 ARTICLE Ketamine as a rapid anti depressant: the debate and implications Roger C. M. Ho & Melvyn W. Zhang Roger Ho is an Associate Professor response rates to SSRIs and NaSSAs are around SUMMARY and consultant psychiatrist in 62% and 67% respectively (Papakostas 2008). the Department of Psychological Ketamine, a synthetic derivative of phencyclidine, Environmental factors such as relationship Medicine, Yong Loo Lin School of is a commonly misused party drug that is Medicine, National University of problems, financial difficulties and comorbid restricted in high-income countries because of Singapore. He has a special interest substance misuse often lead to poor treatment its addictive potential. Ketamine is also used as in psychoneuroimmunology and response, and antidepressants combined with the interface between medicine an anaesthetic in human and veterinary medicine. and psychiatry. Melvyn Zhang In the 1990s, research using ketamine to study the CBT have shown promising results in prevention is a senior resident with the pathophysiology of schizophrenia was terminated of mood disorders (Brenner 2010). Although 70– National Addiction Management owing to ethical concerns. Recently, controversy 90% of patients with depression achieve remission, Service, Institute of Mental Health, surrounding the drug has returned, as researchers around 10–30% are refractory to initial treatment Singapore. Correspondence Dr Roger C. M. have demonstrated that intravenous ketamine but respond to switching or combination of Ho, National University of Singapore, infusion has a rapid antidepressant effect and antidepressants, electroconvulsive therapy (ECT) Department of Psychological have therefore proposed ketamine as a novel or psychotherapy. -
Hallucinogens - LSD, Peyote, Psilocybin, and PCP
Hallucinogens - LSD, Peyote, Psilocybin, and PCP Hallucinogenic compounds found in some • Psilocybin (4-phosphoryloxy-N,N- plants and mushrooms (or their extracts) dimethyltryptamine) is obtained from have been used—mostly during religious certain types of mushrooms that are rituals—for centuries. Almost all indigenous to tropical and subtropical hallucinogens contain nitrogen and are regions of South America, Mexico, and classified as alkaloids. Many hallucinogens the United States. These mushrooms have chemical structures similar to those of typically contain less than 0.5 percent natural neurotransmitters (e.g., psilocybin plus trace amounts of acetylcholine-, serotonin-, or catecholamine- psilocin, another hallucinogenic like). While the exact mechanisms by which substance. hallucinogens exert their effects remain • PCP (phencyclidine) was developed in unclear, research suggests that these drugs the 1950s as an intravenous anesthetic. work, at least partially, by temporarily Its use has since been discontinued due interfering with neurotransmitter action or to serious adverse effects. by binding to their receptor sites. This DrugFacts will discuss four common types of How Are Hallucinogens Abused? hallucinogens: The very same characteristics that led to • LSD (d-lysergic acid diethylamide) is the incorporation of hallucinogens into one of the most potent mood-changing ritualistic or spiritual traditions have also chemicals. It was discovered in 1938 led to their propagation as drugs of abuse. and is manufactured from lysergic acid, Importantly, and unlike most other drugs, which is found in ergot, a fungus that the effects of hallucinogens are highly grows on rye and other grains. variable and unreliable, producing different • Peyote is a small, spineless cactus in effects in different people at different times. -
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. -
Case Discussions in Palliative Medicine Levorphanol For
JOURNAL OF PALLIATIVE MEDICINE Volume 21, Number 3, 2018 Case Discussions in Palliative Medicine ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2017.0475 Feature Editor: Craig D. Blinderman Levorphanol for Treatment of Intractable Neuropathic Pain in Cancer Patients Akhila Reddy, MD,1,* Amy Ng, MD,1,* Tarun Mallipeddi,2 and Eduardo Bruera, MD1 Abstract Neuropathic pain in cancer patients is often difficult to treat, requiring a combination of several different pharmacological therapies. We describe two patients with complex neuropathic pain syndromes in the form of phantom limb pain and Brown-Sequard syndrome who did not respond to conventional treatments but re- sponded dramatically to the addition of levorphanol. Levorphanol is a synthetic strong opioid that is a potent N- methyl-d-aspartate receptor antagonist, mu, kappa, and delta opioid receptor agonist, and reuptake inhibitor of serotonin and norepinephrine. It bypasses hepatic first-pass metabolism and thereby not subjected to numerous drug interactions. Levorphanol’s unique profile makes it a potentially attractive opioid in cancer pain man- agement. Keywords: Brown-Sequard syndrome; cancer; cancer pain; levorphanol; neuropathic pain; phantom limb pain Introduction changes, structural reorganization of spinal cord and primary somatosensory cortex, and increased sensitization of spinal ne-third of cancer patients who experience pain cord may be the neurological basis for PLP.8,9 Because the Oalso experience neuropathic pain1 and about half the pathophysiology of PLP is not clearly understood, the treat- patients with cancer who suffer from neuropathic pain also ment options are mainly based on clinical experience.9 There have nociceptive pain.2 Most neuropathic pain exists as are case series showing that tramadol and methadone may be mixed pain in combination with nociceptive pain. -
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. -
Cerebellar Toxicity of Phencyclidine
The Journal of Neuroscience, March 1995, 75(3): 2097-2108 Cerebellar Toxicity of Phencyclidine Riitta N&kki, Jari Koistinaho, Frank Ft. Sharp, and Stephen M. Sagar Department of Neurology, University of California, and Veterans Affairs Medical Center, San Francisco, California 94121 Phencyclidine (PCP), clizocilpine maleate (MK801), and oth- Phencyclidine (PCP), dizocilpine maleate (MK801), and other er NMDA antagonists are toxic to neurons in the posterior NMDA receptor antagonistshave attracted increasing attention cingulate and retrosplenial cortex. To determine if addition- becauseof their therapeutic potential. These drugs have neuro- al neurons are damaged, the distribution of microglial ac- protective properties in animal studies of focal brain ischemia, tivation and 70 kDa heat shock protein (HSP70) induction where excitotoxicity is proposedto be an important mechanism was studied following the administration of PCP and of neuronal cell death (Dalkara et al., 1990; Martinez-Arizala et MK801 to rats. PCP (10-50 mg/kg) induced microglial ac- al., 1990). Moreover, NMDA antagonists decrease neuronal tivation and neuronal HSP70 mRNA and protein expression damage and dysfunction in other pathological conditions, in- in the posterior cingulate and retrosplenial cortex. In ad- cluding hypoglycemia (Nellgard and Wieloch, 1992) and pro- dition, coronal sections of the cerebellar vermis of PCP (50 longed seizures(Church and Lodge, 1990; Faingold et al., 1993). mg/kg) treated rats contained vertical stripes of activated However, NMDA antagonists are toxic to certain neuronal microglial in the molecular layer. In the sagittal plane, the populations in the brain. Olney et al. (1989) demonstratedthat microglial activation occurred in irregularly shaped patch- the noncompetitive NMDA antagonists,PCP, MK801, and ke- es, suggesting damage to Purkinje cells. -
Hallucinogens
Hallucinogens What Are Hallucinogens? Hallucinogens are a diverse group of drugs that alter a person’s awareness of their surroundings as well as their thoughts and feelings. They are commonly split into two categories: classic hallucinogens (such as LSD) and dissociative drugs (such as PCP). Both types of hallucinogens can cause hallucinations, or sensations and images that seem real though they are not. Additionally, dissociative drugs can cause users to feel out of control or disconnected from their body and environment. Some hallucinogens are extracted from plants or mushrooms, and others are synthetic (human-made). Historically, people have used hallucinogens for religious or healing rituals. More recently, people report using these drugs for social or recreational purposes. Hallucinogens are a Types of Hallucinogens diverse group of drugs Classic Hallucinogens that alter perception, LSD (D-lysergic acid diethylamide) is one of the most powerful mind- thoughts, and feelings. altering chemicals. It is a clear or white odorless material made from lysergic acid, which is found in a fungus that grows on rye and other Hallucinogens are split grains. into two categories: Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) comes from certain classic hallucinogens and types of mushrooms found in tropical and subtropical regions of South dissociative drugs. America, Mexico, and the United States. Peyote (mescaline) is a small, spineless cactus with mescaline as its main People use hallucinogens ingredient. Peyote can also be synthetic. in a wide variety of ways DMT (N,N-dimethyltryptamine) is a powerful chemical found naturally in some Amazonian plants. People can also make DMT in a lab. -
MDMA, Cannabis, and Cocaine Produce Acute Dissociative Symptoms
Psychiatry Research 228 (2015) 907–912 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres MDMA, cannabis, and cocaine produce acute dissociative symptoms Dalena van Heugten-Van der Kloet a,b,n, Timo Giesbrecht a, Janelle van Wel a, Wendy M Bosker a,1, Kim PC Kuypers a, Eef L Theunissen a, Desirée B Spronk c,d, Robbert Jan Verkes c,d, Harald Merckelbach a, Johannes G Ramaekers a a Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands b Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom c Department of Psychiatry (966), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands d Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands article info abstract Article history: Some drugs of abuse may produce dissociative symptoms, but this aspect has been understudied. We Received 4 April 2014 explored the dissociative potential of three recreational drugs (3,4-methylenedioxymethamphetamine Received in revised form (MDMA), cannabis, and cocaine) during intoxication and compared their effects to literature reports of 31 March 2015 dissociative states in various samples. Two placebo-controlled studies were conducted. In Study 1 (N¼16), Accepted 18 April 2015 participants received single doses of 25, 50, and 100 mg of MDMA, and placebo. In Study 2 (N¼21), cannabis Available online 30 April 2015 (THC 300 mg/kg), cocaine (HCl 300 mg), and placebo were administered. Dissociative symptoms as measured Keywords: with the Clinician-Administered Dissociative States Scale (CADSS) significantly increased under the influence Dissociative symptoms of MDMA and cannabis. -
MDMA-Induced Dissociative State Not Mediated by the 5-HT2A Receptor
fphar-08-00455 July 11, 2017 Time: 12:7 # 1 View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Diposit Digital de Documents de la UAB ORIGINAL RESEARCH published: 11 July 2017 doi: 10.3389/fphar.2017.00455 MDMA-Induced Dissociative State not Mediated by the 5-HT2A Receptor Drew J. Puxty1, Johannes G. Ramaekers1, Rafael de la Torre2,3,4, Magí Farré2,5,6, Neus Pizarro2,5, Mitona Pujadas2,3 and Kim P. C. Kuypers1* 1 Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands, 2 Integrative Pharmacology and Neurosciences Systems Research Group, Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain, 3 Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition, Santiago de Compostela, Spain, 4 Facultat de Ciencies de la Salut i de la Vida, Universitat Pompeu Fabra, Barcelona, Spain, 5 Department of Pharmacology, Therapeutic and Toxicology, Universitat Autonoma de Barcelona, Barcelona, Spain, 6 Hospital Universitari Germans Trias i Pujol, Clinical Pharmacology, Badalona, Spain Previous research has shown that a single dose of MDMA induce a dissociative state, by elevating feelings of depersonalization and derealization. Typically, it is assumed that action on the 5-HT2A receptor is the mechanism underlying these psychedelic experiences. In addition, other studies have shown associations between dissociative states and biological parameters (heart rate, cortisol), which are elevated by MDMA. In order to investigate the role of the 5-HT2 receptor in the MDMA-induced dissociative state and the association with biological parameters, a placebo-controlled within- Edited by: subject study was conducted including a single oral dose of MDMA (75 mg), combined Andrew Robert Gallimore, with placebo or a single oral dose of the 5-HT2 receptor blocker ketanserin (40 mg). -
From NMDA Receptor Hypofunction to the Dopamine Hypothesis of Schizophrenia J
REVIEW The Neuropsychopharmacology of Phencyclidine: From NMDA Receptor Hypofunction to the Dopamine Hypothesis of Schizophrenia J. David Jentsch, Ph.D., and Robert H. Roth, Ph.D. Administration of noncompetitive NMDA/glutamate effects of these drugs are discussed, especially with regard to receptor antagonists, such as phencyclidine (PCP) and differing profiles following single-dose and long-term ketamine, to humans induces a broad range of exposure. The neurochemical effects of NMDA receptor schizophrenic-like symptomatology, findings that have antagonist administration are argued to support a contributed to a hypoglutamatergic hypothesis of neurobiological hypothesis of schizophrenia, which includes schizophrenia. Moreover, a history of experimental pathophysiology within several neurotransmitter systems, investigations of the effects of these drugs in animals manifested in behavioral pathology. Future directions for suggests that NMDA receptor antagonists may model some the application of NMDA receptor antagonist models of behavioral symptoms of schizophrenia in nonhuman schizophrenia to preclinical and pathophysiological research subjects. In this review, the usefulness of PCP are offered. [Neuropsychopharmacology 20:201–225, administration as a potential animal model of schizophrenia 1999] © 1999 American College of is considered. To support the contention that NMDA Neuropsychopharmacology. Published by Elsevier receptor antagonist administration represents a viable Science Inc. model of schizophrenia, the behavioral and neurobiological KEY WORDS: Ketamine; Phencyclidine; Psychotomimetic; widely from the administration of purportedly psychot- Memory; Catecholamine; Schizophrenia; Prefrontal cortex; omimetic drugs (Snyder 1988; Javitt and Zukin 1991; Cognition; Dopamine; Glutamate Jentsch et al. 1998a), to perinatal insults (Lipska et al. Biological psychiatric research has seen the develop- 1993; El-Khodor and Boksa 1997; Moore and Grace ment of many putative animal models of schizophrenia. -
From Sacred Plants to Psychotherapy
From Sacred Plants to Psychotherapy: The History and Re-Emergence of Psychedelics in Medicine By Dr. Ben Sessa ‘The rejection of any source of evidence is always treason to that ultimate rationalism which urges forward science and philosophy alike’ - Alfred North Whitehead Introduction: What exactly is it that fascinates people about the psychedelic drugs? And how can we best define them? 1. Most psychiatrists will define psychedelics as those drugs that cause an acute confusional state. They bring about profound alterations in consciousness and may induce perceptual distortions as part of an organic psychosis. 2. Another definition for these substances may come from the cross-cultural dimension. In this context psychedelic drugs may be recognised as ceremonial religious tools, used by some non-Western cultures in order to communicate with the spiritual world. 3. For many lay people the psychedelic drugs are little more than illegal and dangerous drugs of abuse – addictive compounds, not to be distinguished from cocaine and heroin, which are only understood to be destructive - the cause of an individual, if not society’s, destruction. 4. But two final definitions for psychedelic drugs – and those that I would like the reader to have considered by the end of this article – is that the class of drugs defined as psychedelic, can be: a) Useful and safe medical treatments. Tools that as adjuncts to psychotherapy can be used to alleviate the symptoms and course of many mental illnesses, and 1 b) Vital research tools with which to better our understanding of the brain and the nature of consciousness. Classifying psychedelic drugs: 1,2 The drugs that are often described as the ‘classical’ psychedelics include LSD-25 (Lysergic Diethylamide), Mescaline (3,4,5- trimethoxyphenylathylamine), Psilocybin (4-hydroxy-N,N-dimethyltryptamine) and DMT (dimethyltryptamine). -
MDMA Get 24/7 Help Now!
MDMA Illicit substances can be categorized into one of three major drug types: depressants, stimulants, and hallucinogens. Depressants consist of substances that slow or “depress” the body’s normal functions. In contrast, stimulants do the opposite: they jump-start the central nervous system, increasing the user’s heart rate, blood pressure, respiration and body temperature. Hallucinogens are unlike either of the other illicit drug groups; as the name suggests, these are drugs that cause hallucinations, whether visual or auditory. Sometimes, illicit drugs can fall into two of these three categories. Methylenedioxy-methamphetamine, more commonly called MDMA, is one such example. It falls into two categories: stimulant and hallucinogen. MDMA drug addiction is one type of addiction treatment available through the Wellness Retreat Recovery program. Get 24/7 help now! All calls are free and confidential! 888-821-0238 MDMA About MDMA Like any other stimulant, MDMA increases the user’s energy, blood pressure, heart rate, and respiration. Still, MDMA stands apart from other stimulant drugs because it triggers a number of effects that are more common among hallucinogens. In fact, MDMA is most well-known for being the active ingredient in Ecstasy, a “club drug” that distorts the user’s senses and evokes uninhibited feelings of sensuality. Other effects include: increased sensory reception (i.e. fabric seems softer, drinks taste stronger, etc.) increased sensitivity to light emotional exacerbation sexual arousal Overall, MDMA has been known to intensity users’ emotional and physical experiences. However, this does not make MDMA a “safe” drug as many users might argue. The Effects of MDMA on the Brain Just like with any other illicit substance, continued use of MDMA can lead to addiction.