经典致幻剂治疗抑郁症和焦虑症:系统综述
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Classical psychedelics for the treatment of depression and anxiety: a systematic review
背景与目的
抑郁和焦虑是普遍存在的精神疾病，发病率显著。药物和社会心理干预被用于改善这些情况，但效果有限。最近人们开始关注死藤水、裸盖菇素或麦角酸二乙胺(LSD)等致幻剂辅助治疗的作用，这可能成为对传统治疗无反应的患者的一个可替代疗法。本文旨在探讨致幻药物治疗顽固性抑郁症的疗效和耐受性。
方 法
通过MEDLINE、EMBASE和PsychINFO检索了有关抑郁症和/或焦虑症患者中致幻剂研究的临床试验。疗效通过测量基线症状改善来评估，耐受性通过记录不良反应的发生率和类型来评估。评估偏倚风险。
结 果
本文分析了7项研究，共130例患者。其中三项研究是针对抑郁症患者进行的，两项是关于焦虑症患者，两项是同时患有这两种疾病的患者。在支持性环境中，死藤水、裸盖菇素和LSD持续产生即时且显著的抗抑郁和抗焦虑作用，并持续数月。致幻药耐受良好。最常见的副作用是短暂性焦虑、短暂性头痛、恶心以及心率和血压的轻微升高。
结 论
致幻剂可能对显著减轻抑郁和焦虑症状是有效地，而且耐受性良好，但这还需要进一步的证据证实。
原始文献摘要
Muttoni S, Ardissino M, John C. Classical psychedelics for the treatment of depression and anxiety: a systematic review[J]. J Affect Disord,2019,258:11-24. DOI: 10.1016/j.jad.2019.07.076.
Background: Depression and anxiety are prevalent psychiatric disorders that carry significant morbidity. Pharmacological and psychosocial interventions are used to manage these conditions, but their efficacy is limited. Recent interest into the use of psychedelic-assisted therapy using ayahuasca, psilocybin or lysergic acid diethylamide (LSD) may be a promising alternative for patients unresponsive to traditional treatments. This review aims to determine the efficacy and tolerability of psychedelics in the management of resistant depression.
Methods: Clinical trials investigating psychedelics in patients with depression and/or anxiety were searched via MEDLINE, EMBASE and PsychINFO. Efficacy was assessed by measuring symptom improvement from baseline, and tolerability was evaluated by noting the incidence and type of adverse effects reported. Risk of bias was assessed.
Results: Seven studies, with 130 patients, were analysed in this review. Three were conducted in patients with depression, two in patients with anxiety and two in patients with both. In a supportive setting, ayahuasca, psilocybin, and LSD consistently produced immediate and significant anti-depressant and anxiolytic effects that were endured for several months. Psychedelics were well-tolerated. The most common adverse effects were transient anxiety, short-lived headaches, nausea and mild increases in heart rate and blood pressure.
Conclusions: Though further evidence is required, psychedelics appear to be effective in significantly reducing symptoms of depression and anxiety and are well-tolerated.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙