_______________________________________________ Psychedelic Medicine and Interventional Psychiatry
SOCIAL ANXIETY IN PATIENTS WITH AUTISM In a study of 12 adults with autism and issues with severe social anxiety, subjects were randomized to receive either MDMA (75 mg or 125 mg) or placebo during the course of two 8-hour psychotherapy sessions. The MDMA was administered after a guided progressive muscle relaxation exercise. The experi- mental sessions were held one month apart and separated by three nondrug sessions of psychotherapy. The patients were provided with as few sensory interruptions as possible, such as soft lights, noise abatement, and fidget objects to help them with self-regulation through repeated actions (i.e., “stimming”) [100]. On the Leibowitz Social Anxiety Scale, the MDMA group experienced a significantly greater improvement in social anxiety scores compared with the placebo group. Improve- ments persisted at six-month follow-up. The researchers said of the follow-up, “social anxiety remained the same or continued to improve slightly for most participants in the MDMA group after completing the active treatment phase” [100]. Social anxiety disorder is relatively common among the gen- eral population; about 12% suffer from this disorder at some point in their lives [101]. If it is determined to be an effective treatment, MDMA-assisted psychotherapy could be an option for these patients who have not responded to traditional psy- chotherapy or pharmacotherapy. ANOREXIA NERVOSA Anorexia nervosa is a severe eating disorder characterized by restriction of energy intake relative to an individual’s require- ments, typically resulting in low body weight and malnutrition. It is notoriously difficult to treat and has a high mortality rate. Experts have continued to search for more effective treatment options for this population. In one study, the authors treated 15 patients (23 to 42 years of age) with treatment-resistant anorexia nervosa with infusions of 20 mg/hour of ketamine over 10 hours. The subjects were also given 20 mg twice per day of nalmefene. The subjects showed a marked decreased in scores on compulsion. Before the ketamine was administered, the average scores were 44.0; after treatment, mean compulsion scores dropped to 27.0. Nine of the subjects (60%) showed remission after two to nine ketamine infusions over the course of five days to three weeks [102]. The authors reported the following details on three specific patients [102]: Patient 4 increased her weight after three treatments but agreed to more in the hope that her compul- sion score would come down further. After a year in follow-up with a normal weight, she then started work and remained in a stable state while followed- up for nine months. Patient 5 was a married woman and reached a nor- mal weight after five treatments. As an outpatient, her periods returned and she had a successful preg- nancy. Patient 6 had a long history of alternating
anorexia and bulimia. After four treatments and despite only a small fall in compulsion score, she became able to control her eating and her weight. She held a responsible job with no relapse during two years of follow-up. In a 2020 study with only one subject, the researchers treated a patient, 29 years of age, who had developed anorexia nervosa at 14.5 years of age and had been unable to attain remission. The researchers prescribed a ketogenic diet along with intra- venous ketamine infusions. (A ketogenic diet was chosen because it had proven in the past to prevent starvation, a real risk with anorexia.) The patient sustained complete recovery and continued her ketogenic diet while maintaining a normal weight [103]. After three months, the woman remained on the ketogenic diet and reported feeling significantly better but still suffered from anorexic compulsions. At that time, she was sent for ketamine infusions. The patient reported that within one hour of her first infusion the “anorexic voice” inside her was decreasing and she felt more like herself. The patient had three more infusions over the next 14 days. After the fourth infusion, the patient stated [103]: I know this sounds ridiculous, but I am no longer anorexic. I had so many rules I didn’t even know them. But they are gone. I can exercise because it feels good. It isn’t that I have to. I can stop when I want to. Because this study had two potentially essential factors (ket- amine and the ketogenic diet), it is unclear if either or both are responsible for the single patient’s improvements. As is the case for many of these novel treatments, additional research is warranted. CLUSTER HEADACHES Cluster headaches, which affect less than 1% of adults, are considered to be the most painful of all headaches and can last for a week or longer, potentially becoming a chronic health issue [104]. Traditional treatment approaches include triptan medications and oxygen therapy. Understandably, most suf- ferers seek quick relief and would prefer to never experience another attack. In one report, the authors interviewed 53 people with cluster headaches who had self-medicated with psilocybin or LSD. (This is not recommended or considered safe.) Of 26 patients who used psilocybin, 22 said the drug successfully aborted their headache attacks. Of five people who said they used LSD to treat their headaches, four reported experiencing remission [105]. Based on these findings, the authors recommend fur- ther study of psychedelics as a possible treatment for cluster headaches. It is important to remember that self-reports are no basis for concluding that psilocybin or LSD is effective at improving a cluster headache condition. There is a current clinical trial underway examining the role of LSD as a possible treatment for cluster headaches [106].
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