海外医疗动态：致幻药物帮助癌症患者面对死亡恐惧

迷幻药能帮助癌症患者面对死亡恐惧吗？两个长期研究的魔法蘑菇的致幻化合物，psilocybin,“过去50年一种迷幻药物对照试验--它们是严格的双盲安慰剂，”伦敦帝国理工学院药理学家David Nutt写到，他没有参与到这个工作研究当中， 而是在报纸上一篇社论中提到了。

今天在药理学杂志上发布了两个研究，结合心理治疗的几个疗程治疗。一个是在马里兰州的巴尔的摩约翰霍普金斯大学，51位癌症病人分别接受了两次剂量的药物并且相隔5周，一个相对较高，一个很低。在另一个研究中，在纽约大学，29位癌症病人随机服用psilocybin或烟酸，一种化合物，酷似psilocybin的一些副作用-包括脸红，发热-但是没有幻觉的性质。7周后，病人接受另一种化合物。

在两个新的研究中癌症病人服用psilocybin后抑郁症状减轻(魔法蘑菇的致幻化合物)

参与者在个研究中接受高剂量，83%的报告显示抑郁症减少，58%的报告7周后焦虑感会减少。仅仅服用烟碱的14%的人显示焦虑不安症状减轻，抑郁症减轻。几个月后，两个研究结果一直很明显。例如，在Johns Hopkins 的研究中，所有参与者6个月后，60%显示抑郁和焦虑处于正常水平。“研究结果令人印象深刻，具有良好的安全数据性，有很大影响，”在伦敦帝国理工学院研究迷幻药的Robin Carharrt-Harris说，我感觉这些研究在唤醒科学和医学主流方面将发挥很大作用，来发挥致幻药的治疗潜力。

结果有两点儿令人惊讶，柏林大学诊所慈善事业精神科医生Isabella Heuser说：几个月后一直可以检测到，似乎有一个快速起效的效果。“一直有小的试验,” Heuser 提到。“但是事实上他们都显示非常相似的结果，非常鼓舞人心。”Guy Goodwin, 英国牛津大学精神科医生，说试验已经超过了预测 “我认为他们具有里程碑意义,”他说，“但是这仅仅是开始，不是结束或者证明一些事物。”

许多癌症病人在诊断后发展为严重的抑郁症和焦虑，Roland Griffiths说，他指导了 John Hopkins 的研究。当癌症消失的时候这种感觉还在持续。Dinah Bazer, 一位来自纽约布鲁克林区的69岁的女人，参加纽约大学研究，她在2010年诊断为卵巢癌。手术和化疗很成功。但是她对癌症充满了害怕和不安。“它消耗完我的生命，并毁掉了我的生活，”她说。“这种药物拯救了我的生命。”

但是像Bazer这样的病人通常没有像今天的这种选择。20世纪60年代，psilocybin and LSD曾经在大量的试验中用于治疗抑郁和酒精中毒。但是普遍滥用（他们的反文化社团）-终导致了政治对抗。20世纪70年代，美国总统理查德·尼克松禁止了这种药物，几乎所有的研究停止了。在20世纪90年代调查研究再次开始，但是被严格的规定和方法问题所阻碍。

研究者面对的问题之一是如何保证参与者和调查者不知道是否他们正在服用这种药物或者安慰剂。在Johns Hopkins的研究中，参与者和治疗者被告知病人应该在两种情况下服用psilocybin，剂量要改变。但是愚弄参与者，他们可能感到思想强化的影响-改变药物不是那么容易。这特别令人担忧，因为抑郁和焦虑的影响措施是主观的，Goodwin说。“如果他们显示这些情况，例如重返工作或者散步，这将是客观证据。”

Psilocybin如何准确使焦虑和抑郁减少是不清楚的。两个研究发现病人有很强的神秘体验，也会显示一个更好的结果，不管他们是否是信宗教，Stephen Ross说，他们指导了纽约大学研究。例如Bazer，说她曾经体验过服用psilocybin“沐浴在上帝的关爱里”，“我确实没有其他的方法去描述这种令人难以置信的强大的经历”，Bazer说，她说她一直是一个无神论者。“我相信这是发生在我的大脑中的东西。”但是这种体验是否或多或少催化改变自己，或者仅仅是其他改变的一个副面影响，是很困难去界定的。

换种说法，这个治疗将帮助许多病人，Ross说。FDA目前正在审核psilocybin迷幻剂的III期临床试验的应用，治疗之前的后一步可能会批准。Ross说我们有充分的理由抱有希望，周二，监管机构对另一个有争议的药物的III期试验提供了绿灯：使用迷幻药治疗创伤后的应激障碍。（美域国际赵霞编译）

Hallucinogenic drugs help cancer patients deal with their fear of death

By Kai KupferschmidtDec. 1, 2016 , 12:15 AM

Kai Kupferschmidt

Could a psychedelic drug help people who are dying of cancer face their fears? Two long awaited studies suggest that the hallucinogenic compound in magic mushrooms, psilocybin, could do just that. “They are the most rigorous double-blind placebo-controlled trials of a psychedelic drug in the past 50 years,” writes David Nutt, a pharmacologist at Imperial College London who was not involved in the work, in an editorial accompanying the papers.

Both studies, published today in the Journal of Psychopharmacology, combined a psychedelic trip with several sessions of psychotherapy. In one, at Johns Hopkins University in Baltimore, Maryland, 51 cancer patients received two doses of the drug 5 weeks apart, one relatively high and one so low that it was unlikely to have any effect. In the second study, at New York University (NYU), 29 cancer patients randomly received either psilocybin or niacin, a compound that mimics some side effects of psilocybin—including a flushed, hot feeling—but without the hallucinogenic properties. Seven weeks later, the patients received the other compound.

Of the participants who received the high dose in the second study, 83% reported feeling significantly less depression and 58% reported less anxiety after  7 weeks. Only 14% of those who received niacin reported less anxiety and less depression. And the effect in both studies was still apparent months later. For instance, in the Johns Hopkins study, about 60% of all participants still showed normal levels of depression and anxiety after 6 months. “The findings are impressive, with good safety data and large effect sizes,“ says Robin Carharrt-Harris, who studies psychedelic drugs at Imperial College London. My feeling is that these studies will play a significant role in waking up the scientific and medical mainstream to the therapeutic potential of psychedelics.

“Two things in particular are striking about the results, says Isabella Heuser, a psychiatrist at the Charité, the University Clinic in Berlin: There seemed to be a rapid onset of the effect, and it was still measurable months later. “These are still small trials,” Heuser cautions. “But the fact that they both show very similar results is very encouraging.” Guy Goodwin, a psychiatrist at Oxford University in the United Kingdom, says the trials have moved the field forward. “I think they represent a kind of landmark,“ he says. “But they are the beginning of something, not the end or the proof of something.”

Many cancer patients develop severe depression and anxiety after their diagnosis, says Roland Griffiths, who led the John Hopkins study. These feelings can persist even when the cancer is gone. Dinah Bazer, a 69-year old woman from Brooklyn, New York, who participated in the NYU study, was diagnosed with ovarian cancer in 2010. Surgery and chemotherapy were successful but she was consumed with anxiety and fear of the cancer coming back. “It was running my life and ruining my life,” she says. “This drug saved my life.”

But patients like Bazer don’t typically have the option for such treatment today. In the 1960s, psilocybin and LSD were used to treat depression or alcoholism in numerous trials. But widespread misuse—and their association with the counter-culture—led to a political backlash. In 1970, U.S. President Richard Nixon banned the drugs and virtually all research ceased. Research started up again in the 1990s, but it has been hampered by strict regulations and methodological issues.

 One of the problems facing researchers is how to ensure that participants and investigators don’t know whether they are dealing with the drug or a placebo. In the Johns Hopkins study, participants and therapists were told that patients would receive psilocybin on both occasions and that the dose could vary. But fooling participants who might be feeling the effects of a powerful mind-altering drug isn’t easy. This is particularly worrisome, because the measures of effect on depression or anxiety tend to be subjective, says Goodwin. “If they could show for instance that people go back to work or that they move around more, that would be objective evidence.”

How exactly psilocybin could lead to a decrease in anxiety and depression is unclear. Both studies found that patients who have a stronger mystical experience also showed a better outcome, whether or not they reported being religious, says Stephen Ross, who led the NYU study. Bazer, for instance, says she experienced “being bathed in god’s love” for hours after taking psilocybin. “I really had no other way to describe this incredibly powerful experience“, says Bazer, who says she was and still is an atheist. “I believe this was something that happened in my brain.“ But whether that experience somehow catalyzes changes itself, or is just a side effect of other changes, is hard to pinpoint.

Either way, the treatment could help many patients, says Ross. The Food and Drug Administration is currently reviewing an application for a phase III trial of psilocybin, the last step before the therapy could be approved. There is good reason to be hopeful, says Ross. On Tuesday, the regulatory body gave the green light for a phase III trial of another contentious drug: using ecstasy to treat post-traumatic stress disorder.