
Contents
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Introduction Introduction
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Prohibition Prohibition
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Post-Scheduling Research Post-Scheduling Research
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Psychedelic-Assisted Psychotherapy Psychedelic-Assisted Psychotherapy
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Neurobiology Neurobiology
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Tryptamines Tryptamines
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Introduction Introduction
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Psilocybin Structure and Metabolism Psilocybin Structure and Metabolism
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Effects and Side Effects Effects and Side Effects
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Physiologic and Adverse Events Physiologic and Adverse Events
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Subjective Effects Subjective Effects
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Clinical Trials Clinical Trials
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Neurobiology and Proposed Mechanisms of Action of Tryptamines Neurobiology and Proposed Mechanisms of Action of Tryptamines
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Receptor Profiles Receptor Profiles
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Plasticity Plasticity
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Proposed Networks and Models of the Psychedelic Experience Proposed Networks and Models of the Psychedelic Experience
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Other Tryptamines Other Tryptamines
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Phenethylamines Phenethylamines
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Introduction Introduction
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Effects and Side Effects Effects and Side Effects
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Subjective Effects Subjective Effects
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Physiological Effects Physiological Effects
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Adverse Events Adverse Events
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Long-Term Neuropsychological Effects Long-Term Neuropsychological Effects
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Recreational Risks Recreational Risks
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Pharmacology Pharmacology
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Properties Properties
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Metabolism Metabolism
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Clinical Trials Clinical Trials
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MDMA-Assisted Psychotherapy for Severe PTSD: Pooled Analyses of Phase II RCTs MDMA-Assisted Psychotherapy for Severe PTSD: Pooled Analyses of Phase II RCTs
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MDMA-Assisted Psychotherapy for Severe PTSD: Phase III Study MDMA-Assisted Psychotherapy for Severe PTSD: Phase III Study
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MDMA-Assisted Psychotherapy for Social Anxiety in Adults with Autism: Phase II Study MDMA-Assisted Psychotherapy for Social Anxiety in Adults with Autism: Phase II Study
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MDMA-Assisted Psychotherapy for Treatment of Anxiety and Other Psychological Distress Related to Life-Threatening Illnesses: Phase II Study MDMA-Assisted Psychotherapy for Treatment of Anxiety and Other Psychological Distress Related to Life-Threatening Illnesses: Phase II Study
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Proposed Mechanisms Underlying Therapeutic Benefits of MDMA Proposed Mechanisms Underlying Therapeutic Benefits of MDMA
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Receptor Profiles Receptor Profiles
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Social Effects Social Effects
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Reopening of a Critical Period for Social Reward Learning Reopening of a Critical Period for Social Reward Learning
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Optimal Zone of Arousal Optimal Zone of Arousal
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Memory Reconsolidation and Fear Extinction Hypotheses Memory Reconsolidation and Fear Extinction Hypotheses
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Future Directions for Research Future Directions for Research
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Conclusions Conclusions
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References References
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74. Psychedelic Drugs as Treatment Agents
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Published:January 2025
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Abstract
Psychedelics are compounds that alter consciousness. Currently, most psychedelic substances are federally illegal in the United States; however, the U.S. Food and Drug Administration has designated three psychedelic-assisted psychotherapy treatments as breakthrough therapies. Treatment with psychedelic drugs involves administering a medication only once or a few times to facilitate a psychotherapeutic process. Extrapharmacologic factors of treatment are central to the design of these trials. Recent clinical research has found large effect sizes with no serious adverse events reported. Although the basic psychopharmacology profiles of these drugs have been characterized, and neuroscientific and psychotherapeutic frameworks have been proposed, the mechanisms of action for these treatments are under active investigation. The observed durable and transdiagnostic psychiatric effects are likely partially related to their robust induction of neuroplasticity. This chapter describes the state of psychiatric research involving the two major classes of psychedelic compounds—tryptamines and phenethylamines—and their psychotherapeutic context.
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