Psychedelic Therapy: A Primer for Primary Care Clinicians-Historical Perspective and Overview.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing prior trials and regulatory milestones without a systematic review protocol
PubMed 38518266 · doi:10.1097/MJT.0000000000001727
What was done
This narrative review summarizes the historical context, regulatory status, and clinical trial evidence for psychedelic therapeutics (including esketamine, MDMA, psilocybin, LSD, DMT/ayahuasca, and ibogaine) in managing neuropsychiatric conditions such as depression and post-traumatic stress disorder (PTSD) for primary care clinicians.
What was found
Esketamine gained FDA approval for major depressive disorder in 2019. Two completed Phase III trials demonstrated that MDMA is superior to existing pharmacotherapies for PTSD. For depression, larger trials of psilocybin (100+ participants) reported remission rates of 25%–29%, comparable to the approximately 30% remission rate reported for standard antidepressants in the STAR*D trial.
Why it matters
It provides clinicians with a realistic appraisal of psychedelic therapy, noting that as trial sizes increase, remission rates for conditions like depression appear similar to conventional antidepressants rather than the outsized effects reported in preliminary studies.
Limits
As an unsystematic narrative review, it does not pool effect estimates or assess risk of bias formally. The broader psychedelic literature is limited by historically small trial sizes, which may obscure rare but serious adverse events, and primary numerical trial data in the abstract are limited to psilocybin and STAR*D benchmarks.
Cited by
- supports Ibogaine and DMT are not FDA approved and remain illegal in the United States.