Psilocybin in Bipolar II: New Study

A study led by Dr. Scott T. Aaronson, published in JAMA Psychiatry, offers new insights into treating treatment-resistant bipolar type II depression with synthetic psilocybin combined with psychotherapy. The study involved 15 participants, aged 18 to 65, who received a single 25mg dose of synthetic COMP360 psilocybin along with psychotherapy sessions.

Significantly, 80% of the participants met the remission criteria 12 weeks post-treatment without experiencing an increase in bipolar II symptoms. This indicates psilocybin's potential efficacy in treating bipolar II depression in a clinical setting. The controlled environment and the guidance of trained mental health professionals are important factors distinguishing this clinical application from recreational scenarios.

"Individuals in this study displayed strong and persistent antidepressant effects with no signal of worsening mood instability or increased suicidality."​

The study's findings suggest that while psilocybin shows promise in treating certain mental health conditions, it is most effective for mental health conditions in clinical settings. This research is optimistic about new avenues in mental health treatment, particularly for conditions that have proven challenging to manage with traditional therapies.

The study specifically excluded individuals with Bipolar I Disorder, widely recognized as a contraindication for the use of psychedelic medicines. However, if an individual with Bipolar I is not currently experiencing a manic phase, some researchers and clinicians believe that the use of such treatments may be acceptable under some conditions.

About Bipolar II

Bipolar II Disorder is characterized by a pattern of depressive episodes and hypomanic episodes, distinguishing it from other depressive disorders. Unlike Bipolar I, which involves more severe manic episodes, Bipolar II features milder hypomanic episodes that do not cause significant social or occupational impairment. This contrasts with Major Depressive Disorder, which involves depressive episodes without the accompanying manic or hypomanic phases seen in bipolar disorders.

For more detailed insights, you can access the full study here.

Paradox of the Sympathetic Nervous System and Sex

The human body is a marvel of biological engineering, including the intricacies of sexual response. A key player in this process is the autonomic nervous system (ANS), which consists of two branches: the sympathetic and parasympathetic nervous systems. These systems, while seemingly opposed, work in tandem to modulate sexual experience, but not without a fascinating paradox.

The Role of the Sympathetic Nervous System

The sympathetic nervous system, often associated with the "fight or flight" response, plays a surprising role in sexual desire. Its activation, contrary to what one might expect, can promote sexual desire. This is because sexual desire, at its onset, is a form of physiological curiosity and requires a motivator. The sympathetic system prepares the body for action, which, in this context, translates to the initiation of sexual desire.

For sexual activity to progress from desire to arousal and fulfillment, there's a need for a shift—a transition from the energy-driven sympathetic activation to a more relaxed state governed by the parasympathetic nervous system.

The Parasympathetic Nervous System and Its Role in Arousal

The parasympathetic nervous system is famously known for "rest and digest" functions. In the context of sexual activity, it translates to relaxation, which is essential for arousal and subsequent sexual performance. This shift facilitates increased blood flow, which is crucial for arousal and, for men and women, sexual activity.

The paradox lies in this shift. While the sympathetic nervous system kickstarts desire, its continued dominance can inhibit the relaxation necessary for arousal, mediated by the parasympathetic system. Finding the balance between these two systems is essential for a healthy and enjoyable sexual experience.

Navigating the Paradox

Understanding this paradox empowers individuals to navigate their sexual health better. Techniques like deep breathing, mindfulness, and relaxation exercises can help activate the parasympathetic response when this doesn't occur organically. Additionally, being cognizant of one's mental state before and during sexual activity can help in managing the balance between these two systems.

The Complications of PTSD

This balance, however, can be particularly challenging for individuals with PTSD. PTSD often involves a heightened sympathetic response, making it difficult for the body to shift into the relaxed state necessary for arousal. This can lead to frustration and a sense of disconnection during sexual activities. Therapy and specialized treatment focusing on managing PTSD symptoms and training the body to activate the parasympathetic response can be instrumental in overcoming these challenges.

The sympathetic and parasympathetic nervous systems play vital yet paradoxical roles in sexual health. While the former ignites desire, the latter facilitates arousal and completion. Understanding and managing this balance is helpful, especially for individuals with conditions like PTSD.

Esketamine Nasal Spray for MDD

In the ceaseless pursuit of unlocking viable treatment options for individuals grappling with Treatment-Resistant Depression (TRD), a recent study presented at Psych Congress 2023 piqued interest in the medical and mental health community. The findings, stemming from the ESCAPE-TRD trial, emphasized the potential economic and therapeutic benefits of esketamine (ketamine in the form of a nasal spray) in comparison to quetiapine extended-release treatment, particularly in the context of work productivity loss (WPL) improvements and associated cost implications.

TRD has many challenges for those directly affected but casts an economic shadow, notably affecting employers in the United States through healthcare costs and impaired work productivity. Esketamine nasal spray has demonstrated a promise in this regard, as outlined in the study, presenting a tangible reduction in WPL and thus suggesting not only a clinical but an economic advantage.

Diligent investigators navigated through an analysis involving participants with major depressive disorder (MDD), who were administered either esketamine nasal spray or quetiapine extended-release treatment in conjunction with specific reuptake inhibitors.

Upon evaluating the findings, a significant decrease in total WPL from baseline was evident in participants administered esketamine nasal spray, alongside weekly cost savings, which showcased a marked disparity when pitted against the alternative treatment group.

While the findings underscored in the study are palpably valuable, it's important to underscore that this research didn’t integrate psychotherapy as part of the delivery for Ketamine, an element often deemed instrumental in amplifying its efficacy. Ketamine, when paired with psychotherapy, frequently paves the way for a synergistic effect, enhancing treatment outcomes, particularly in mental health and well-being.

Moreover, while the study elucidated the merits of nasal delivery of esketamine, it's helpful to acknowledge the existence and potential of alternative delivery methods. The nasal approach is a pricier option of available treatment modes. However, it’s worth noting that in some instances, these costs may be mitigated through insurance provisions, softening the financial impact upon the individual receiving treatment.

Navigating through the myriad of treatment options in the mental health space demands a thorough, multi-faceted examination. While the findings from the study presented at Psych Congress 2023 undeniably carve out a niche of interest and promise within the TRD treatment landscape, it also sparks further curiosity. It opens doors to future research that interweaves psychotherapy and explores varied ketamine delivery methods, each with its own clinical and economic implications, all in pursuit of architecting a robust, accessible, and effective treatment paradigm for TRD.

I've seen transformative change when using ketamine with psychotherapy in my practice. I'm excited about emerging research that continues to demonstrate the results I see in my office.