LSDDEP2: study protocol for a randomised, double-dummy, triple-blind, active placebo-controlled, parallel groups trial of LSD microdosing in patients with major depressive disorder.


Journal

Trials
ISSN: 1745-6215
Titre abrégé: Trials
Pays: England
ID NLM: 101263253

Informations de publication

Date de publication:
24 Aug 2024
Historique:
received: 18 04 2024
accepted: 06 08 2024
medline: 26 8 2024
pubmed: 26 8 2024
entrez: 24 8 2024
Statut: epublish

Résumé

Major depressive disorder (MDD) poses a significant global health burden with available treatments limited by inconsistent efficacy and notable side effects. Classic psychedelics, including lysergic acid diethylamide (LSD), have garnered attention for their potential in treating psychiatric disorders. Microdosing, the repeated consumption of sub-hallucinogenic doses of psychedelics, has emerged as a self-treatment approach for depression within lay communities. Building upon preliminary evidence and the successful completion of an open-label pilot trial of microdosing LSD for depression (LSDDEP1), this protocol outlines a phase 2b randomised controlled trial (LSDDEP2). The main objective of LSDDEP2 is to assess the modification of depressive symptoms, measured by the Montgomery-Åsberg Depression Rating Scale (MADRS), following a regimen of LSD microdoses versus placebo. This is a randomised, double-dummy, triple-blind, active placebo-controlled, parallel groups trial of LSD microdosing in patients meeting DSM-5 criteria for major depressive disorder. Participants will undergo an 8-week LSD microdosing regimen using the titratable MB-22001 formulation taking two doses a week. All doses will be self-administered at home and will be titratable from 4 to 20 μg based on subjective perception and tolerability. In addition to depression symptoms, outcome will include psychiatric and personality inventories, sleep and activity tracking, electroencephalography (EEG), blood biomarkers, semi-structured interviews, and safety (e.g. adverse event, laboratory exam) measures. This study will be the first randomised controlled trial to administer controlled microdoses of LSD for treatment of MDD in participants' naturalistic environment. The measures included are designed to assess the drug's safety, mechanism, and treatment efficacy over placebo in this population. The results of this study will be important for assessing the viability of psychedelic microdosing as an additional treatment option and for informing the direction of future clinical trials. ANZCTR, ACTRN12624000128594. Prospectively Registered on 13 February 2024.

Sections du résumé

BACKGROUND BACKGROUND
Major depressive disorder (MDD) poses a significant global health burden with available treatments limited by inconsistent efficacy and notable side effects. Classic psychedelics, including lysergic acid diethylamide (LSD), have garnered attention for their potential in treating psychiatric disorders. Microdosing, the repeated consumption of sub-hallucinogenic doses of psychedelics, has emerged as a self-treatment approach for depression within lay communities. Building upon preliminary evidence and the successful completion of an open-label pilot trial of microdosing LSD for depression (LSDDEP1), this protocol outlines a phase 2b randomised controlled trial (LSDDEP2). The main objective of LSDDEP2 is to assess the modification of depressive symptoms, measured by the Montgomery-Åsberg Depression Rating Scale (MADRS), following a regimen of LSD microdoses versus placebo.
METHODS METHODS
This is a randomised, double-dummy, triple-blind, active placebo-controlled, parallel groups trial of LSD microdosing in patients meeting DSM-5 criteria for major depressive disorder. Participants will undergo an 8-week LSD microdosing regimen using the titratable MB-22001 formulation taking two doses a week. All doses will be self-administered at home and will be titratable from 4 to 20 μg based on subjective perception and tolerability. In addition to depression symptoms, outcome will include psychiatric and personality inventories, sleep and activity tracking, electroencephalography (EEG), blood biomarkers, semi-structured interviews, and safety (e.g. adverse event, laboratory exam) measures.
DISCUSSION CONCLUSIONS
This study will be the first randomised controlled trial to administer controlled microdoses of LSD for treatment of MDD in participants' naturalistic environment. The measures included are designed to assess the drug's safety, mechanism, and treatment efficacy over placebo in this population. The results of this study will be important for assessing the viability of psychedelic microdosing as an additional treatment option and for informing the direction of future clinical trials.
TRIAL REGISTRATION BACKGROUND
ANZCTR, ACTRN12624000128594. Prospectively Registered on 13 February 2024.

Identifiants

pubmed: 39182140
doi: 10.1186/s13063-024-08384-3
pii: 10.1186/s13063-024-08384-3
doi:

Substances chimiques

Lysergic Acid Diethylamide 8NA5SWF92O
Hallucinogens 0

Types de publication

Clinical Trial Protocol Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

560

Informations de copyright

© 2024. The Author(s).

Références

Depressive disorder (depression): World Health Organization. https://www.who.int/news-room/fact-sheets/detail/depression . Accessed 16 Jul 2024.
Herrman H, Kieling C, McGorry P, Horton R, Sargent J, Patel V. Reducing the global burden of depression: a lancet-world psychiatric association commission. The Lancet. 2019;393(10189):e42–3.
doi: 10.1016/S0140-6736(18)32408-5
Warden D, Rush AJ, Trivedi MH, Fava M, Wisniewski SR. The STAR*D project results: a comprehensive review of findings. Curr Psychiatry Rep. 2007;9(6):449–59.
doi: 10.1007/s11920-007-0061-3 pubmed: 18221624
hom R, Silbersweig D A, Boland R J. Major Depressive Disorder in Medical Illness: A Review of Assessment, Prevalence, and Treatment Options. Psychosom Med. 2019;81(3):246–55.
doi: 10.1097/PSY.0000000000000678
Cartwright C, Gibson K, Read J, Cowan O, Dehar T. Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Prefer Adherence. 2016;10:1401–7.
doi: 10.2147/PPA.S110632 pubmed: 27528803 pmcid: 4970636
Kwan AC, Olson DE, Preller KH, Roth BL. The neural basis of psychedelic action. Nat Neurosci. 2022;25(11):1407–19.
doi: 10.1038/s41593-022-01177-4 pubmed: 36280799 pmcid: 9641582
Andersen KAA, Carhart-Harris R, Nutt DJ, Erritzoe D. Therapeutic effects of classic serotonergic psychedelics: a systematic review of modern-era clinical studies. Acta Psychiatr Scand. 2021;143(2):101–18.
doi: 10.1111/acps.13249 pubmed: 33125716
Kuypers KP, Ng L, Erritzoe D, Knudsen GM, Nichols CD, Nichols DE, et al. Microdosing psychedelics: more questions than answers? An overview and suggestions for future research. J Psychopharmacol. 2019;33(9):1039–57.
doi: 10.1177/0269881119857204 pubmed: 31303095 pmcid: 6732823
Lea T, Amada N, Jungaberle H. Psychedelic microdosing: a subreddit analysis. J Psychoactive Drugs. 2020;52(2):101–12.
doi: 10.1080/02791072.2019.1683260 pubmed: 31648596
Cameron LP, Nazarian A, Olson DE. Psychedelic microdosing: prevalence and subjective effects. J Psychoactive Drugs. 2020;52(2):113–22.
doi: 10.1080/02791072.2020.1718250 pubmed: 31973684 pmcid: 7282936
Polito V, Stevenson RJ. A systematic study of microdosing psychedelics. PLoS ONE. 2019;14(2):e0211023.
doi: 10.1371/journal.pone.0211023 pubmed: 30726251 pmcid: 6364961
Murphy R, Muthukumaraswamy S, de Wit H. Microdosing Psychedelics: Current Evidence From Controlled Studies. Biol Psychiatry Cogn Neurosci Neuroimaging. 2024;9(5):500–11.
pubmed: 38280630
Murphy RJ, Sumner R, Evans W, Ponton R, Ram S, Godfrey K, et al. Acute mood-elevating properties of microdosed lysergic acid diethylamide in healthy volunteers: a home-administered randomized controlled trial. Biol Psychiat. 2023;94(6):511–21.
doi: 10.1016/j.biopsych.2023.03.013 pubmed: 36997080
Donegan CJ, Daldegan-Bueno D, Sumner R, Menkes D, Evans W, Hoeh N, et al. An open-label pilot trial assessing tolerability and feasibility of LSD microdosing in patients with major depressive disorder (LSDDEP1). Pilot Feasib Stud. 2023;9(1):169.
doi: 10.1186/s40814-023-01399-8
Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ : British Medical Journal. 2013;346:e7586.
doi: 10.1136/bmj.e7586 pubmed: 23303884 pmcid: 3541470
Shields MD, Alqahtani F, Rivey MP, McElnay JC. Mobile direct observation of therapy (MDOT) - a rapid systematic review and pilot study in children with asthma. PLoS ONE. 2018;13(2):e0190031.
doi: 10.1371/journal.pone.0190031 pubmed: 29401500 pmcid: 5798760
Psychedelic drugs: considerations for clinical investigations. Food and Drug Administration; https://www.fda.gov/regulatory-information/search-fda-guidance-documents/psychedelic-drugs-considerations-clinical-investigations . Accessed 16 Jul 2024.
Guideline on clinical investigation of medicinal products in the treatment of depression. European Medicines Agency. https://www.ema.europa.eu/en/documents/scientific-guideline/draft-guideline-clinical-investigation-medicinal-products-treatment-depression-revision-3_en.pdf . Accessed 16 Jul 2024.
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–9.
doi: 10.1192/bjp.134.4.382 pubmed: 444788
Williams JBW, Kobak KA. Development and reliability of a structured interview guide for the Montgomery-Åsberg Depression Rating Scale (SIGMA). Br J Psychiatry. 2008;192(1):52–8.
doi: 10.1192/bjp.bp.106.032532 pubmed: 18174510
Bates D. Fitting linear mixed models in R. R news 2005;5:27-30. https://journal.r-project.org/articles/RN-2005-005/ . Accessed 16 July 2024.
Sumner RL, McMillan R, Spriggs MJ, Campbell D, Malpas G, Maxwell E, et al. Ketamine improves short-term plasticity in depression by enhancing sensitivity to prediction errors. Eur Neuropsychopharmacol. 2020;38:73–85.
doi: 10.1016/j.euroneuro.2020.07.009 pubmed: 32763021
Cavarra M, Falzone A, Ramaekers JG, Kuypers KPC, Mento C. Psychedelic-assisted psychotherapy—a systematic review of associated psychological interventions. Front Psychol. 2022;13:887255.
doi: 10.3389/fpsyg.2022.887255 pubmed: 35756295 pmcid: 9226617
Golden TL, Magsamen S, Sandu CC, Lin S, Roebuck GM, Shi KM, et al. Effects of setting on psychedelic experiences, therapies, and outcomes: a rapid scoping review of the literature. Curr Top Behav Neurosci. 2022;56:35–70.
doi: 10.1007/7854_2021_298 pubmed: 35138585
Ly C, Greb AC, Cameron LP, Wong JM, Barragan EV, Wilson PC, et al. Psychedelics promote structural and functional neural plasticity. Cell Rep. 2018;23(11):3170–82.
doi: 10.1016/j.celrep.2018.05.022 pubmed: 29898390 pmcid: 6082376
Calder AE, Hasler G. Towards an understanding of psychedelic-induced neuroplasticity. Neuropsychopharmacology. 2023;48(1):104–12.
doi: 10.1038/s41386-022-01389-z pubmed: 36123427
Earleywine M, Low F, Lau C, De Leo J. Integration in psychedelic-assisted treatments: recurring themes in current providers’ definitions, challenges, and concerns. J Humanist Psychol. 2022;0(0):00221678221085800.
Kaertner LS, Steinborn MB, Kettner H, Spriggs MJ, Roseman L, Buchborn T, et al. Positive expectations predict improved mental-health outcomes linked to psychedelic microdosing. Sci Rep. 2021;11(1):1941.
doi: 10.1038/s41598-021-81446-7 pubmed: 33479342 pmcid: 7820236
Szigeti B, Kartner L, Blemings A, Rosas F, Feilding A, Nutt DJ, et al. Self-blinding citizen science to explore psychedelic microdosing. eLife. 2021;10:e62878.
doi: 10.7554/eLife.62878 pubmed: 33648632 pmcid: 7925122
Thase ME, Rush AJ. When at first you don’t succeed: sequential strategies for antidepressant nonresponders. J Clin Psychiatry. 1997;58 Suppl 13:23–9.
pubmed: 9402916

Auteurs

Dimitri Daldegan-Bueno (D)

School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand. d.daldegan@auckland.ac.nz.

Carina Joy Donegan (CJ)

Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22 Park Avenue, Grafton, Auckland, 1023, New Zealand.

Anna Forsyth (A)

School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.

Rachael Louise Sumner (RL)

School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.

Robin J Murphy (RJ)

School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.

David B Menkes (DB)

Department of Psychological Medicine, Waikato Clinical Campus, University of Auckland, Pembroke Street, Hamilton, 3240, New Zealand.

William Evans (W)

Mana Health, 7 Ruskin St, Parnell, Auckland, 1052, New Zealand.

Nicholas Hoeh (N)

Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22 Park Avenue, Grafton, Auckland, 1023, New Zealand.

Frederick Sundram (F)

Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22 Park Avenue, Grafton, Auckland, 1023, New Zealand.

Lisa M Reynolds (LM)

Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22 Park Avenue, Grafton, Auckland, 1023, New Zealand.

Rhys Ponton (R)

School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.

Alana Cavadino (A)

School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, 22 Park Avenue, Grafton, Auckland, 1023, New Zealand.

Todd Smith (T)

Te Whatu Ora, Auckland, 1023, New Zealand.

Partha Roop (P)

Faculty of Engineering, University of Auckland, Auckland, 1023, New Zealand.

Nathan Allen (N)

Faculty of Engineering, University of Auckland, Auckland, 1023, New Zealand.

Binu Abeysinghe (B)

Faculty of Engineering, University of Auckland, Auckland, 1023, New Zealand.

Darren Svirskis (D)

School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.

Mahima Bansal (M)

School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.

Suresh Muthukumaraswamy (S)

School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand. sd.muthu@auckland.ac.nz.

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