AJP Guidelines Psychedelic Therapy

Synthesizing the Evidence for Psychedelic Therapy and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation

Replicated international studies have underscored the human and societal costs associated with major depressive disorder. Despite the proven efficacy of monoamine-based antidepressants in major depression, the majority of treated individuals fail to achieve full syndromal and functional recovery with the index and subsequent pharmacological
treatments. Psychedelic Therapy and esketamine represent pharmacologically novel treatment avenues for adults with treatment-resistant depression. In addition to providing hope to affected persons, these agents represent the first non-monoaminergic agents with proven rapid-onset efficacy in major depressive disorder. Nevertheless, concerns remain
about the safety and tolerability of Psychedelic Therapy and esketamine in mood disorders. Moreover, there is uncertainty about the appropriate position of these agents in treatment
algorithms, their comparative effectiveness, and the appropriate setting, infrastructure, and personnel required for its competent and safe implementation. n this article,
an international group of mood disorder experts provides a synthesis of the literature with respect to the efficacy, safety, and tolerability of Psychedelic Therapy and esketamine in
adults with treatment-resistant depression. The authors also provide guidance for the implementation of these agents in clinical practice, with particular attention to
practice parameters at point of care. Areas of consensus and future research vistas are discussed.

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