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Recent open-label trials show that psychedelics, such as ayahuasca, hold promise as fast-onset antidepressants in treatment-resistant depression.
To test the antidepressant effects of ayahuasca, we conducted a parallel-arm, double-blind randomized placebo-controlled trial in 29 patients with treatment-resistant depression. Patients received a single dose of either ayahuasca or placebo. We assessed changes in depression severity with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating scale at baseline, and at 1 (D1), 2 (D2), and 7 (D7) days after dosing.
We observed significant antidepressant effects of ayahuasca when compared with placebo at all-time points. MADRS scores were significantly lower in the ayahuasca group compared with placebo at D1 and D2 (p = 0.04), and at D7 (p < 0.0001). Between-group effect sizes increased from D1 to D7 (D1: Cohen's d = 0.84; D2: Cohen's d = 0.84; D7: Cohen's d = 1.49). Response rates were high for both groups at D1 and D2, and significantly higher in the ayahuasca group at D7 (64% v. 27%; p = 0.04). Remission rate showed a trend toward significance at D7 (36% v. 7%, p = 0.054).
To our knowledge, this is the first controlled trial to test a psychedelic substance in treatment-resistant depression. Overall, this study brings new evidence supporting the safety and therapeutic value of ayahuasca, dosed within an appropriate setting, to help treat depression. This study is registered at http://clinicaltrials.gov (NCT02914769).
This chapter describes the specific magnetic resonance imaging (MRI) features of pediatric multiple sclerosis (MS). It also discusses proposed MRI criteria for pediatric MS and compares these to the MRI diagnostic criteria well established for adult patients who present with a first demyelinating event. MRI studies in children help to understand early pathogenic events that lead to clinical symptoms and signs of MS. MRI detects white matter pathology that represents clinically silent demyelination in adults. The absence of brain or spine lesions on the initial MRI study seems to be associated with very low risk of progression to MS. Studies in adult MS patients have shown that the initial lesion burden on brain imaging may be an important prognostic factor. The MRI criteria for acute disseminated encephalomyelitis (ADEM) include the presence of poorly defined lesions and a high lesion load, associated with thalamus and basal ganglia involvement.