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Tijdschrift voor Psychiatrie 62 (2020) 8, 659 - 668

Review article

Psychedelics for existential distress in terminally ill patients

N. Schimmel, J.J. Breeksema, J.K.E. Veraart, W. van den Brink, R.A. Schoevers

background Existential distress in patients with a terminal illness is often associated with (symptoms of) anxiety and depression. Psychotherapeutic interventions seem effective but effects are short-lived. There are no proven effective pharmacological interventions.
aim To present an overview of literature on psychedelic treatment of existential distress in patients with terminal illness.
method Literature research in PubMed/Medline databases, supplemented with cross-references.
results 14 clinical studies have been conducted: 6 with classic psychedelics between 1960 and 1980, and 8 with classic psychedelics and ketamine after 2000. Results of early pre-post studies are promising but have serious methodological limitations. Recent clinical research with lsd, psilocybin and ketamine are also promising although limited in terms of research design and generalizability. Overall, studies show a positive effect on existential and spiritual well-being, quality of life, acceptance and (symptoms of) anxiety and depression. Mystical experiences are correlated with positive outcomes. Few adverse effects are reported.
conclusion Treatment of existential distress using classical psychedelics or ketamine in patients with terminal illness seems auspicious. Larger clinical studies in a more diverse patient population with fewer methodological limitations are needed to draw conclusions about efficacy and generalizability.

keywords anxiety, cancer, depression, existential distress, life-threatening disease, psychedelics, psilocybin, lsd, dpt, ketamine