I was pleased to see the BCMJ publish Dr Mark Elliott’s piece, “The age of mushrooms is upon us in medicine.” Psychedelics such as LSD and psilocybin showed great promise as investigational tools and, in the case of LSD, as a treatment for addiction, until politics and irrational fears essentially ended all research into these agents for decades. Fortunately, this is changing and a number of studies, as imperfect as they are, suggest that psychedelics, combined with appropriate psychotherapy, may hold great promise in treating end-of-life anxiety, depression, and addiction.
Dr Elliott incorrectly states that psychedelics “seem to affect serotonin and/or monoamine oxidase (MAO) receptors in the brain.” MAO is not a receptor but rather an enzyme that is widely distributed throughout the body (including the CNS). It is generally agreed that the actions of psychedelic agents are primarily mediated through agonism at the 5-HT2A receptor (a class of serotonin receptor) in the brain. I suspect that Dr Elliott was referring to ayahuasca, a plant-derived psychoactive brew containing Banisteriopsis caapi and DMT containing vines (such as Psychotria viridis or Acacia sp). B. caapi contains natural MAO inhibitors that may have some minor CNS effects but act primarily by preventing metabolism of DMT in the gut. This allows the DMT to be absorbed and to exert its effects on the CNS.
Thank you for publishing this otherwise excellent brief overview of the emerging field of psychedelic medicine.
—Jeffrey Eppler, MD
This letter was submitted in response to “The age of mushrooms is upon us in medicine.”
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org