The Impact of Ayahuasca on Suicidality: Results From a Randomized Controlled Trial

Richard J Zeifman, Fernanda Palhano-Fontes, Jaime Hallak, Emerson Arcoverde, João Paulo Maia-Oliveira, Draulio B Araujo, Richard J Zeifman, Fernanda Palhano-Fontes, Jaime Hallak, Emerson Arcoverde, João Paulo Maia-Oliveira, Draulio B Araujo

Abstract

Suicide is a major public health problem. Given increasing suicide rates and limitations surrounding current interventions, there is an urgent need for innovative interventions for suicidality. Although ayahuasca has been shown to target mental health concerns associated with suicidality (i.e., depression and hopelessness), research has not yet explored the impact of ayahuasca on suicidality. Therefore, we conducted secondary analyses of a randomized placebo-controlled trial in which individuals with treatment-resistant depression were administered one dose of ayahuasca (n = 14) or placebo (n = 15). Suicidality was assessed by a trained psychiatrist at baseline, as well as 1 day, 2 days, and 7 days after the intervention. A fixed-effects linear mixed model, as well as between and within-groups Cohen's d effect sizes were used to examine changes in suicidality. Controlling for baseline suicidality, we found a significant effect for time (p < .05). The effect of the intervention (i.e., ayahuasca vs. placebo) trended toward significance (p = .088). At all time points, we found medium between-group effect sizes (i.e., ayahuasca vs. placebo; day 1 Cohen's d = 0.58; day 2 d = 0.56; day 7 d = 0.67), as well as large within-group (ayahuasca; day 1 Cohen's d = 1.33; day 2 d = 1.42; day 7 d = 1.19) effect sizes, for decreases in suicidality. Conclusions: This research is the first to explore the impact of ayahuasca on suicidality. The findings suggest that ayahuasca may show potential as an intervention for suicidality. We highlight important limitations of the study, potential mechanisms, and future directions for research on ayahuasca as an intervention for suicidality. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02914769.

Keywords: ayahuasca; novel intervention; psychedelics; randomized controlled trial; suicidality.

Copyright © 2019 Zeifman, Palhano-Fontes, Hallak, Arcoverde, Maia-Oliveira and Araujo.

Figures

Figure 1
Figure 1
Changes in suicidality (MADRS-SI) over time. Baseline values are means (± standard error of the mean) for MADRS-SI. Day 1, Day 2, and Day 7 values are estimated marginal means (±standard error of the mean) for MADRS-SI.

References

    1. Argento E., Braschel M., Walsh Z., Socias ME., Shannon K. (2018). The moderating effect of psychedelics on the prospective relationship between prescription opioid use suicide risk among marginalized women. J. Psychopharmacol. 32 (12), 1385–1391. 10.1177/0269881118798610
    1. Argento E., Strathdee S. A., Tupper K., Braschel M., Wood E., Shannon K. (2017). Does psychedelic drug use reduce risk of suicidality? evidence from a longitudinal community-based cohort of marginalized women in a Canadian setting. Br. Med. J. Open 7 (9), e016025. 10.1136/bmjopen-2017-016025
    1. Baldessarini R. J., Tondo L., Davis P., Pompili M., Goodwin F. K., Hennen J. (2006). Decreased risk of suicides attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disord. 8, 625–639. 10.1111/j.1399-5618.2006.00344.x
    1. Ballard E. D., Luckenbaugh D. A., Richards E. M., Walls T. L., Brutsché N. E., Ameli R., et al. (2015). Assessing measures of suicidal ideation in clinical trials with a rapid-acting antidepressant. J. Psychiatr. Res. 68, 68–73. 10.1016/j.jpsychires.2015.06.003
    1. Barnby J. M., Mehta M. A. (2018). Psilocybin mental health-don't lose control. Front. In Psychiatry 9, 293. 10.3389/fpsyt.2018.00293
    1. Bartoli F., Riboldi I., Crocamo C., Di Brita C., Clerici M., Carra G. (2017). Ketamine as a rapid-acting agent for suicidal ideation: a meta-analysis. Neurosci. Biobehav. Rev. 77, 232–236. 10.1016/j.neubiorev.2017.03.010
    1. Bateman A. (2012). Treating borderline personality disorder in clinical practice. Am. J. Psychiatry 169, 560–563. 10.1176/appi.ajp.2012.12030341
    1. Batterham P. J., van Spijker B. A., Mackinnon A. J., Calear A. L., Wong Q., Christensen H. (2019). Consistency of trajectories of suicidal ideation depression symptoms: evidence from a randomized controlled trial. Depression Anxiety 36 (4), 321–329. 10.1002/da.22863
    1. Baumeister R. F. (1990). Suicide as escape from self. Psychol. Rev. 97, 90–113. 10.1037/0033-295X.97.1.90
    1. Brent D. (2010). What family studies teach us about suicidal behavior: implications for research, treatment, prevention. Eur. Psychiatry 25 (5), 260–263. 10.1016/j.eurpsy.2009.12.009
    1. Brent D. A., Mann J. (2005). Family genetic studies, suicide, suicidal behavior. Am. J. Med. Genet. Part C Semin. In Med. Genet. 133C (1), 13–24. 10.1002/ajmg.c.30042
    1. Brent D. A., Bridge J., Johnson B. A., Connolly J. (1996). Suicidal behavior runs in families: a controlled family study of adolescent suicide victims. Arch. Gen. Psychiatry 53 (12), 1145–1152. 10.1001/archpsyc.1996.01830120085015
    1. Brown G. K., Beck A. T., Steer R. A., Grisham J. R. (2000). Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. J. Consulting Clin. Psychol. 68 (3), 371–377. 10.1037/0022-006X.68.3.371
    1. Carhart-Harris R. L., Bolstridge M., Day C. M. J., Rucker J., Watts R., Erritzoe D. E., et al. (2018). Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacol. 235 (2), 399–408. 10.1007/s00213-017-4771-x
    1. Carhart-Harris R. L., Bolstridge M., Rucker J., Day C. M., Erritzoe D., Kaelen M., et al. (2016). Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 3 (7), 619–627. 10.1016/S2215-0366(16)30065-7
    1. Carpenter R. W., Trull T. J. (2013). Components of emotion dysregulation in borderline personality disorder: a review. Curr. Psychiatry Rep. 15, 1–8. 10.1007/s11920-012-0335-2
    1. Cavanagh J. T., Carson A. J., Sharpe M., Lawrie S. M. (2003). Psychological autopsy studies of suicide: a systematic review. Psychol. Med. 33 (3), 395–405. 10.1017/S0033291702006943
    1. Chanen A. M. (2015). Borderline personality disorder in young people: are we there yet?. J. Clin. Psychol. 71 (8), 778–791. 10.1002/jclp.22205
    1. Christensen H., Farrer L., Batterham P. J., Mackinnon A., Griffiths K. M., Donker T. (2013). The effect of a web-based depression intervention on suicide ideation: secondary outcome from a randomised controlled trial in a helpline. BMJ Open 3 (6), e002886. 10.1136/bmjopen-2013-002886
    1. Conway C. R., George M. S., Sackeim H. A. (2017). Toward an evidence-based, operational definition of treatment-resistant depression: when enough is enough. JAMA Psychiatry 74 (1), 9–10. 10.1001/jamapsychiatry.2016.2586
    1. Curtin S. C., Warner M., Hedegaard H. (2016).Increase in suicide in the United States, 1999-2014. Hyattsville: National Center for Health Statistics, 1–8.
    1. Dadiomov D., Lee K. (2019). The effects of ketamine on suicidality across various formulations study settings. Ment. Health Clinician 9 (1), 48–60. 10.9740/mhc.2019.01.048
    1. Deisenhammer E. A., Ing C. M., Strauss R., Kemmler G., Hinterhuber H., Weiss E. M. (2009). The duration of the suicidal process: how much time is left for intervention between consideration accomplishment of a suicide attempt?. J. Clin. Psychiatry 70 (1), 19–24. 10.4088/JCP.07m03904
    1. Del-Ben C. M., Vilela J. A. A., Crippa J. A. D. S., Hallak J. E. C., Labate C. M., Zuardi A. W. (2001). Reliability of the structured clinical interview for DSM-IV-clinical version translated into Portuguese. Rev. Bras. Psiquiatria 23 (3), 156–159. 10.1590/S1516-44462001000300008
    1. Desseilles M., Perroud N., Guillaume S., Jaussent I., Genty C., Malafosse A., et al. (2012). Is it valid to measure suicidal ideation by depression rating scales?. J. Affect. Disord. 136 (3), 398–404. 10.1016/j.jad.2011.11.013
    1. Ding Y., Lawrence N., Olié E., Cyprien F., Le Bars E., Bonafe A., et al. (2015). Prefrontal cortex markers of suicidal vulnerability in mood disorders: a model-based structural neuroimaging study with a translational perspective. Trans. Psychiatry 5, e516. 10.1038/tp.2015.1
    1. Domínguez-Clavé E., Soler J., Pascual J. C., Elices M., Franquesa A., Valle M., et al. (2019). Ayahuasca improves emotion dysregulation in a community sample in individuals with borderlinelike traits. Psychopharmacol. 236 (2), 573–580. 10.1007/s00213-018-5085-3
    1. dos Santos R. G., Bouso J. C., Alcázar-Córcoles M. Á., Hallak J. E. (2018). Efficacy, tolerability, safety of serotonergic psychedelics for the management of mood, anxiety, substance-use disorders: a systematic review of systematic reviews. Expert Rev. Clin. Pharmacol. 11 (9), 889–902. 10.1080/17512433.2018.1511424
    1. Dutta R., Ball H. A., Siribaddana S. H., Sumathipala A., Samaraweera S., McGuffin P., et al. (2017). Genetic other risk factors for suicidal ideation the relationship with depression. Psychol. Med. 47 (14), 2438–2449. 10.1017/S0033291717000940
    1. First M. B., Spitzer R. L., Gibbon M., Williams J. B. W. (1997).Structured Clinical Interview for DSM-IV Axis I Disorders (SCID), Clinician Version. Washington, DC: American Psychiatric Press.
    1. Forgeard M. J., Elstein J. G. (2014). Advancing the clinical science of creativity. Front. In Psychol. 5, 613. 10.3389/fpsyg.2014.00613
    1. Galione J., Zimmerman M. (2010). A comparison of depressed patients with without borderline personality disorder: implications for interpreting studies of the validity of the bipolar spectrum. J. Pers. Disord. 24 (6), 763–772. 10.1521/pedi.2010.24.6.763
    1. Gould M. S., Fisher P., Parides M., Flory M., Shaffer D. (1996). Psychosocial risk factors of child adolescent completed suicide. Arch. Gen. Psychiatry 53 (12), 1155–1162. 10.1001/archpsyc.1996.01830120095016
    1. Greenland S., Senn S. J., Rothman K. J., Carlin J. B., Poole C., Goodman S. N., et al. (2016). Statistical tests, P values, confidence intervals, power: a guide to misinterpretations. Eur. J. Epidemiol. 31 (4), 337–350. 10.1007/s10654-016-0149-3
    1. Griffiths J. J., Zarate C. A., Jr., Rasimas J. J. (2014). Existing novel biological therapeutics in suicide prevention. Am. J. Preventive Med. 47, S195–S203. 10.1016/j.amepre.2014.06.012
    1. Griffiths R. R., Johnson M. W., Carducci M. A., Umbricht A., Richards W. A., Richards B. D., et al. (2016). Psilocybin produces substantial sustained decreases in depression anxiety in patients with life-threatening cancer: a randomized double-blind trial. J. Psychopharmacol. 30 (12), 1181–1197. 10.1177/0269881116675513
    1. Griffiths R. R., Richards W. A., McCann U., Jesse R. (2006). Psilocybin can occasion mystical-type experiences having substantial sustained personal meaning spiritual significance. Psychopharmacol. 187 (3), 268–283. 10.1007/s00213-006-0457-5
    1. Hamill L., Hallak J., Dursun S. M., Baker G. (2019). Ayahuasca: psychological physiologic effects, pharmacology potential uses in addiction mental illness. Curr. Neuropharmacol. 17 (2), 108–128. 10.2174/1570159X16666180125095902
    1. Hendricks P. S., Thorne C. B., Clark C. B., Coombs D. W., Johnson M. W. (2015). Classic psychedelic use is associated with reduced psychological distress suicidality in the United States adult population. J. Psychopharmacol. 29 (3), 280–288. 10.1177/0269881114565653
    1. Jick H., Kaye J. A., Jick S. S. (2004). Antidepressants the risk of suicidal behaviors. JAMA 292 (3), 338–343. 10.1001/jama.292.3.338
    1. Johnson M. W., Richards W. A., Griffiths R. R. (2008). Human hallucinogen research: guidelines for safety. J. Psychopharmacol. 22 (6), 603–620. 10.1177/0269881108093587
    1. Kellner C. H., Fink M., Knapp R., Petrides G., Husain M., Rummans T., et al. (2005). Relief of expressed suicidal intent by ECT: a consortium for research in ECT study. Am. J. Psychiatry 162 (5), 977–982. 10.1176/appi.ajp.162.5.977
    1. Larkin G. L., Beautrais A. L. (2011). A preliminary naturalistic study of low-dose ketamine for depression suicide ideation in the emergency department. Int. J. Neuropsychopharmacol. 14 (8), 1127–1131. 10.1017/S1461145711000629
    1. Linehan M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
    1. Ly C., Greb A. C., Cameron L. P., Wong J. M., Barragan E. V., Wilson P. C., et al. (2018). Psychedelics promote structural and functional neural plasticity. Cell Rep. 23 (11), 3170–3182. 10.1016/j.celrep.2018.05.022
    1. Malhi G. S., Parker G. B., Crawford J., Wilhelm K., Mitchell P. B. (2005). Treatment-resistant depression: resistant to definition?. Acta Psychiatr. Scand. 112 (4), 302–309. 10.1111/j.1600-0447.2005.00602.x
    1. Montgomery S. A., Åsberg M. (1979). A new depression scale designed to be sensitive to change. Br. J. Psychiatry 134, 382–389. 10.1192/bjp.134.4.382
    1. Näslund J., Hieronymus F., Lisinski A., Nilsson S., Eriksson E. (2018). Effects of selective serotonin reuptake inhibitors on rating-scale-assessed suicidality in adults with depression. Br. J. Psychiatry 212 (3), 148–154. 10.1192/bjp.2017.24
    1. National Action Alliance for Suicide Prevention: Research Prioritization Task Force (2014).A prioritized research agenda for suicide prevention: an action plan to save lives. Rockville: National Institute of Mental Health Research Prioritization Task Force.
    1. Nelsen M. R., Dunner D. L. (1995). Clinical differential diagnostic aspects of treatment-resistant depression. J. Psychiatr. Res. 29 (1), 43–50. 10.1016/0022-3956(94)00042-P
    1. Nichols C. D., Sanders-Bush E. (2002). A single dose of lysergic acid diethylamide influences gene expression patterns within the mammalian brain. Neuropsychopharmacol. 26 (5), 634–642. 10.1016/S0893-133X(01)00405-5
    1. Nock M. K., Hwang I., Sampson N., Kessler R. C., Angermeyer M., Beautrais A., et al. (2009). Cross-national analysis of the associations among mental disorders suicidal behavior: findings from the WHO World Mental Health Surveys. PloS Med. 6 (8), e1000123. 10.1371/journal.pmed.1000123
    1. Osório F. D. L., Sanches R. F., Macedo L. R., et al. (2015). Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: a preliminary report. Rev. Bras. Psiquiatria 37 (1), 13–20. 10.1590/1516-4446-2014-1496
    1. Palhano-Fontes F., Barreto D., Onias H., Andrade K. C., Novaes M. M., Pessoa J. A., et al. (2019). Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial. Psychol. Med. 49 (4), 655–663. 10.1017/S0033291718001356
    1. Perroud N., Bondolfi G., Uher R., Gex-Fabry M., Aubry J. M., Bertschy G., et al. (2011). Clinical genetic correlates of suicidal ideation during antidepressant treatment in a depressed outpatient sample. Pharmacogenomics 12 (3), 365–377. 10.2217/pgs.10.189
    1. Perugi G., Angst J., Azorin J. M., Bowden C., Vieta E., Young A. H., BRIDGE Study Group (2013). Is comorbid borderline personality disorder in patients with major depressive episode bipolarity a developmental subtype? findings from the international BRIDGE study. J. Affect. Disord. 144 (1), 72–78. 10.1016/j.jad.2012.06.008
    1. Pompili M., Serafini G., Innamorati M., Ambrosi E., Giordano G., Girardi P., et al. (2010). Antidepressants suicide risk: a comprehensive overview. Pharm. 3 (9), 2861–2883. 10.3390/ph3092861
    1. Price R. B., Iosifescu D. V., Murrough J. W., Chang L. C., Al Jurdi R. K., Iqbal S. Z., et al. (2014). Effects of ketamine on explicit implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depression Anxiety 31 (4), 335–343. 10.1002/da.22253
    1. Price R. B., Nock M. K., Charney D. S., Mathew S. J. (2009). Effects of intravenous ketamine on explicit implicit measures of suicidality in treatment-resistant depression. Biol. Psychiatry 66, 522–526. 10.1016/j.biopsych.2009.04.029
    1. Prudic J., Sackeim H. A. (1999). Electroconvulsive therapy suicide risk. J. Clin. Psychiatry 60, 104–110.
    1. Ross S., Bossis A., Guss J., Agin-Liebes G., Malone T., Cohen B., et al. (2016). Rapid sustained symptom reduction following psilocybin treatment for anxiety depression in patients with life-threatening cancer: a randomized controlled trial. J. Psychopharmacol. 30 (12), 1165–1180. 10.1177/0269881116675512
    1. Sampedro F., de la Fuente Revenga M., Valle M., Roberto N., Domínguez-Clavé E., Elices M., et al. (2017). Assessing the psychedelic “after-glow” in ayahuasca users: post-acute neurometabolic functional connectivity changes are associated with enhanced mindfulness capacities. Int. J. Neuropsychopharmacol. 20 (9), 698–711. 10.1093/ijnp/pyx036
    1. Sanches R. F., de Lima Osório F., dos Santos R. G., Macedo L. R., Maia-de-Oliveira J. P., Wichert-Ana L., et al. (2016). Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: a SPECT study. J. Clin. Psychopharmacol. 36 (1), 77–81. 10.1097/JCP.0000000000000436
    1. Santos R. D., Landeira-Fernandez J., Strassman R. J., Motta V., Cruz A. P. M. (2007). Effects of ayahuasca on psychometric measures of anxiety, panic-like hopelessness in Santo Daime members. J. Ethnopharmacol. 112 (3), 507–513. 10.1016/j.jep.2007.04.012
    1. Schak K. M., Vande Voort J. L., Johnson E. K., Kung S., Leung J. G., Rasmussen K. G., et al. (2016). Potential risks of poorly monitored ketamine use in depression treatment. Am. J. Psychiatry 173 (3), 215–218. 10.1176/appi.ajp.2015.15081082
    1. Shneidman E. S. (1998).The suicidal mind. New York: Oxford University Press.
    1. Simon G. E., Savarino J., Operskalski B., Wang P. S. (2006). Suicide risk during antidepressant treatment. Am. J. Psychiatry 163 (1), 41–47. 10.1176/appi.ajp.163.1.41
    1. Soler J., Elices M., Dominguez-Clavé E., Pascual J. C., Feilding A., Navarro-Gil M., et al. (2018). Four weekly ayahuasca sessions lead to increases in “acceptance” capacities: a comparison study with a standard 8-week mindfulness training program. Front. In Pharmacol. 9. 10.3389/fphar.2018.00224
    1. Soler J., Elices M., Franquesa A., Barker S., Friedlander P., Feilding A., et al. (2016). Exploring the therapeutic potential of Ayahuasca: acute intake increases mindfulness-related capacities. Psychopharmacol. 233 (5), 823–829. 10.1007/s00213-015-4162-0
    1. Soloff P. H., Lynch K. G., Kelly T. M., Malone K. M., Mann J. J. (2000). Characteristics of suicide attempts of patients with major depressive episode borderline personality disorder: A comparative study. Am. J. Psychiatry 157 (4), 601–608. 10.1176/appi.ajp.157.4.601
    1. Souery D., Oswald P., Massat I., Bailer U., Bollen J., Demyttenaere K., et al. (2007). Clinical factors associated with treatment resistance in major depressive disorder: Results from a European multicenter study. J. Clin. Psychiatry 68 (7), 1062–1070. 10.4088/JCP.v68n0713
    1. Starcevic V., Janca A. (2018). Pharmacotherapy of borderline personality disorder: Replacing confusion with prudent pragmatism. Curr. Opin. In Psychiatry 31 (1), 69–73. 10.1097/YCO.0000000000000373
    1. Stone M., Laughren T., Jones M. L., Levenson M., Holland P. C., Hughes A., et al. (2009). Risk of suicidality in clinical trials of antidepressants in Adults analysis of proprietary data submitted to US Food Drug Administration. BMJ 339, b2880. 10.1136/bmj.b2880
    1. Strong C. E., Kabbaj M. (2018). On the safety of repeated ketamine infusions for the treatment of depression: effects of sex developmental periods. Neurobiol. Stress 9, 166–175. 10.1016/j.ynstr.2018.09.001
    1. Tanney B. L. (1986). Electroconvulsive therapy suicide. Suicide Life Threatening Behav. 16 (8), 198–222. 10.1111/j.1943-278X.1986.tb00352.x
    1. Thiessen M. S., Walsh Z., Bird B. M., Lafrance A. (2018). Psychedelic use intimate partner violence: The role of emotion regulation. J. Psychopharmacol. 32 (7), 749–755. 10.1177/0269881118771782
    1. Thomas G., Lucas P., Capler N. R., Tupper K. W., Martin G. (2013). Ayahuasca-assisted therapy for addiction: Results from a preliminary observational study in Canada. Curr. Drug Abuse Rev. 6 (1), 30–42. 10.2174/15733998113099990003
    1. Uthaug M. V., Van Oorsouw K., Kuypers K. P. C., Van Boxtel M., Broers N. J., Mason N. L., et al. (2018). Sub-acute long-term effects of ayahuasca on affect cognitive thinking style their association with ego dissolution. Psychopharmacol. 235 (10), 2979–2989. 10.1007/s00213-018-4988-3
    1. Valuck R. J., Orton H. D., Libby A. M. (2009). Antidepressant discontinuation risk of suicide attempt: A retrospective, nested case-control study. J. Clin. Psychiatry 70 (8), 1069–1077. 10.4088/JCP.08m04943
    1. Vitiello B., Ordóñez A. E. (2016). Pharmacological treatment of children adolescents with depression. Expert Opin. Pharmacother. 17 (17), 2273–2279. 10.1080/14656566.2016.1244530
    1. Vollenweider F. X., Kometer M. (2010). The neurobiology of psychedelic drugs: Implications for the treatment of mood disorders. Nat. Rev. Neurosci. 11 (9), 642–651. 10.1038/nrn2884
    1. Wasserman D. (2001). A stress-vulnerability model the development of the suicidal process, in Suicide: An Unnecessary Death. Ed. Wasserman D. (London: Martin Dunitz; ), 13–27. 10.1201/b14713-5
    1. Wilkinson S. T., Ballard E. D., Bloch M. H., Mathew S. J., Murrough J. W., Feder A., et al. (2018). The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review individual participant data meta-analysis. Am. J. Psychiatry 175 (2), 150–158. 10.1176/appi.ajp.2017.17040472
    1. World Health Organization (2014).Preventing Suicide: A Global Imperative. Geneva: Author.
    1. Zalsman G., Hawton K., Wasserman D., van Heeringen K., Arensman E., Sarchiapone M., et al. (2016). Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 3 (7), 646–659. 10.1016/S2215-0366(16)30030-X
    1. Zeng R., Cohen L. J., Tanis T., Qizilbash A., Lopatyuk Y., Yaseen Z. S., Galynker I. (2015). Assessing the contribution of borderline personality disorder features to suicide risk in psychiatric inpatients with bipolar disorder, major depression schizoaffective disorder. Psychiatry Res. 226 (1), 361–367. 10.1016/j.psychres.2015.01.020

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit