Inhaled DMT for Major Depressive Disorder

The MADRS is a clinician-rated scale used to evaluate the severity of depressive symptoms. It consists of 10 items, each rated from 0 to 6. The total score ranges from 0 to 60. Higher scores indicate greater severity of depression (worse outcome).

The MADRS is a clinician-rated scale to monitor depression severity. Total score ranges from 0 to 60. Higher scores indicate greater severity of depression (worse outcome). This measure will assess the durability of the antidepressant effect in participants who achieved remission.

AEs defined by CTCAE v5.0, occurring after DMT administration and compared between study arms across assessment time points.

The C-SSRS is a standardized tool used to evaluate the occurrence, severity, and intensity of suicidal ideation and behavior. It assesses 5 levels of ideation (from "wish to be dead" to "active ideation with specific plan and intent") and 5 types of suicidal behavior. Results are reported as the number of participants who endorse any suicidal ideation or behavior (Yes/No) during the assessment period.

This is a single item (Item 10) from the MADRS scale that specifically evaluates suicidal ideation. The score ranges from 0 to 6. Higher scores indicate greater severity of suicidal thoughts (worse outcome).

The Beck Scale for Suicide Ideation (BSI) is a 21-item instrument used to assess the severity of suicidal ideation. Each item is rated on a 3-point scale (0 to 2), yielding a total score ranging from 0 to 42. Higher scores indicate greater severity of suicidal ideation. Higher scores indicate a higher risk of suicide (worse outcome).

The CGI-SS is a clinician-rated scale used to assess the patient's overall severity of suicidality. The scoring is strictly informed by the findings of the Columbia-Suicide Severity Rating Scale (C-SSRS) to ensure objective evaluation. The score ranges from 1 (normal, not at all suicidal) to 7 (among the most extremely suicidal patients). Higher scores indicate greater severity of suicidality (worse outcome).

The State-Trait Anxiety Inventory (STAI) is a 40-item self-report questionnaire that differentiates between temporary, situational anxiety (State) and long-term personality anxiety (Trait). It features two 20-item subscales rated on 4-point Likert scales, with higher scores indicating greater anxiety.

The PHQ-9 is a self-report tool for screening and monitoring depression. Scores range from 0 to 27. Higher scores indicate more severe depressive symptoms (worse outcome).

A clinician-rated scale used to assess a range of psychiatric symptoms. In the 18-item version with 1-7 item scoring, total scores range from 18 to 126, with higher scores indicating greater severity of psychopathology.

The YMRS is a clinician-rated scale to assess manic symptoms. Total scores range from 0 to 60. Higher scores indicate greater severity of mania (worse outcome).

The WHOQOL-BREF is a 26-item instrument that assesses quality of life across four domains: Physical health, Psychological, Social relationships, and Environment. Domain scores can be transformed to a 0-100 scale, with higher scores indicating better quality of life.

The EuroQol 5-Dimension 3-Level (EQ-5D-3L) is a standardized instrument used to measure health outcomes. It comprises a descriptive system covering five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and a Visual Analogue Scale (VAS). The VAS records the respondent's self-rated health on a vertical scale ranging from 0 ('Worst imaginable health state') to 100 ('Best imaginable health state'). Higher scores indicate a better health state.

The Psychedelic Integration Scales (PIS) is a 24-item self-report instrument designed to assess internal and experiential aspects of how an individual integrates insights from a psychedelic experience into their daily life. Each item is scored on a 5-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Total scores are calculated by summing the items and range from 24 to 120, where higher scores indicate a greater internal sense of psychedelic integration (better outcome).

The Five-Dimensional Altered States of Consciousness Rating Scale (5D-ASC) is a 94-item visual analogue scale (VAS) used to retrospectively assess subjective effects of psychoactive substances. It captures five core dimensions: Oceanic Boundlessness, Dread of Ego Dissolution, Visionary Restructuralization, Auditory Alterations, and Vigilance Reduction. Each item is rated from 0 to 100, with higher scores indicating greater alterations from normal waking consciousness. Scores are typically aggregated into dimension-specific and total scores.

Change from baseline in serum brain-derived neurotrophic factor (BDNF) levels, measured in nanograms per milliliter (ng/mL). Positive values indicate an increase in serum BDNF levels from baseline, with greater increases representing a more favorable outcome.

A participant-rated Visual Analogue Scale (VAS) used to measure the overall peak intensity of the subjective effects during the DMT session. The scale consists of a 100mm line where 0 represents "No effects at all" and 100 represents "Extremely intense effects." Higher scores indicate a more intense psychedelic experience. Unit of Measure: units on a scale (0-100).

A participant-rated Visual Analogue Scale (VAS) used to measure the emotional quality (valence) of the experience. The scale is bipolar, ranging from -50 to +50, where -50 represents an "Extremely unpleasant/negative experience," 0 represents a "Neutral experience," and +50 represents an "Extremely pleasant/positive experience." Positive scores indicate a better outcome (pleasant experience), while negative scores indicate a worse outcome (unpleasant experience). Unit of Measure: units on a scale (-50 to +50).

Continuous monitoring of heart rate to assess the sympathomimetic effects of DMT. Data will be reported as the change from pre-dose levels. Unit of Measure: Beats per minute (bpm).

Measurement of systolic blood pressure to monitor cardiovascular safety and potential transient hypertension during the experience. Unit of Measure: Millimeters of mercury (mmHg).

Measurement of diastolic blood pressure to assess acute cardiovascular response. Unit of Measure: Millimeters of mercury (mmHg).

Monitoring of blood oxygen levels via pulse oximetry to ensure respiratory safety during DMT administration. Unit of Measure: Percentage of oxygen saturation (%).

The Clinical Global Impression - Severity (CGI-S) is a clinician-rated scale used to assess the patient's overall severity of illness at the time of evaluation. Scores range from 1 (normal, not at all ill) to 7 (among the most extremely ill patients).

The Clinical Global Impression-Improvement (CGI-I) is a clinician-rated scale that assesses the patient's overall clinical improvement relative to baseline. Scores range from 1 (very much improved) to 7 (very much worse), with lower scores indicating greater clinical improvement.

Time Frame: Baseline (pre-DMT session), 150 minutes post-DMT session (Day 0), Day 1, Day 7, Day 14, 1 month, 3 months, and 12 months post-intervention.

The Death Attitude Profile-Revised (DAP-R) is a 32-item multidimensional scale that assesses attitudes toward death across five domains: Fear of Death, Death Avoidance, Neutral Acceptance, Approach Acceptance, and Escape Acceptance. Items are rated on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). Higher scores indicate greater endorsement of each respective attitude dimension.

The Duke University Religion Index (DUREL) is a 5-item self-report instrument that assesses religious involvement across three dimensions: organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiosity (IR). Higher scores indicate greater religious or spiritual involvement.

The Meaning in Life Questionnaire (MLQ) is a 10-item self-report instrument that assesses two distinct dimensions of meaning in life: Presence of Meaning (MLQ-P) and Search for Meaning (MLQ-S). Each item is rated on a 7-point Likert scale ranging from 1 (Absolutely Untrue) to 7 (Absolutely True). Subscale scores range from 5 to 35.

The Big Five Inventory (BFI) is a 44-item self-report inventory that assesses the Five Factor Model of personality: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience. Each item is rated on a 5-point Likert scale. Domain scores are calculated for each trait and analyzed separately. This measure is used to evaluate potential changes in personality traits following the DMT experience. Changes such as reductions in Neuroticism or increases in Openness are commonly reported in psychedelic research and may be associated with positive psychological outcomes.

The Cognitive Triad Inventory (CTI) is a self-report instrument designed to assess the cognitive triad, encompassing views of the self, world, and future. It evaluates patterns of depressive and non-depressive thinking. Items are rated on a Likert scale, and total scores are calculated, with higher scores indicating more positive and adaptive cognitive patterns (better outcome).

The Psychological Flexibility Scale (Psy-Flex) is a 6-item self-report instrument designed to assess psychological flexibility based on the Acceptance and Commitment Therapy (ACT) hexaflex model. Each item is rated on a 5-point Likert scale ranging from 1 ("very rarely") to 5 ("very often"). Total scores range from 6 to 30, with higher scores indicating greater psychological flexibility (better outcome).

The WHODAS 2.0 (12-item) is a self-report instrument assessing functioning across six domains: cognition, mobility, self-care, getting along, life activities, and participation. Each item is rated on a 5-point scale (1 = none to 5 = extreme/cannot do). Total scores are calculated by summing item responses (range 12-60), with higher scores indicating greater disability (worse outcome).

The PANAS-NA is a 10-item subscale that assesses subjective distress and unpleasurable engagement, including states such as anger, contempt, and fear. Participants rate each item (e.g., "distressed," "guilty," "scared") on a 5-point Likert scale (1 = "very slightly or not at all" to 5 = "extremely"). The total subscale score ranges from 10 to 50. Higher scores indicate greater negative affect (worse outcome).

The PANAS-PA is a 10-item subscale that assesses the extent to which a person feels enthusiastic, active, and alert. Participants rate each item (e.g., "interested," "excited," "proud") on a 5-point Likert scale (1 = "very slightly or not at all" to 5 = "extremely"). The total subscale score ranges from 10 to 50. Higher scores indicate a greater level of positive affect (better outcome).