Safety, Tolerability, and Efficacy of Sublingual Microdoses of 5-MeO-DMT for Depression and Anxiety

This Phase I/II clinical trial employs a rigorous, randomized, double-blind, placebo-controlled design to evaluate the safety, tolerability, pharmacokinetics, and efficacy of a novel sublingual formulation of 5-MeO-DMT. The trial focuses on understanding the compound's effects in healthy volunteers and those with elevated symptoms of anxiety and depression, aiming to build a comprehensive profile of its potential therapeutic and pharmacological properties.

Study Objectives

The Phase I component emphasizes:

• Safety and Tolerability: Assessing physiological responses, including vital signs (heart rate, blood pressure, respiration rate, temperature) and cardiac function (ECGs). Biochemical markers of renal, hepatic, and hematological health will be monitored to detect potential adverse effects.
• Pharmacokinetics: Evaluating how 5-MeO-DMT is absorbed, distributed, metabolized, and eliminated through blood sampling at multiple time points. Key metrics include peak plasma concentration (Cmax), time to peak (Tmax), and overall exposure (AUC).

The Phase II component explores the efficacy of 5-MeO-DMT in reducing symptoms of anxiety and depression and enhancing emotional well-being.

Participants and Dosing Regimen The trial enrolls 40 participants aged 40-80, divided into four groups: one placebo group and three active treatment groups receiving sublingual doses of 6 mg, 9 mg, or 12 mg of 5-MeO-DMT. A single weekly dose is administered over four weeks, enabling the evaluation of immediate and cumulative effects.

Recruitment will target healthy volunteers who meet specific anxiety and mood criteria. Notably, participants will be screened to exclude individuals with previous psychedelic experiences involving tryptamines, ergolines, or phenethylamines, those with contraindications to the use of psychedelics, and those currently taking prescribed psychoactive medications. This includes serotonin reuptake inhibitors, benzodiazepines, medications primarily affecting serotonin neurons (e.g., ondansetron), and MAO inhibitors.

Neurocognitive and Psychological Assessments

Participants undergo validated assessments to evaluate changes in:

• Mood and Anxiety: Tools include the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory II (BDI-II), Depression, Anxiety, and Stress Scale (DASS-21), and Suicidal Ideation Scale (SSI).
• Cognitive Function: Neurocognitive tests like the Phonological Verbal Fluency Test (FAS), Paced Auditory Serial Addition Test (PASAT), and Digit Span Scale (DSS) assess executive function, working memory, and attention.

Validated instruments will be employed to evaluate mood, anxiety levels, cognitive function, and any perceptual or psychological effects experienced by participants. These assessments will be conducted at baseline (Week 0), during each dosing week (Weeks 1-4), and at the end of the study (Week 5). By measuring these parameters, the trial aims to identify the effects of sub-psychedelic doses of 5-MeO-DMT on cognitive processes and emotional states.

Safety Protocols The study complies with Good Clinical Practice (GCP) and ethical standards, including approval from the CEI of the Ministry of Health of San Juan, Argentina. Informed consent is obtained from all participants, who are screened to exclude individuals with prior psychedelic experiences, contraindications, or concurrent use of psychoactive medications.

The trial prioritizes participant safety with continuous monitoring and immediate medical response protocols for any adverse events.

Expected Outcomes This study aims to generate a comprehensive dataset on the safety, pharmacokinetics, and potential efficacy of sublingual 5-MeO-DMT, providing a clear and detailed understanding of its safety and tolerability profile under controlled conditions.

The findings are expected to inform future research into the therapeutic potential of 5-MeO-DMT for anxiety, depression, and other mental health disorders, offering critical insights into its clinical applications. By advancing the understanding of psychedelic compounds, this study represents a pivotal step toward developing innovative, evidence-based treatments for mental health challenges.

Inclusion criteria

• Voluntary participants aged between 40 and 80 years, regardless of sex.
• Must provide written informed consent to participate in the study.
• Participants must exhibit moderate to high levels of anxiety and/or depression:
• Anxiety levels assessed using the State-Trait Anxiety Inventory (STAI):
• STAI-S (State) score of ≥20 for men and ≥23 for women
• STAI-T (Trait) score of ≥20 for men and ≥26 for women
• Depression levels assessed using the Beck Depression Inventory (BDI):
• BDI score of ≥21 indicating the presence of moderate to severe depressive symptoms.
• Participants may meet the criteria for either anxiety, depression, or both, as long as they meet the respective thresholds for each

Exclusion criteria

• Liver dysfunction
• Cardiovascular conditions, including: Uncontrolled hypertension, Angina, Clinically significant ECG abnormalities (e.g., atrial fibrillation), Transient ischemic attack (TIA) within the last 6 months.
• Stroke or peripheral/pulmonary vascular disease without active claudication.
• Blood pressure exceeding 140 mmHg systolic or 90 mmHg diastolic.
• Epilepsy or a history of seizures.
• Kidney failure.
• Insulin-dependent diabetes.
• Chronic obstructive pulmonary disease (COPD).
• Increased intracranial or cerebrospinal pressure
• Hyperthyroidism
• Psychotic symptoms or a family history of psychotic disorders
• Prodromal symptoms of schizophrenia or dissociative identity disorder.
• Severe symptoms of depression or anxiety requiring immediate treatment with antidepressants or daily anxiolytic medications, especially in cases involving suicidal ideation.
• Medications: Regular use of prescribed psychoactive medications, such as: Benzodiazepines, Medications affecting serotonin neurons (e.g., ondansetron), Monoamine oxidase inhibitors (MAOIs).
• Drug Interactions: Use of potent metabolic inducers or inhibitors, including: Inducers: Rifampicin (rifabutin, rifapentine), anticonvulsants (carbamazepine, phenytoin, phenobarbital), nevirapine, efavirenz, taxol, dexamethasone. or Inhibitors: All HIV protease inhibitors, itraconazole, ketoconazole, erythromycin, clarithromycin, and troleandomycin.