Researchers say people with depression may benefit from treatment with psilocybin.
- In a new study, psilocybin from so-called magic
mushrooms showed better results fighting depression than a placebo,
niacin, or microdoses of psychedelics.
- Researchers also reported that psilocybin
showed greater effects on people with secondary depression related to an
underlying disease.
- They did note that the findings were limited
due to a lack of diversity among study participants.
A
Published inThe BMJ, the peer-reviewed research states that
psilocybin was a more effective treatment of depression symptoms among study
participants than a placebo, niacin (vitamin B), or microdoses of psychedelics.
The study authors said in a statement that depression affects an
estimated 300 million people worldwide and is a leading cause of disability.
Researchers said psilocybin has shown promise in
reducing symptoms of depression after one or two doses with few side effects
and no current evidence that the substance causes addiction.
They also said published
studies to date haven’t examined factors that could moderate psilocybin’s
effects, including dosage, type of depression, past use of psychedelics, and
publication biases.
Details from
the study on psilocybin and depression
The team of UK
researchers searched databases for randomized controlled trials comparing
psilocybin as a depression treatment to other substances.
They also looked at studies where psychotherapy was
used under both the experimental and the control conditions to distinguish
psilocybin’s effects from those produced by psychotherapy. They settled on
seven trials relevant for their analysis that involved 436 subjects with
depression (52% were female and 90% were white).
The researchers measured changes in depression scores
using a statistical method called Hedges’ g. A Hedges’ g score of 0.2 indicates a
small effect, 0.5 a moderate effect, and 0.8 or more a large effect.
The researchers reported that after psilocybin
treatments the change in depression scores was significantly greater than those
shown by a proven comparator treatment, with an overall Hedge’s g of 1.64 – a
score that indicates a large effect favoring psilocybin.
Further analysis showed greater improvements with
secondary depression (related to an underlying disease) than primary
depression, assessed with a self-reported scale rather than a
clinician-assessed scale. Older age and previous use of psychedelics were also
correlated with greater improvements.
The study authors said high levels of variation
between trials resulted in a low certainty of evidence to support a strong
antidepressant effect of psilocybin. Generalizability of findings was limited
by the lack of diversity in study participants.
The researchers also said pre-treatment expectations and
the extent to which participants knew they were being treated with psilocybin
or a placebo were also not measured. In clinical trials, people receive
psilocybin in a calm comfortable room with soothing music and supervised by a
psychotherapist, a situation the researchers said was unlikely to be achievable
in a healthcare system.
Obstacles to
psilocybin in clinical practice
The scientists concluded
that although their findings are encouraging for psilocybin’s potential as an
effective antidepressant, issues such as legal safeguards as well as cost and
lack of regulatory guidelines need to be dealt with before psilocybin can be
established in clinical practice.
Researchers not connected to the study said in an
accompanying editorial that the research didn’t answer
questions such as those about psilocybin’s effectiveness under “real world”
conditions. They said more information about potential effect modifiers is
necessary, which could be delivered by pragmatic clinical trials and real world
data.
The editorial authors also said there’s still debate
as to whether psychedelics can express antidepressant activity on their own
rather than in concert with specific forms of psychotherapy.
They added that as with all analyses using aggregate
data they couldn’t differentiate between individuals most likely to benefit
from psilocybin and those who might instead experience adverse events.
They concluded the study’s findings “support a prudent
approach in both scholarly and public settings because more and better evidence
is needed before any clinical recommendation can be made about therapeutic use
of psilocybin.”
Reaction to
the study on depression and magic mushrooms
Dr. Akanksha Sharma is a neurologist, neuro-oncologist
and palliative medicine practitioner at the Pacific Neuroscience Institute in
Santa Monica, California.
Sharma, who wasn’t involved in the research, told Medical News
Today that there’s still much to be learned about how psychedelics
such as psilocybin change the brain.
“At this point, we know that altered states of
consciousness can help patients face and process difficult emotions associated
with their mental health condition or disease,” Sharma said. “In this state
with the right guides, we can potentially reframe and accept our condition or
find peace. These agents can contribute to neuro-plasticity, which means that
our brain can make new connections and change the way it is responding to
stress and negative emotions.”
Sharma said psychedelics can shift perspective and
help people think differently about life and death and bring spiritual peace
and acceptance, which can be helpful for people experiencing cancer and
depression.
Much
research needed on psilocybin
However, there are also
downsides to treatments such as psilocybin.
“We still have a lot to learn regarding how it works
and how it affects us so there is always inherent risk with that,” Sharma said.
“Opening our mind and heart in this manner cannot be done without expert
therapists and support. Patients should be guided through this otherwise they
can experience anxiety, panic, confusion, and can have high blood pressure, and
cardiac side effects they may not be able to manage. We also don’t yet know any
long-term effects.”
Amy Reichelt, the chief innovation officer at
PurMinds Neuropharma in Ontario, Canada, who wasn’t involved in the research,
noted that the study showed the effects of psilocybin treatment was much larger
in those with secondary depression compared to primary depression.
However, she said it was important to consider that
the people with secondary depression were self-reporting symptoms as opposed to
a more stringent clinician administered scale.
“Also, the root cause of secondary depression likely
differs from primary depression with the secondary depression patients enrolled
in the clinical trials experiencing depression as a manifestation of their
struggle with anxiety around death from their diagnosis of a life-threatening
illness,” Reichelt told Medical News Today.
She said the “
“As the psilocybin was administered as part of a
therapeutic program that also includes therapy, some of the variance may be
attributed to the patient-therapist relationship that was provided as
psychological support,” Reichelt said. “However in these studies the placebo
control group also received therapy.”
She added that a dose response effect was also shown
with higher doses (20 to 25mg) showing greater effectiveness than lower dose
(10 to 15mg), which indicates the more pronounced hallucinogenic effects
generated by a high dose of psilocybin.
“The studies with secondary depression used one dose
of psilocybin whereas the studies with primary depression used two high doses
or one high dose of psilocybin,” Reichelt said. “Again, the greater effect size
in secondary depression compared to primary depression may be due to a greater
severity and duration of depressive symptoms in the primary depression
patients, and that the secondary depression patients were experiencing a more
situational depression.”
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