Could psilocybin, the active ingredient in 'magic mushrooms', be a safe and effective treatment for depression? – The Irish Times

There is a resurgence of interest in the use of psychedelics and mind-altering substances such as psilocybin, the active ingredient in “magic mushrooms,” to treat depression.

Michael Pollan, an American author, journalist, and psychedelic advocate, says there has never been a more exciting or perplexing time in the psychedelic world. Take for example the Psychedelic Science 2023 conference, hosted by the Interdisciplinary Association for Psychedelic Studies (MAPS) in Denver, Colorado, which drew 12,000 attendees.

Everyone from doctors and psychotherapists to pharmaceutical companies, self-help gurus, and individuals seeking spiritual transformation are jumping on the bandwagon. Added to this is a vibrant subculture of psychedelic microdosing, or low-dose use, which attracts people who want to improve mood, reduce anxiety, and increase focus and creativity.

[ ‘It’s a treat’: The rise of magic mushroom microdosing ]

However, some doctors, researchers, and patients believe that there is no statistically significant effect on patients with “treatment-resistant” or so-called secondary depression related to physical disease processes such as cancer. They are more cautious about the results of small studies that report that they do.

So who should we believe? There could be a more considered re-evaluation of the use of 20th century psychotropic drugs (including LSD, ketamine and psilocybin) by advocates including the late controversial American psychologist Timothy Leary. Does it really exist? Scottish psychiatrist RD Laing. and the deceased Irish psychiatrist. Ivor Brown?

A recent systematic review of randomized controlled trials by Researchers Athina Marina Metaxa and Mike Clark We looked at seven trials involving 436 people with depression. These studies compared psilocybin as a treatment for symptoms of depression to control groups such as a placebo, niacin (vitamin B), and microdoses of psychedelic drugs (with or without psychotherapy).

The researchers concluded that changes in depression scores following treatment with psilocybin were significantly greater than with other treatments, but further analyses are needed to take into account differences in type of depression (primary or secondary depression), self-reported or clinician-administered depression scales, and whether participants had previously used hallucinogens.

Commenting on the systematic review, Professor David Nutt, head of neuropsychopharmacology in the Faculty of Medicine at Imperial College London (ICL), said that psilocybin appears to be quite good as an antidepressant. He said it was backed by research.

“It's good to see so much progress in this field, especially given that most Western countries are facing a mental health crisis,” Professor Nutt said.

Professor Nutt is part of ICL's Psychedelic Research Group, supported by biotechnology company Compass, which focuses on new mental health treatments, including psilocybin therapy, and the Usona Institute, which tests consciousness-expanding medicines and psychedelic therapies. .

Dr Paul Keedwell, consultant psychiatrist at Cardiff University Hospital in Wales, called the study a welcome review of “the efficacy of a single dose of psilocybin in treating depression”.

“There is some concern about expectancy, because the majority of patients knew when they would be active or receiving the same drug at a higher dose. However, these concerns are allayed by the fact that improvements were maintained for up to 12 weeks in one study,” Dr. Keedwell said.

He added that the main drawback is that some patients find the effects of hallucinogens unpleasant, so care must be taken to ensure a quiet environment during treatment. “Preparation by a psychologist before administration and debriefing after administration are crucial,” he said.

in Editorial on the use of psilocybin for depression Riccardo De Giorgi, a lecturer in psychiatry at the University of Oxford, and patient Roger Ede said in the British Medical Journal that there was still debate about whether psychedelics should be widely used to treat depression. “Polarized opinions between hard-line supporters and detractors are unlikely to inform clinical decision-making,” the researchers said.

De Giorgi and Ede note that while some proponents of psilocybin point out that side effects are negligible, other researchers are concerned by reports of “confusion, substance abuse, deliberate self-harm, suicidal behavior, and psychotic symptoms, especially in people with pre-existing vulnerabilities.”

[ Another Life: Foraging for mushrooms and natural psychedelics ]

They conclude that the review by Metaxa and Clark “does not quantitatively evaluate the safety of psilocybin use in patients with depression.” [Since the systematic review was published on May 1st, concerns have been raised about an error in the calculation of standardised mean differences which is likely to have overestimated the benefits of psilocybin].

his A recent reader's guide to microdosing Tunde Aydeyan, a doctoral student in counseling psychology at Northeastern University in Boston, acknowledged in an Aeon newsletter that there is growing concern among doctors about psilocybin's potential cardiovascular side effects.

“Given the neurochemical mechanisms by which psychedelics mimic serotonin and trigger various receptors in the brain, the effects of repeated dosing are an important issue,” he wrote, noting that serotonin constricts blood vessels and lowers blood pressure. It added that the effects of repeated dosing could increase the Further research is needed regarding the cardiovascular system.

Other studies have found that compared to other recreational substances, psilocybin is the least harmful and has the least physiological side effects. Brain imaging studies have also shown that psychedelics change neural connections in the brain, suggesting that psychedelics may be able to reduce so-called depressive rumination.

Dr. Brendan Kelly, Professor of Psychiatry trinity college dublin (TCD) and Consultant Psychiatrist Tallahat University Hospitalsays there's a lot of interest in psilocybin right now because it's been a long time since there's been a new treatment for depression.

“There is also a great deal of therapeutic enthusiasm, which is good, but the history of psychiatry is full of therapeutic enthusiasm that is not supported by evidence and has proven to be misguided at times. “You have to be careful,” he says.

Dr. Kelly said evidence from previous studies indicates that significant doses (25 mg) in conjunction with psychotherapy are required to achieve results. But, he added, “mindset and environment are very important in psychedelic research.”

“Studies to date have shown that physical side effects are very minor and easy to manage in the right clinical setting. Most studies include one to three sessions with a therapist beforehand to ensure a positive mindset, which reduces the chance of a negative experience. There is usually music playing, soothing lighting, and a therapist remains present throughout the treatment, which can last up to eight hours,” says Dr. Kelly.

Dr. Kelly acknowledges that a resource-intensive treatment model for this new therapy would be very taxing on publicly funded healthcare, stating, “We need to prove the concept first, and then understand the setting.” Pharmaceutical and venture capital companies that are closely monitoring developments are keenly aware of the huge market for new treatments for depression.

In Ireland, psilocybin is currently classified as a dangerous substance with no medical or scientific value and its cultivation, possession, consumption, manufacture, sale, supply and marketing are prohibited. In February 2023, Australia became the first country in the world to legalize psilocybin for medical purposes when prescribed by a licensed psychiatrist. In the United States, some cities have decriminalized the use of psilocybin.

Meanwhile, TCD researchers led by psychiatrist John Kelly are participating in multicenter, double-blind (meaning that neither the researchers nor the patients know whether they are receiving a placebo or an active drug) clinical trials in Europe and North America of the use of psilocybin, along with psychological support, to treat depression.

[ Patrick Freyne: Psychedelic research could hold key to treatment-resistant depression ]

In a 2019 paper published by Cambridge University Press titled “Psychedelic Renaissance: New Journeys for Psychiatry?”, researchers discussed the key differences between recreational and therapeutic use of psilocybin: “In contrast to recreational use, therapeutic use takes place in a controlled, supportive environment with a trained therapist. Building trusting relationships with the team and therapist is crucial to maximizing therapeutic benefits and minimizing the risk of adverse events,” the researchers wrote.

Dr Brendan Kelly remains cautiously optimistic: “There are risks associated with administering any potent psilocybin substance, but there is a significant risk of distress, self-harm and suicide if depression is not properly treated.”