Psilocybin therapy may work like common antidepressants

In the first randomized controlled trial comparing illicit psychedelic urinals with traditional selective serotonin reuptake inhibitors (SSRIs) antidepressants, Psychedelic improvement symptoms of depression The same is true for established metrics, with fewer side effects. However, this study was fairly small and was not explicitly intended to show how well the drug stacks on other measures of well-being.

In a study published Thursday New England Journal of Medicine, Psychiatrist David Nutt, psychologist Robin Carhartt Harris, and other researchers at Imperial College London at the time divided 59 participants into two groups for six weeks. The test was conducted. One group received the full dose of psilocybin, the active ingredient in “magic mushrooms,” in combination with psychotherapy. The other received a daily dose of SSRI escitalopram and two small doses of psilocybin for psychotherapy.All participants suffer from major depressive disorder (MDD), which has a broad impact 10 percent of the US population In a given year.

Researchers have previously conducted an open-label trial (which knows which treatments subjects and practitioners are receiving) and four randomized controlled trials of psilocybin for depression and anxiety. However, until now, there have been no randomized controlled trials that directly compared psilocybin with SSRIs.

“Traditional antidepressants have long dominated psychiatry, so it’s worth noting to compare the still illicit drug psilocybin with standard first-line treatment,” said the Neuroscape Center at the University of California, San Francisco. Carhartt Harris in. Psilocybin Schedule I A substance that is defined as “having no currently accepted medical use and likely to be abused.” “This study clearly suggests that psilocybin is in complete conflict with the data and that the legal status of psilocybin needs to be changed,” says Carhartt Harris.

Researchers used various scales to score study subjects for depressive symptoms, and the main result of the study was a 16-point quick inventory of depressive symptoms-self-report (QIDS-SR-16) (self-assessment question). Vote) was adopted. The mean score for QIDS-SR-16 showed no statistically significant difference between the group receiving psilocybin alone and the group receiving SSRIs 6 weeks later.

However, the psilocybin group has suicidal tendencies, anhedonia (lack of ability to feel pleasure), and the Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HAM-D). In particular, Carhart-Harris states that among the 16 items in the QIDS-sR-16 questionnaire, many differences were very significant. 70% of the subjects in the urinal group responded to treatment, whereas the SSRI group. The difference in remission rate was also statistically significant. The rate in the psilocybin group was 57% and in the escitalopram group was 28%.

“Looking at their data, it’s very clear that there is a substantial difference between these two groups in the direction we predicted,” said Roland Griffith, director of the Johns Hopkins Psychedelic Awareness Research Center. Says.I’m involved in this research Launched his own “breakthrough” newspaper Last year’s JAMA Psychiatry: The first randomized controlled trial investigated MDD psilocybin therapy..

“One of the most notable aspects of this new treatise from Imperial [College London] That’s where it’s published, NEJM, It’s a marker of where mainstream medicine is, “said Charles Glob, a psychiatrist at the University of California, Los Angeles. His most cited paper examined the ability of psilocybin to reduce anxiety and improve quality of life in end-stage cancer patients. “This also shows where we are in society,” says Grob. “When we started hiring in 2006 Research on cancer, It was very challenging. By comparison, scientists conducting new trials were overwhelmed by volunteers. They finally screened 1,000 people, of whom only 59 were selected.

Carhart-Harris said the team predicted that this large number of “self-introductions”, which favor psilocybin over SSRIs, would likely influence the outcome of the study. Those who received escitalopram probably expressed disappointment, and those who received psilocybin could be even better than if the study was done 10 years ago. Many factors make statistical scrutiny of psychedelic therapy difficult and raise the question of whether such powerful psychotropic drugs can “blind” the treatment a subject receives.

Researchers sought to minimize this effect by informing both groups of people that they would receive psilocybin to set equal expectations. They gave both groups a standard experience of psychedelic medication: while each subject was blindfolded and listening to music, while one or two therapists were in the room for support. An extended 4-6 hour session instructed to lie down. Participants assigned to the psilocybin group received 25 milligrams of psilocybin for full efficacy. People in the escitalopram group were given a perceptual “microdose” of 1 milligram with no apparent psychedelic effect. Finally, after the first dose, the team gave all subjects a bottle of tablets and instructed them to take it once daily. The escitalopram group received SSRIs, while the silosibine group simply took placebo.

“This is a very exciting topic, but a very rigorous scientific methodology is needed to actually understand the safety and efficacy of these therapies,” said Yale, an associate professor at Yale University School of Medicine. Said Gerald Sanacola, a psychiatrist who is the director of the Depression Research Program. , Those who were not involved in the study. Since this is a relatively small number of people who do not have a placebo group, there are limits to the conclusions that can be drawn from this data, “he says. “I see this data as promising and legitimate, but sometimes the excitement goes beyond science, so I need to be honest about what the limits are.”

Sanakora also states that the psychotherapeutic component of this study, which provided equal amounts of preparation, counseling, and follow-up to both the escitalopram and psilocybin groups, is unusual and noteworthy. All participants received a total of 38-40 hours of psychotherapy. This is about twice the normal amount that most psychedelic study subjects receive. “Such psychosocial interventions are really very powerful,” he says.

“It’s very important to recognize that both groups worked in this study. The reason both groups worked was because so much attention and attention was paid to this study.” , Said psychologist Rosalind Watts. Treatises and leads in the clinical part of the study. She is currently a member of the Advisory Board of Synthesis, a center that provides psychedelic therapy retreats in the Netherlands. The country is one of the few jurisdictions where psilocybin (in the form of truffles) is legal. In Oregon, citizens voted in November 2020 to legalize psilocybin therapy for medical purposes.

The psychological component of psychedelic therapy tends to be unemphasized by both scientists and the media, but is still considered essential to the effectiveness of the therapy. In particular, these experiences can be anxious, powerful, confusing, and even frightening. A sense of “safety” and “alliance” with the therapist is often important for psychological breakthroughs. This is especially true for many patients with depression who are often unsure of trying new treatments after many have failed.

“I thought this drug might work for some people, but probably not for me. I was pretty afraid because I didn’t really trust my brain. Alysone, a 32-year-old registered nurse in the UK who took part in the study after suffering from depression for 20 years, says, “This study really saved my life with both psilocybin and psychological support. I think. “(Following the study, participants were informed of the treatment they received.)

However, after the study was completed, some subjects experienced a lasting benefit, while others relapsed into depression. Leonie Schneider, a 44-year-old Greek woman living in the United Kingdom, is one of the participants who was depressed again after a particularly difficult period of unfortunate events with serious financial difficulties as a result of COVID and a family with terminal illness. was. .. “I was more depressed than my whole life, and it was even more difficult because I quit the drug I had previously relied on before the exam. In addition, the stabilizing crutches that COVID started and usually had to deal with There wasn’t, “she says.

However, Schneider says that 20 years of trying a number of SSRI antidepressants in addition to talk therapy did not give her the resilience she needed. “Antidepressants often felt like a palliative care approach to mental health,” she says. By comparison,” [psilocybin] The trial gave me the tools to start the job and build its emotional resilience. “

“Studies of people who are dying from a terminal illness and are depressed may show permanent changes from a single session with silocibin, but dozens for no recognizable reason. If you’ve been depressed for years, one or two doses are less likely to be alleviated, “says Watts.

At the end of the trial in March 2020, the COVID-19 pandemic exploded, and Watts and other members of the team had an online therapy session for study participants who felt they needed additional support. Was set. Schneider, like Thorne, immediately signed up with 16 other participants who met with research psychologists online for a year on a regular basis. This extended the period known as “integration” to understand the visions and insights individuals felt under the influence of psilocybin.

“People describe psychedelic therapy as 25 years of therapy in the afternoon of the day, and it can definitely feel that way, but it’s not a silver bullet-and it’s just an afternoon.” Schneider says. “The real magic of this is not in the medication day, but in the work done later.”