A few doses of a psychedelic drug can be just as effective in treating depression as one of the most prescribed antidepressants, according to a small and brief study published Wednesday.
A Phase 2 clinical trial, conducted by researchers in London, was the first random one to compare therapeutic doses of psilocybin – the psychedelic compound found in so-called magic mushrooms – with a daily medication. The results were published in The New England Journal of Medicine.
“This is great because it shows that psilocybin is at least as good – and probably better – than the gold standard treatment for depression,” said Roland Griffiths, director of the Center for Psychedelic and Consciousness Research at Johns Hopkins University. in the study.
Research on how psychedelics can be used to treat mental health conditions is still at an early stage, and much more will be needed to determine if psychedelics, including psilocybin, are an effective long-term treatment. It is also still unclear how the treatment of psychedelics will be used in the real world, as patients have to be monitored for hours when they receive the drug.
This small, six-week trial included 59 adults, of whom nearly 40 percent used medication to treat their depression but were weaned. Thirty participants received two doses of 25 mg psilocybin three weeks apart, plus six weeks of a daily placebo pill. The remaining 29 were also given psilocybin during two visits, but such a small amount that it had no effect and was only a placebo. The second group also took a daily dose of escitalopram – the generic version of the antidepressant Lexapro – a selective serotonin reuptake inhibitor, or SSRI.
Participants in both groups received the dose of psilocybin in a clinician where they were monitored until the clinician determined that the effects had disappeared and the individual could safely return home.
At the end of the six weeks, the researchers used four different degrees of depression to determine whether or not the participants’ symptoms improved: two questionnaires completed by the participants, and two evaluations by the clinicians.
All but one, a self-reported questionnaire called QIDS-SR-16, showed that people who took psilocybin reported a greater improvement in depressive symptoms than those who took Lexapro. The QIDS-SR-16 results, which were the depression measurement method the researchers reported they would focus on before starting the trial, showed that psilocybine was just as effective as escitalopram. (Before starting researchers, they should outline what measures they plan to evaluate, and they should stick to this methodology, regardless of the results.)
“We were honestly surprised that psilocybine performed as well as it did,” said lead researcher Robin Carhart-Harris, head of the Center for Psychedelic Research at Imperial College London.
Carhart-Harris and his team noted that they could not measure the long-term effects of psilocybin compared to escitalopram, which takes longer to start working and may not have reached its full therapeutic potential during the six-week trial.
The researchers kept the trial relatively short because some volunteers had to come down from their current depression treatments to participate, which can be risky, Carhart-Harris noted. To look at long-term effects, his team plans to collect the participants ’data by the six-month mark.
Some outside experts also point to the limitations of the study: it does not include a control group of people who received no treatment, and the group was 66 percent men, although women in the real world are more likely to experience depression . It is also difficult to make a study with psychedelics truly blind, as patients may be able to guess which group they are in if they experience noticeable effects from the higher dose of psilocybin.
But the findings contribute to a growing body of research suggesting that psychedelic drugs may be used in a clinical setting to treat depression and are likely to have lasting effects.
According to Alan Davis, an assistant professor of social work at Ohio State University and deputy assistant professor of psychiatry at Johns Hopkins University, the new trial shows that there may be untapped depression treatments that can help people achieve remission without daily medication – and the costs and side effects that come with it. “For me, it’s a breakthrough,” he said.
More than 13 percent of U.S. adults have been prescribed antidepressants, according to the Centers for Disease Control and Prevention, and SSRIs are the most prescribed class of drugs. However, scientists still do not understand exactly how that medicine – or psychedelics – works on symptoms of depression.
“The receptors that SSRIs work on seem to respond to responses in the brain, especially stress responses, and we think it takes the lead so you can better tolerate stress,” Carhart-Harris said. ‘With psychedelics, it’s almost the opposite. It’s almost like a cruel confrontation with the root of your suffering, which can help people better understand where their depression is coming from. ‘
Griffiths, who has also done research on psilocybin and depression, said he was initially skeptical about the drug, if any, of the drug on symptoms of depression. He expected the results of psilocybine research to change far more than has been the case so far – most research has shown that psilocybine has a positive effect on depressive symptoms in many of the trials in which it has been studied. For example, another small clinical trial published in JAMA Psychology in November found that more than 70 percent of participants reported that their depression eased within the first week after taking two comparable doses of psilocybin and that more than the half were in remission within four weeks.
“People ask me what I believe and my answer is that I believe in the data,” Griffiths said. ‘Psilocybine therapy is not going to be effective for everyone and we are still very early in understanding which populations will be the most sensitive to treatment. But there is no doubt that there is something very real. ”
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