A small scale MRC-funded pilot study into treating
depression resistant to current therapies using
psilocybin, the psychedelic compound of magic
mushrooms, has found that it can be safely
administered with appropriate support. This could
pave the way for future randomised-controlled trials
to establish the efficacy of the compound in
treating this form of depression.
Most people with depression respond positively to
treatment using antidepressant medication and
cognitive behavioural therapy. But around 20% of
those with depression do not respond to treatments
and are classified as having treatment-resistant
depression.
Previous studies have looked into the potential of
using psychedelic drugs for conditions such as end
of life anxiety and obsessive-compulsive disorder.
Psilocybin acts on the serotonin system suggesting
it could be developed for use in the treatment of
depression.
The study aimed to assess safety and whether a
potential treatment dose of psilocybin could be
tolerated.
Hallucinogenics such as psilocybin can cause
unpleasant reactions, including anxiety and
paranoia, so it is important to establish whether
the drug can be administered safely to people with
depression.
To investigate the safety and feasibility of using
psilocybin for treatment-resistant depression,
researchers from Imperial College London conducted a
strictly monitored feasibility study. As this was
not a randomised-controlled trial, the patients knew
they were receiving the drug and there was no
control group to provide comparison either with
existing treatments or with no treatment at all.
Twelve people with moderate to severe
treatment-resistant depression who had not responded
to at least two courses of antidepressants were
recruited (six men and six women, aged 30-64). Most
of the participants actively volunteered to take
part following presentations by the researchers and
media coverage.
Eleven of the participants had previously undergone
psychotherapy. The volunteers went through a
thorough screening process before they were allowed
to participate.
Criteria used to rule out participants from taking
part included people with a history of suicide
attempts, those with diagnosis of a psychotic
disorder and other significant medical conditions.
Participants were fully supported at all times
before, during and after they received psilocybin.
The patients received Home Office-approved
psilocybin capsules during two dosing sessions seven
days apart.
The psilocybin was administered to the participants
at a research facility and participants were
monitored by at least two members of clinical staff
at all times during the psilocybin administration
sessions. There was a follow-up with patients the
next day, and then one, two, three and five weeks
after the second dosing session.
Blood pressure, heart rate and the self-reported
intensity of the effects of psilocybin were
monitored before and continuously during each dosing
session. No serious unexpected side effects were
reported during the study. All participants reported
temporary anxiety before and during initial drug
administration.
All patients showed some decrease in symptoms of
depression for at least three weeks. Seven of them
continued to show a positive response three months
after the treatment, with five remaining in
remission after three months.
There are some limitations to this study, in
addition to the small sample size. Previous studies
have shown that using psychedelics can leave one
open to suggestion, which could have been part of
the positive outcomes seen here. It was also not
possible to control for the psychological support
received throughout this study.
Lead author, Dr Robin Carhart-Harris, Imperial
College London, said: 'Psychedelic drugs have potent
psychological effects and are only given in our
research when appropriate safeguards are in place,
such as careful screening and professional
therapeutic support. I wouldn't want members of the
public thinking they can treat their own depressions
by picking their own magic mushrooms. That kind of
approach could be risky.'
Senior author, Professor David Nutt, Imperial
College London, said: 'It is important that academic
research groups try to develop possible new
treatments for depression as the pharmaceutical
industry is pulling out of this field. Our study has
shown psilocybin is safe and fast acting so may, if
administered carefully, have value for these
patients.'
Dr Louise Jones, head of translational research at
the MRC, said: 'We currently don't have effective
treatments for some people's depression so we need
to know more about how drugs such as psilocybin
could be used for patient benefit. This study showed
that, with appropriate safeguards, psilocybin can be
safely administered to some patients with
treatment-resistant depression. It will now be
important to undertake studies that evaluate its
role as a potential treatment.'
The study was published in The Lancet Psychiatry.
For more information
The Lancet Psychiatry
Psilocybin with psychological support for
treatment-resistant depression: an open-label
feasibility study
Carhart-Harris, Robin L et al.
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Imperial College London
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MRC - Medical Research Council
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