A single, well-managed dose of psilocybinthe active substance found in some ‘magic’ mushroomshas shown to provide distinctly fast and significant relief for patients suffering from depression previously unresponsive to conventional treatments. This is the result of a studypublished this month in Nature Medicinedescribed as the first publicly funded, randomized controlled trial of the therapy in the settings of the English NHS. Scientists from the King’s College London, South London and Maudsley NHS Foundation Trust recruited 60 adults suffering from treatment resistant major depressive disorder, meaning they had not improved following at least two prior medicine treatments alone or one medicine followed by Psychotherapy.
Participants were randomly allocated to receive a placebo or synthetic psilocybin at a dose of 25 mg, both groups received identical support throughout the dosing session before and afterwards. The clinicians administering the treatment and the subjects did not know who received the placebo and who did not. But, three weeks later the gap between groups was considerable.
Scores on the Montgomery-sberg Depression Rating Scale- a commonly used measure of clinical depression, showed a reduction averaging more than ten points more in the psilocybin group than in the placebo group. The effect size at this point was considered large. About four out of ten patients in each group receiving the active compound met the traditional criterion for treatment response and remission (where their symptoms decline to such a degree they no longer meet diagnostic criteria), respectively; these figures remained stable at the six-week follow-up. Conversely, within the placebo group similar numbers ranged at around three percent. Overall the treatment was well tolerated.
The side effects observed were largely mild to moderate in intensity and of short duration (generally on the day of treatment administration). The trial team were pleased to report that administration of the sessions within a routine NHS setting was feasible. For those patients who have failed to respond to several antidepressants and talking treatments, then the findings give a rare glimmer of sober hope.
Treatment resistant depression affects a significant minority of individuals with depression and carries a higher burden of disability and physical illness, and risk of suicide. None of the current optionsadditional medication trials, more arduous psychotherapy, or invasive interventionsare appropriate or effective for all.
The mechanism by which psilocybin, and Yes other classical psychedelics, seem to operate is quite distinct from traditional antidepressants. Instead of taking 4-6 weeks of daily medication, and expecting to have to wait a certain amount of time, a single supervised session can result in quick changes in outlook and mood which are then maintained through psychological integration. In fact, many former patients have called the experience quite emotional yet significant, allowing them to re-evaluate engrained thoughts and views of their role in the world.
This current trial was First and foremost aimed at feasibility and obtaining initial signals of efficacy and is not powered to provide a definitive indication of the treatment for routine clinical use. Larger trials would be necessary to establish the longer term sustainability of any observed benefits, to establish the optimal psychotherapeutic regimens and the characteristics of those most likely to respond as well as to investigate issues of safety, session number and integration into regular NHS pathways.
