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Psychedelic treatment for depression | MHT


Earlier this month, Dr Robin Carhart-Harris, head of the Centre for Psychedelic Research and also head of the DMT trials that we covered last month, penned an article for The Guardian on these new and promising results from a recent trial into the treatment of depression with psilocybin.

Ever since Prozac was introduced as the most widely prescribed anti-depressant, researchers have consistently been attempting to improve on the side-effects that come with all selective serotonin reuptake inhibitors (SSRI’s).

Since the introduction of Prozac (chemical name fluoxetine), other SSRI’s such as citalopram, sertraline and escitalopram which has had some of the more promising results in trials for the treatment of depression.

On the topic of these SSRI’s and their side-effects Dr Carhart-Harris said they can have an emotional blunting effect, stressing that they don’t necessarily help people to “feel great” and can in fact put people off from taking medication for their depression all together.

Whereas, using psilocybin in conjunction with therapy can have a “resetting” affect.

Dr Carhart-Harris reported that participants felt “recalibrated, reset like they haven’t for years…enjoying life”. He believes this is because psychedelics can “get more at the root cause of suffering [rather than] plastering over or muting their symptoms”.

The study and trial consisted of two groups of patients (59 in total) all with moderate-to-severe major depressive disorder. They compared one group, who took escitalopram, an SSRI, every day for 6 weeks, to another who took two high doses of psilocybin, three weeks apart and in conjunction with specialist therapy.

Both treatment groups were measured across five different types of depressive symptoms: sleep, energy, appetite, mood and suicidal thoughts. The positive response across these measures by the end of the six-week trial in the SSRI treatment group was 33%.

For the psilocybin treatment group, they seemed to respond positively far more rapidly with reported decreased depressive scores only one day after the first dosing session. By the end of the 6-week trial the average response rate to psilocybin therapy was more than 70%.

Dr Carhartt-Harris notes that the hypothesis for this trial was that the psilocybin therapy would indeed have more positive effects on the psychological wellbeing of those in that treatment group, however it out-performed the SSRI more than they had ever predicted.

Patients also reported a reduction in anxiety symptoms, an increase in work and social functioning, decrease in suicidal feelings and increase in “the ability to feel emotion and pleasure.”

Another promising finding from this trial was the lack of side effects for those in the psilocybin treatment group. Where those in the SSRI group experienced drowsiness, dryness in the mouth, anxiety and sexual dysfunction, the psilocybin group had only one prevalent side effect of a mild to moderate headache one day after dosing.

Dr Carhartt-Harris stated that a six-month follow up with all participants is now under way to test a prediction that “the positive side effects seen in the psilocybin group will be longer lasting”.

Other experts in the field warn that we are very much in the early stages of this kind of research.

Guy Goodwin, a professor of Psychiatry at the University of Oxford has said of this most recent published study, “It is under-powered and did not prove that psilocybin is a better treatment than standard treatment with escitalopram for major depression” and noted that this trial was particularly small.

The researchers themselves have admitted that larger trials that assess patients over a longer period are necessary to establish whether psilocybin does actually out-perform more established antidepressant treatments.

The researchers involved in the study and trials also want the public to approach the findings of this trial in a realistic and safe way.

Professor David Nutt who co-authored the study wanted to emphasise that the trip involved in the psilocybin therapy was not easy, saying “This is hard, hard work. It’s often very challenging.” And also mentioned that the therapy in conjunction with the psilocybin is just “as important as the drug action”.

Professor Nutt and Dr Carhartt-Harris are very cautious to warn those suffering with depressive disorders should never self-medicate with psilocybin. The treatment of depression with this psychedelic compound was successful in this very specific clinical setting, where specialised therapy was provided during and after every dosing session.

In the absence of these clinical safeguards, taking any psychedelic drug can be dangerous.

“We are on the verge of a paradigm shift in mental healthcare”

Dr Carhartt-Harris is most excited by the developments being made by this study and the Centre for Psychedelic Research’s previous study on DMT because he believes it is a sign, we, as a society are moving away from an “outdated” view of mental health treatments. This view that medication alone should solve the problem.

Instead, Dr Carhartt-Harris sees the potential of a “biopsychosocial model” and that psychedelics can fit into this model because they have the ability to activate “powerful brain sates that have evolved in humans to catalyse deep psychological change” naming these states as “hyper-plastic”.

Finally, Dr Carhartt-Harris acknowledges the obstacles that will no doubt come into play in the development of psychedelic medicine noting that “this road won’t be easy”. He ponders on the “moral objections” and “litigation issues” wondering if they’ll ever make it at all, but finishes on the positive not of “One thing I am more certain of, however, is that we must try.”



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