New Research on Psilocybin for Depression
The research regarding the therapeutic potential of the psychedelic compound psilocybin found in mushrooms continues to grow. The latest double-blind randomized clinical trial was published recently in JAMA and featured physicians, nurses, and other healthcare professionals who provided frontline care during the pandemic. These clinicians had no pre-pandemic mental health issues but after the pandemic were experiencing moderate to severe symptoms of depression and burnout.
The participants were randomly assigned to receive either one dose of 25 milligrams (mg) of psilocybin along with three follow up integration visits or one dose of 100 mg of niacin. Twenty-eight days after the medication was administered the mean change in the depression symptoms score in the psilocybin group was -21.33 compared to -9.33 in the niacin group. The secondary outcome measurement was burnout and after 28 days there was a larger improvement in burnout scores in the psilocybin group compared to the niacin group, however, it was not statistically significant.
This is consistent with previous research showing that psilocybin can help patients with treatment-resistant depression. Other research also shows psilocybin may be effective for easing anxiety and treating anorexia.
From a clinical standpoint, questions remain regarding strain, preparation, integration, and dosage.
Clinical Variables
In this latest study and a previous 2023 study conducted by Raison et al, a single dose of 25 mg was used. The Raison study also featured adults with moderate to severe depression and found a significant reduction in symptoms after 43 days compared to the niacin group.
“25 mg of psilocybin has been used in several important studies,” explained psychedelic expert, researcher, and clinician Emily Whinkin, ND. “Traditionally, dosing has been individualized with whole mushrooms and depends heavily on the strain which can vary in psilocin and psilocybin concentrations.”
Dr. Whinkin said there are other factors beyond dose that can impact clinical outcomes including how the mushroom is prepared.
“The mushroom may be in the form of a tea, powdered, or whole,” said Dr. Whinkin who is with the Advanced Integrative Medical Science Institute in Seattle. “Efficacy can also depend on the person consuming it. For example, how is their digestion or are they feeling open or resistant?”
Dr. Whinkin explained that in addition to dose, preparation, and the patient, integration can influence outcomes.
Integration and Psychological Support
The Raison study from last year utilized psychological support following the single dose while the latest study included integration follow up visits.
“Integration is one of the ways that a therapeutic relationship can resolve any loose ends,” explained Dr. Whinkin who is also a physician with the Amenda Clinic in Portland, OR. “The relationship holds space for the process of unlearning and relearning oneself, which can offer people a priceless experience of being witnessed and supported as they sort out what is next for themselves.”
Dr. Whinkin believes that integration is what sets apart psychedelic assisted psychotherapy from escapism.
“Integration can look differently but it is typically within integration that we are tasked with articulating the lessons or action steps gleaned from the session, processing challenges from the session, and showing up to the shifts we want to see in our lives,” she explained.
Unpacking Psilocybin’s Potential
From a clinical standpoint, future research will likely home in on issues such as dose and delivery. However, as Dr. Whinkin pointed out in a podcast interview from last year, legal status and availability remain key barriers to using psilocybin in clinical practice.
“Federally, psilocybin is still Schedule 1, which means there's basically no acknowledged therapeutic benefit deemed on the federal level,” said Dr. Whinkin. “But we do have some examples within the United States, specifically in Oregon and Colorado, where they're creating policy and pursuing the belief that this should be accessible to some extent and should be regulated so people can legally receive the potential benefits.”
To date, there has been little progress in legalizing psilocybin in other states or on the federal level.
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