A new research review has explored the use of psilocybin for the treatment of resistant depression.
Increasing clinical research is pointing towards psychedelics as useful treatments for a number of mental health conditions. However, there remain a number of barriers before any of these treatments can be approved including regulatory challenges and understanding clinical benefits.
In the research review, published in the Journal of Psychiatric Practice, members of the Psychopharmacology Committee of the Group for the Advancement of Psychiatry and consultants discuss current research findings to provide guidance to clinicians concerning the prospects for psilocybin treatment for patients struggling with depression, says lead author Amir Garakani, MD, of Greenwich Hospital, Greenwich, and the Department of Psychiatry at the Yale School of Medicine, New Haven, Conn.
Garakani stated: “At a time of growing excitement regarding the potential use of psychedelic agents to improve outcomes of otherwise intractable disorders, psychiatrists and patients alike need perspective on the current state of the evidence and the prospects moving forward.”
How does psilocybin affect the brain?
Many recent clinical trials have reported positive effects of psilocybin in treating psychiatric disorders, including major depressive disorder (MDD) and treatment-resistant depression (TRD).
Evidence suggests that therapeutic responses to psilocybin “stem from, or at least go hand-in-hand with, an intense emotional or mystical experience,” Garakani and colleagues write.
Studies suggest that psilocybin leads to increased “openness to experience” and psychological flexibility – enabling patients to “reconsider stereotyped perspectives and move beyond accustomed patterns of thinking.”
Research into psilocybin’s biological effects suggests increased activity between brain networks, without corresponding increases within single networks. Greater changes in brain network flexibility have been linked to lasting reductions in depression symptoms six months later.
Research
The review highlights that, to date, all psilocybin treatment studies have included a psychotherapy component. This includes preparation, dosing and integration phases.
Additionally, it notes that various dosing strategies are being evaluated in academic and commercial settings, with such studies following highly controlled protocols in carefully selected populations, with special attention to maximising patient safety during the psychedelic experience.
On the number of studies in clinical trial registries that are targeting MDD, TRD, and other conditions such as cancer-related anxiety and post-traumatic stress disorder, the authors write: “The large number and wide-ranging scope of ongoing and future psilocybin trials not only show the interest in this drug in the scientific community but also the potential therapeutic role of psychedelics across diagnoses and clinical domains.”
Regulation
As well as research advances, a number of policy advances concerning psychedelics have been made in the last year.
In particular, the Australian regulatory agency announced approval for psychiatrists to prescribe psilocybin treatment for TRD and in the US, psilocybin has been designated as a “breakthrough therapy” for TRD and MDD. Oregon and Colorado have legalised and decriminalised psilocybin, respectively, however, it still remains a Schedule 1 controlled substance under federal law.
An official American Psychiatric Association position states that there is “currently inadequate scientific evidence” to endorse the use of psychedelics for treatment of any psychiatric disorder, outside of approved research studies.”
“The research evidence presented here offers further support for the potential of psychedelics in mental health care,” Dr. Garakani and colleagues conclude. “Psilocybin has demonstrated promise as a novel therapeutic and offers new perspectives on the function and dysfunction of the brain.
“It remains to be seen if the current clinical, legal, and research landscapes will allow delivery on that promise.”
