June 13th, 2022

Depression has been a problem for humans for a very long time. It is a leading cause of suicide and lost vitality for life. It is a tricky disease that has been more prevalent and severe in the last few decades. The pandemic was not kind to people suffering from mood dysthymia. Traditional pharmacological and verbal based therapies have been useful for some while not so for others. The treatment resistant group is the focus of a new series of studies with psychedelic medicines. These studies are offering hope for many individuals that previously had none.

Psilocybin is a naturally occurring tryptamine chemical that is found in mushrooms.

The molecule is converted to psilocin in the body where it attaches to a serotonin 2A receptor in the brain stimulating a response that we see as time altered and mind altered state of being. The effect occurs 20 to 30 minutes after ingestion and peaks a few hours in leveling off over the next few hours. Total time of effect is usually 5-6 hours based on dose. These compounds are not addicting and are considered very safe when the set and setting of their use is controlled for a pleasant and safe experience. The current legal use is restricted to study settings. These drugs have garnered a bad reputation based on inappropriately perceived use in the 1960's. The truth about them as a biochemical molecule that the body has receptors for makes me think that we evolved with them even if culturally people have issues with there use. The body does not lie.

In a study from a recent conference, the study researchers found that a single dose of a synthetic formulation of psilocybin provides rapid improvement in treatment-resistant depression, with benefits sustained for up to 12 weeks, according to results from the largest randomized controlled study of psilocybin to date. “This is easily the largest study of a psychedelic drug employing modern randomized controlled trial methodology at 22 sites and 10 countries, so it’s not your typical phase 2 trial,” the study’s lead author, Guy M. Goodwin, MD, emeritus professor of psychiatry at the University of Oxford, England, said in an interview. “Importantly, 93% of the patients in the study were psychedelic naive, which is very important for generalizability,” Goodwin noted. (Melville N. 2022)

A current meta-analysis examined the effects of psilocybin in combination with behavioral interventions on anxiety and depression in samples with elevated symptoms. Across four studies (one uncontrolled; three randomized, placebo-controlled, within-group pre-post and pre-follow-up effects on anxiety and depression were large and statistically significant. Across three placebo-controlled studies, pre-post placebo-controlled effects were also large and statistically significant. No serious adverse events were reported. Limitations include the small number of studies and risk for bias within studies. Results tentatively support future research on psilocybin for the treatment of anxiety and depression. (Goldberg et. al. 2021)

The future for this type of therapy appears to be very bright now that we are past the stigma of the 60's hippie counter culture users that caused the government to restrict access.

Listen to the Adult Chair Podcast #316 with Paul Austen and The Drive Podcast #182 with David Nutt.

There is an excellent book by Micheal Pollan on this topic called How to Change Your Mind.

Dr. M

Melville Medscape
Goldberg Psychiatry Research
Vargas Biomedicines
McCorvy J Psychopharm