Psilocybin, the chemical that gives some mushrooms their “magic” seems to decrease the symptoms of some people with major depressive disorder.
Two studies, one conducted at the Center for Psychedelic and Consciousness Research (for ease of reference, study 1) and one conducted at Imperial College London (study 2), show promising results for the efficacy of psilocybin as a treatment for depression.
In the 1960s there was much research being done on the use of psychedelics in a medical setting. However, once those drugs started being used recreationally, the Controlled Substances Act of 1971 made psilocybin (and other drugs such as LSD) Schedule 1, meaning they could not be used for research. The chart below shows the dip in studies being done on psilocybin during the 1970s until very recently.
The recent spike in studies is due to places such as the Center for Psychedelic and Consciousness Research, which was founded in 2019. Places such as the Center are necessary for advancing our understanding of these substances which have great potential for healing.
According to Dr. Albert Garcia-Romeu, a researcher at the Center for Psychedelic and Consciousness Research, “about one-third of patients do not respond to other treatments.” Treatments such as antidepressants or regular talk therapy.
Psilocybin-assisted therapy was not the first option for anyone in these studies. They had all tried other treatment options and saw very little to no benefit. For them, it’s either stay depressed their whole lives or try psilocybin-assisted therapy. Some participants of these studies saw little to no benefit, however, for the most part, the participants of these studies benefited from the psilocybin-assisted therapy, which is a good sign.
Many people have used psychedelic substances recreationally. Some may have traveled in order to take part in religious and/or spiritual ceremonies involving psychedelics. However, very few people have experienced psychedelics the way the participants of these studies do.
First of all, the enrollment process of these studies is selective and rigorous. 870 people applied to participate in study 1, but only 27 were enrolled. Reasons for exclusion include not living within commuting distance, not meeting MRI criteria, having a or a relative with a complicating disorder, and currently being on an antidepressant. According to Dr. Albert Garcia-Romeu, a researcher at the Center for Psychedelic and Consciousness Research, “people who are currently on antidepressants will not have the same type of benefit”
Another important factor is the participant’s GRID-HAMD score. GRID-HAMD is short for the GRID-Hamilton Depression Rating Scale and it is used to determine the severity of one’s depression. In both studies participants needed at least a 17 in order to be considered, so all participants had moderate to severe depression. It should also be noted that study 2 required participants to have tried at least two other antidepressant medications without response.
Second, there was a preparation process participants undergo before they were given the psilocybin. According to Dr. Garcia-Romeu, it is important to build “a solid working relationship” with the participants before the administration sessions. “We usually spend at least a month doing different kinds of preparatory sessions.”
It is essential that the participants feel comfortable with the researchers in the room with them because there are certain risks to taking psilocybin, the most famous one being the “bad trip”. The effects of psilocybin are very dependent on the person’s “set” and “setting”.
The term “set” refers to the mindset of the person leading up to and during the experience. Having a bad set can easily lead to an unpleasant experience, so researchers need to ensure participants are prepared.
The other term “setting”, refers to the environment in which the psilocybin is taken. Taking psilocybin in an uncomfortable or inappropriate setting could lead to a bad trip. Again, researchers must prepare and inform the participants and make sure they will be comfortable during the administration sessions.
Lastly, the administration sessions themselves are designed so that the participants will have the best possible experience. Participants were given a blindfold so that they do not focus on any visual distortions they might have had because they were encouraged to focus on themselves and embrace any feelings evoked by the psilocybin. There are also two trained professionals in the room in order to provide support if a participant is feeling overwhelmed.
Interestingly, in both studies, participants were encouraged to wear headphones and each study had a specific playlist that played throughout the session. According to Dr. Garcia-Romeu, the playlist was organized in a way that “helps people go from the gentler phase to the more emotional peak phase.”
Both studies had two administration sessions as well as follow up sessions. The follow-up sessions were important in order to solidify any realizations that were made during the sessions. Dr. Garcia-Romeu compared it to going to the gym, “you can’t just go to the gym once.”
The results of both studies were fairly positive, although the results of each study were analyzed in different ways. Study 1 had participants take the GRID-HAMD rating test twice more after their sessions in order to see a quantifiable change in participants’ depression. Study 2 analyzed how participants felt during the sessions as well as answers to questions in the follow-up sessions, in a more qualitative approach.
The graph above shows that “psilocybin therapy led to a statistically significant and very large reduction in depression symptoms” said Alan Davis, another researcher at the Center of Psychedelic and Consciousness Research and one of the leading authors of the study, in a presentation he gave about the study.
In either case, both studies showed that psilocybin is capable of helping people with major depressive disorder when antidepressants can not. This might be due to a phenomenon dubbed “quantum change”.
Dr. Garcia-Romeu described quantum change as a sort of “aha moment” in which, under the influence of the psilocybin, participants are able to make some profound realizations about whatever it is they were seeking to gain from the experience.
While some people were able to gain from their experience, not everyone did. These studies show that psilocybin can be a very effective treatment for major depressive disorder, but they also show that for some people, it may not be.
It is important to remember that these studies are being done on 20 or so people at a time. A very small percentage of the major depressive population. It should also be noted that in both studies, most of the participants were white. According to Dr. Garcia-Romeu, there is a “long history of taking advantage of marginalized people” within big medicine. It is not necessarily that minorities are being actively excluded from these trials, but they are less likely to apply due to a large mistrust of the American health care system.
Either way, while these studies are promising, in order for psilocybin to be taken more seriously as a treatment for major depressive disorder, larger and more diverse studies need to be done.