Psilocybin for Depression

 But hasn't your doctor already prescribed psilocybin for your stroke recovery? WHY NOT? They are that fucking incompetent?

• psilocybin (17 posts to May 2014)

Psilocybin for Depression

Elizabeth: Moving on. Let's go to the New England Journal of Medicine, another very common issue, and that's depression. They were using a single dose of psilocybin for treatment-resistant major depression. We have talked about psilocybin a whole lot in the last, now, what do you think, decade or so?

In this case, they had a single dose of a proprietary synthetic formulation of psilocybin and they did this at 3 different dosages: 25 mg, 10 mg, or 1 mg, which was the control.

Their primary endpoint was a change from baseline to week 3 in their score on the Montgomery–Åsberg Depression Rating Scale (MADRS). It ranges from 0 to 60, with higher scores indicating more severe depression.

It's 79 participants in the high -- the 25-mg group, 75 in the 10-mg, and 79 in the 1-mg. They had the model where they did psychotherapy, I'm going to call it, and development of a relationship with a therapist previous to the administration of the psilocybin, so that that person could be comfortable and knew what to expect.

They looked at a number of outcomes, including suicidal ideation or self-injury in all dose groups. The high-dose group did experience better remission of their depression, somewhat of a dose-response in this group. It wasn't very durable in comparison to other strategies for treating depression, including medicines, and really did not appear to be that much better.

Rick: When we use these drugs for people who had cancer, they seemed to help their depression. Now, there are 180 different studies that are currently being undertaken looking at psilocybin and LSD, and MDMA. As you mentioned, these are sessions that take 6 to 8 hours of treatment. It was tremendously involved and intensive, therefore costly. It really casts some doubt about the long-term benefit of these drugs in treatment-resistant depression.

Elizabeth: Right, so let's just review some of the numbers. Their response at week 3 was 37% in the high dose, the 25-mg group, 19% in the 10-mg group, and 18%. We know that there is that substantial placebo response with regard to depression that we have talked about so many times before. That sustained response, however, at week 12 was 20% in the 25-mg group, 5% in the 10, and 10%, interestingly, in the control group. Then they also reported some adverse events including suicidal ideation. The other curiosity for me about this study was it was conducted in 22 sites in 10 countries.

Rick: That was over a 2-year period too, by the way. It was a big effort. That's why the data I think are very robust, but the results aren't nearly as robust.

Elizabeth: I would finally say that the editorialist notes that the United States has failed to prevent conflation of biomedical and commercial marijuana enterprises, and expresses concern that this should not be repeated with psilocybin because there is a lot of energy behind that right now.