Are We Ready For Psychedelic Therapies?

    Drugs like psilocybin offer new therapeutic opportunities for mental health, but require special management.

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    The results of a study just published confirmed the great potential of psilocybin in the treatment of major depression.  Interest and evidence in favor of psychedelic drugs as a treatment for mental disorders is increasing.  The following question then arises: is the current medical world capable of removing these molecules from illegality and using them as drugs? 

    The new data

    The American phase 2 study involved 104 adult patients who had suffered from major depressive disorder for more than two months with symptoms of moderate or severe severity.  Patients with psychotic or manic episodes or suicidal ideation were excluded from the study.  Participants were randomly assigned to receive a single dose of psilocybin or niacin (active placebo).  Administration took place in a controlled environment, accompanied by psychological support.  The primary outcome was improvement in depression (Montgomery-Asberg Depression Rating Scale, MADRS; range 0-60) after six weeks.

     Depressive symptoms decreased more with psilocybin than with niacin (mean difference -12.3 [95% CI -17.5 to -7.2]; p<0.001).  A significant difference was already observed eight days after treatment (mean difference -12.0 [95% CI: -16.6 to -7.4]; p<0.001).  Patients treated with psilocybin also showed improvement in psychosocial functioning.  No serious adverse events occurred during the study, however, psilocybin treatment was associated with a higher frequency of adverse events.

     It’s not a miracle cure

    “The study by Raison and colleagues provides an excellent example of the potential of the new approach using psilocybin for patients with major depressive disorder,” said Rachel Yehuda, professor of psychiatry at the Icahn School of Medicine at Mount Sinai and chair of the Department of Medicine. Mental Health at the James J. Peters Medical Center (New York), and Amy Lehrner, his assistant at the same institutions.

     “The psychedelic approach is radically different from traditional approaches that attempt to suppress depressive symptoms by targeting the presumed underlying pathophysiology or biological dysregulation,” they say, emphasizing that the benefits of pharmacotherapy and psychotherapy are usually small and gradual (up to the point that true remission can take years) and that symptoms can reappear after stopping psychotropic drugs, which are responsible for several side effects.  Psychedelic therapies address the cause of symptoms, rather than simply suppressing them.  In this case, a drug is administered in a few sessions (sometimes in a single session) in a context that offers the opportunity to integrate and synthesize the revelations that occur during the therapy session.” It should be noted that, before being prohibited As illegal drugs, psychedelic compounds had been used in psychotherapy precisely to help patients open up.

     A challenge for the future

    Classic psychedelics have rapid and profound effects on perception, cognitive processes and consciousness, which can lead to heightened awareness of one’s own state and feelings of connection that last for several hours,” the two experts explain. Psychedelics can also induce difficult experiences and challenging, so they should be used carefully in the presence of facilitators or therapists trained to work with patients experiencing non-ordinary states of consciousness.

     “Psychedelic therapies require a rethinking of the way mental health care is delivered, in which the drug is combined with psychotherapy and administered in a new environment and framework,” they conclude, highlighting the challenge it poses for the healthcare system, “which will require an investment of time and resources and it is unlikely that these approaches will be widely available to patients with psychiatric disorders in the coming years, except within clinical trials.

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