An active compound in ‘magic’ mushrooms is as effective as leading antidepressant medications, a small study has found.
Researchers at the Centre for Psychedelic Research at Imperial College London compared two sessions of therapy with psilocybin, the active compound, with a six-week course of escitalopram in 59 people with moderate-to-severe depression.
Although they found that depression scores reduced in both groups, and that they occurred more quickly in the psilocybin group, writing in the New England Journal of Medicine, the researchers warn that the main comparison between psilocybin and the antidepressant was not statistically significant, meaning larger and longer trials are needed.
Volunteers received an oral dose of psilocybin in a specialist clinical setting. At the same time, they listened to a curated music playlist and were guided through their experiences by a psychological support team, which included registered psychiatrists.
They experienced significant improvements across a range of measures, including in their ability to feel pleasure, and express emotions, greater reductions in anxiety and suicidal ideation, and increased feelings of wellbeing.
Study leader Dr Robin Carhart-Harris, head of the Centre for Psychedelic Research at Imperial, said: “These results comparing two doses of psilocybin therapy with 43 daily doses of one of the best performing SSRI antidepressants help contextualise psilocybin’s promise as a potential mental health treatment. Remission rates were twice as high in the psilocybin group than the escitalopram group.
“One of the most important aspects of this work is that people can clearly see the promise of properly delivered psilocybin therapy by viewing it compared with a more familiar, established treatment in the same study. Psilocybin performed very favourably in this head-to-head.”
During the study, 59 volunteers with moderate-to-severe depression received either a high dose of psilocybin and a placebo, or a very low dose of psilocybin and escitalopram.
In the psilocybin cohort, 30 people received an initial dose of 25mg psilocybin at the start of the study, followed by a second 25mg dose three weeks later. They were also given six weeks of daily placebo capsules.
The 29 participants in the escitalopram study received 1mg psilocybin at the dosing sessions, which is classed as a non-active and unlikely to have an effect. They were also given six weeks of daily escitalopram: one 10mg capsule per day after the first dosing session, increasing to two per day after the second dosing session at 20mg per day.
All participants were assessed using standardised scales of depressive symptom severity, with the mean score being 14.5 for the psilocybin group. After six weeks, scores reduced by an average of 8.0 points.
Response was seen in 70% of people in the psilocybin group, compared with 48% in the escitalopram group, while remission of symptoms was reported in 57% of the psilocybin group and 28% in the escitalopram group.
Principal study investigator Professor David Nutt said: “These findings provide further support for the growing evidence base that shows that in people with depression, psilocybin offers an alternative treatment to traditional antidepressants.
“In our study, psilocybin worked faster than escitalopram and was well tolerated, with a very different adverse effects profile. We look forward to further trials, which if positive should lead to psilocybin becoming a licensed medicine.”
NEJM 14 April 2021
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