Psilocybin as a Drug Treatment for Anxiety and Depression

Abstract

The Anxiety and Depression Association of America (2018) states that “Anxiety disorders are considered” the “most” “common mental illness in the US” with about “40 million adults,” 18 years old and older suffering from it, and that “Depression is considered to be the leading cause of disability worldwide,” while Major Depressive Disorder (MDD) is the “leading cause of disability in the US,” between the ages of 15 and 44.3. To make things worst current pharmacological treatments available to treat these disorders are not always effective. Jessica Brown from the Johnson & Johnson foundation (2018) found that even though some antidepressant medications can be effective at treating MDD, up to one third of adults find no relief to their symptoms from any of these medications, which is why this paper focuses on investigating psychedelics, specifically Psilocybin, as a novel treatment for depression and anxiety.

Introduction

Psilocybin is a psychedelic (induces hallucinations and exploration of consciousness) mushroom that has been used by many cultures for centuries, as a ritual way to explore consciousness. Recent research studies suggest that psychedelics like psilocybin, may be a very promising, safe, and alternative way to treat patients suffering from treatment-resistant depression and other anxiety disorders. (Muttoni, Ardissino, & John, 2019). Psychedelics like psilocybin have an ancient “medicinal” pass and have been used for many years as a way to explore the consciousness. Carhart-Harris and Goodwin (2017) mention that “plant-based” psychedelics have been used for centuries for “holistic healing” and that one of the first reported English-language research use of psychedelics in psychology and psychiatry, goes all the way back to the 1950s, where it was successfully use in “psychotherapy for the treatment of mood disorders and alcohol dependence” (pp. 2105, 2106).

Psilocybin’s Chemical and neurobiological Properties

Psilocybin is

A study investigating  psilocybin’s potential for abuse and harm provided an analysis of psilocybin’s “abuse potential” as a medically administered medication using the 8-factor model (“1-Potential for abuse, 2-Scientific evidence of its pharmacological effects, 3-Current scientific knowledge regarding the drug, 4. History and current pattern of abuse, 5-The scope, duration, and significance of abuse, 6-Risk to public health, 7-Psychic or physiological dependence liability and factor 8-Immediate precursor of substance controlled”) of the Controlled Substance Act (Johnson, Griffiths & Henningfield, 2018). The authors performed a historical review of Psilocybin use and a systemic analysis of different clinical trials and major national surveys performed in the US.  Based on findings collected from different data sources, and animal and human clinical trials, the authors concluded that psilocybin’s “risk for abuse and harm” is low and that its benefits support psilocybin’s development as a new drug (Johnson et al., 2018). The authors also support that psilocybin be scheduled as a no more than a scheduled drug IV (the lowest risk for abuse) instead of the current schedule I (the highest risk for abuse). These findings support the beneficial use of psychedelics like psilocybin in a controlled setting, and psilocybin’s low potential for abuse (Johnson, Griffiths, Hendricks and Hennigfield, 2018).

In a paper published in the journal of Neurotherapeutics by Johnson and Griffiths (2019) researchers found that most “drug-related” adverse effect from psilocybin administration are “modest” and “readily” managed. In another article, the authors wanted to investigate the efficiency of psychedelics like psilocybin, ayahuasca, and LSD at managing treatment resistant depression, and in order to investigate this, they searched and reviewed clinical trials that have investigated the use of psychedelics to manage depression and anxiety. They analyze seven studies and 130 patients. They noted symptom improvement and adverse effects. Based on their analysis, they found that in a “supporting setting” psychedelics like Ayahuasca, LSD and Psilocybin “consistently” showed “significant” short term and long term antianxiety and antidepressant effects and that overall, they were well tolerated by patients. The study concluded that psychedelics appear to be an effective and well tolerable alternative for treatment-resistant depression.

According to an article published in the British Medical Journal by Pitman, Suleman, Hyde & Hodgkiss (2018), depression can affect “up to 20 percent of cancer patients”  and anxiety can affect “up to 10 percent of cancer patients” and what is worse is that for some cancer patients taking antidepressants is not an option because certain antidepressants can interact with chemotherapy agents they may be taking. In A study by Griffiths et. al, (2016),  researchers wanted to investigate the effects of psilocybin as an antianxiety and antidepressant in cancer patients. They investigated 51 cancer patients. Some participants received a low placebo like dose of psilocybin (“1 or 3 mg/70 kg”) in comparison to a high psilocybin does (“22 or 30 mg/70 kg”). The doses were administered in 5-week sessions and after 6 months. Participants were also administered questionnaires that measured their anxiety and depression levels. The study found that participants who were administered the high psilocybin dose had decreased clinical depression and anxiety and increased quality of life that was sustained even at the 6-month follow-up. Because this study is double blind and randomized it provides a very rigorous assessment of psilocybin’s effectiveness and tolerability as an antidepressant and antianxiety medication. It showed that even in a very controlled environment, a single psilocybin can produce significant and long-lasting antidepressant and antianxiety effects.

 Psilocybin has also been used for many generations to explore the unconscious mind and enhance creativity and well-being. Another recent study published by Smigielski, L., Scheidegger, M., Kometer, M., & Vollenweider (2019) found that psilocybin combined with meditation can facilitate self-consciousness and “induced state of transcendence”. I also found this other research study by Mason, Mischler, Uthaug & Kuypers (2019) in which researchers wanted to investigate the “effects of psilocybin” on “creative thinking”, “empathy” and “well-being”. In this study the researchers recruited 55 volunteer participants, 26 females and 29 males, who were attending a psilocybin retreat. Participants were given an average of 32.4 grams of psilocybin per day and were also administered psychological and wellbeing questionnaires and cognitive-emotional abilities tests before taking psilocybin, the morning after psilocybin administration and seven days after psilocybin administration. Data analysis showed that participant’s life satisfaction, emotional arousal and concern for other people significantly increased the morning after, and seven days after taking psilocybin. The study concluded that one single dose of psilocybin when administered in a social environment is associated with an “enhancement of creativity, empathy and well-being”.

After doing all my research on the past and current research and state of psychedelics like psilocybin, I am left with many questions. For example, I wonder why if psychedelics like psilocybin have been widely researched and widely used for many years with many positive and clinical significant benefits, are they still so strictly regulated and inaccessible, specially to patients that need them the most like patients suffering from treatment resistant depression or cancer patients. There have been many clinically significant trials showing the many benefits of psychedelics like psilocybin for the treatment of Anxiety, Depression, Alcohol Dependence, OCD and many other mental disorders. Recent clinical trials have also shown the psilocybin has low potential for abuse and modest and manageable adverse effects. After doing this research narrative I would like to advocate for more research support for psilocybin and other psychedelics as alternative treatments for mental health disorders.

References

• Anxiety and Depression Association of America. (2018). ADAA. Retrieved 2019, from https://adaa.org/about-adaa/press-room/facts-statistics
• Brown, J. (2018, July 6). 4 Things We Now Know About Treatment-Resistant Depression. Retrieved October 6, 2019, from https://www.jnj.com/health-and-wellness/4-facts-about-treatment-resistant-depression
• Carhart-Harris, R. L., & Goodwin, G. M. (2017). The Therapeutic Potential of Psychedelic Drugs: Past, Present, and Future. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 42(11), 2105–2113. doi:10.1038/npp.2017.84
• Daniel, J., & Haberman, M. (2018). Clinical potential of psilocybin as a treatment for mental health conditions. The mental health clinician, 7(1), 24–28.doi:10.9740/mhc.2017.01.024
• Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of psychopharmacology (Oxford, England), 30(12), 1181–1197. doi:10.1177/0269881116675513
• Johnson, M. W., Griffiths, R. R., Hendricks, P. S., & Henningfield, J. E. (2018). The abuse potential of medical psilocybin according to the 8 factors of the controlled substances act doi://doi-org.proxy1.library.jhu.edu/10.1016/j.neuropharm.2018.05.012
• Johnson MW, Griffiths RR. Potential Therapeutic Effects of Psilocybin. Neurotherapeutics. 2017;14(3):734–740. doi:10.1007/s13311-017-0542-y
• Mason NL, Mischler E, Uthaug MV, Kuypers KPC. Sub-acute effects of psilocybin on empathy, creative thinking, and subjective well-being. J Psychoactive Drugs. 2019;51(2):123-134. https://doi-org.proxy1.library.jhu.edu/10.1080/02791072.2019.1580804. doi: 10.1080/02791072.2019.1580804.
• Muttoni, S., Ardissino, M., & John, C. (2019). Classical psychedelics for the treatment of depression and anxiety: A systematic review.   Journal of Affective Disorders, 258, 11–24. https://doi.org/10.1016/j.jad.2019.07.076
• Pitman Alexandra, Suleman Sahil, Hyde Nicholas, Hodgkiss Andrew. Depression and anxiety in patients with cancer  BMJ  2018;  361 :k1415
• Smigielski, L., Scheidegger, M., Kometer, M., & Vollenweider, F. X. (2019). Psilocybin-assisted mindfulness training modulates self-consciousness and brain default mode network connectivity with lasting effects doi:https://doi-org.proxy1.library.jhu.edu/10.1016/j.neuroimage.2019.04.009