Therapeutic role of psilocybin and 3,4-methylenedioxymethamphetamine in trauma: A literature review

Rationale Recent clinical trials are reporting marked improvements in mental health outcomes with psychedelic drug-assisted psychotherapy.Objectives Here, we report on safety and efficacy outcomes for up to 6 months in an open-label trial of psilocybin for treatmentresistant depression.Methods Twenty patients (six females) with (mostly) severe, unipolar, treatment-resistant major depression received two oral doses of psilocybin (10 and 25 mg, 7 days apart) in a supportive setting.Depressive symptoms were assessed from 1 week to 6 months post-treatment, with the self-rated QIDS-SR16 as the primary outcome measure.Results Treatment was generally well tolerated.Relative to baseline, marked reductions in depressive symptoms were observed for the first 5 weeks post-treatment (Cohen's d = 2.2 at week 1 and 2.3 at week 5, both p < 0.001); nine and four patients met the criteria for response and remission at week 5. Results remained positive at 3 and 6 months (Cohen's d = 1.5 and 1.4, respectively, both p < 0.001).No patients sought conventional antidepressant treatment within 5 weeks of psilocybin.Reductions in depressive symptoms at 5 weeks were predicted by the quality of the acute psychedelic experience.Conclusions Although limited conclusions can be drawn about treatment efficacy from open-label trials, tolerability was good, effect sizes large and symptom improvements appeared rapidly after just two psilocybin treatment sessions and remained significant 6 months post-treatment in a treatmentresistant cohort.Psilocybin represents a promising paradigm for unresponsive depression that warrants further research in double-blind randomised control trials.