Loading ...

A single dose of psilocybin combined with psychological support can provide lasting relief from depression and anxiety in patients with cancer.

In a phase 2 clinical trial, more than half of patients reported sustained reductions in depression, and nearly half reported significant reductions in anxiety 2 years after treatment.

Psilocybin is a “potentially paradigm-shifting alternative to traditional antidepressants,” wrote the investigators, led by Manish Agrawal, MD, Sunstone Therapies, Rockville, Maryland.

Sandeep Nayak, MD, medical director, Johns Hopkins Center for Psychedelic and Consciousness Research, Baltimore, who wasn’t involved in the study, said that the antidepressant effects of psilocybin in patients with cancer are “consistent” with those found in larger studies of people with depression.

“If psilocybin works for major depression in general, it’s likely to work for major depression in people with cancer, even though there are, of course, unique aspects of psychological suffering with cancer,” Nayak told Medscape Medical News.

He cautioned, however, that more study is needed.

“Ultimately, this data is encouraging but not a game changer,” said Nayak. “We do need bigger studies, which are coming.”

Limited Success Treating Cancer Depression

Depression remains common in patients with cancer, and the typical treatment approaches — antidepressants and psychotherapy — have demonstrated limited success.

Agrawal and colleagues explored the safety, feasibility, and efficacy of psilocybin-assisted group therapy in 30 patients (mean age, 58 years; 70% women; 80% White individuals) with major depressive disorder and curable or noncurable cancer.

Participants received one-on-one and group therapy sessions before, during, and after receiving a single 25-mg psilocybin dose. No patients were taking an antidepressant or antipsychotic medications or using medical cannabis.

Earlier results from this trial showed that, at 8 weeks posttreatment, 25 of 30 patients (80%) had a lasting response to psilocybin, with half demonstrating full remission of depressive symptoms by week 1, which lasted for at least 8 weeks.

The latest findings explore depression after 2 years in the 28 patients available for follow-up (two patients died).

The new 2-year data, published June 16 in the journal Cancer, highlight the durability of these effects.

At 2 years, 15 patients (54%) demonstrated ongoing benefit, with a significant 15-point reduction in Montgomery-Åsberg Depression Rating Scale scores, 14 of which had full remission of depressive symptoms.

Psilocybin also helped relieve anxiety. At 2 months, 22 patients (79%) had a significant 17-point reduction from baseline in Hamilton Anxiety Rating Scale, with 13 (46%) having a sustained reduction in anxiety at 2 years (average, 13.9-point reduction from baseline).

‘Impressive’ Data With Caveats

Nayak said the fact that 50% of patients with cancer were in remission from their depression at 2 years is “impressive and consistent with a long-lasting antidepressant effect of psilocybin.”

“However, the study had no control group, which is a limitation in that we can’t tell how much of the benefit was from the intervention vs other causes (placebo effect, depression improving on its own, social support following the trial),” he noted.

“If psilocybin receives approval for major depressive disorders, studies like this will I think spur clinical work with psilocybin and cancer,” Nayak said.

So why does psilocybin relieve depression?

“There are a lot of theories,” F. Perry Wilson, MD, Yale School of Medicine, New Haven, Connecticut, and Medscape’s Impact Factor commentator, said in a recent post. 

Wilson noted that some researchers are using a new term — psychoplastogens — to describe drugs like psilocybin.

“The science suggests that one-time use of these agents can allow for a sudden increase in neural plasticity, allowing new neuronal connections to form where they wouldn’t in other conditions, and for older connections to break down and restructure,” Wilson explained. “If our brains are etched with the stories of our lives, if our behaviors deepen and reinforce those psychological ruts, psychoplastogens like psilocybin may loosen the soil, so to speak.”

This also suggests that concomitant psychotherapy could be a critical component of psilocybin treatment for depression, he added. “Perhaps the psilocybin shakes loose some maladaptive pathways, but putting them together in a healthy way still takes work.”

Wilson said it wouldn’t surprise him if this is the case, “and it’s a good reminder to those of you reading this that these drugs are not a panacea for mental health.”

This study was partially funded by Compass Pathways, a mental health care company, as well philanthropic as support through the Shady Grove Adventist Medical Center Foundation. Some authors reported various relationships with Compass Pathways and Sunstone Therapies. Nayak and Wilson had no relevant disclosures.