Psilocybin may offer benefits over current drugs





Even with a limited amount of data, it’s clear that psilocybin stands apart from current antidepressants.

Psilocybin acts quickly, whereas antidepressants can take weeks to work. Also, the effects of a single dose of psilocybin appear to last for weeks to months.

Ross says if these effects are confirmed by randomized clinical trials, it could lead to a major change in the treatment of depression.

“Rather than a pill every day, it’s one treatment or maybe a couple treatments with enduring effects,” Ross said. “And because you wouldn’t have to keep taking the medication, it minimizes side effects compared to antidepressants.”

Hellerstein says psilocybin also stands out in how it’s given to patients.

In current clinical trials, participants are given a single dose of psilocybin and monitored by a specially trained psychotherapist, who stays in the room for the entire six- to eight-hour hallucinogenic “trip.”

Participants are also prepared for their experience beforehand. They meet with the therapist several times afterward to help them process what they went through.

“This is not just a medication effect,” Hellerstein said. “It’s a medication interwoven with interpersonal experience.”

Ross says the approach they use at NYU for psilocybin is as a medication-assisted psychotherapy.

“We don’t think this is a pharmacologic-only intervention,” he said. “This is used in the hands of skilled psychotherapists to inform the psychotherapy and to deepen it.”

This approach means it’s harder to test psilocybin than other medications; you can’t just give people a pill and send them on their way.

Researchers also have to consider the effect that therapy and the psychotherapist have on a patient’s depression, not just the effects of the psilocybin.

In addition, if clinical trials show that psilocybin is effective for treating depression, doctors will need to contend with other issues related to this type of medication-assisted psychotherapy.

“It makes it much more challenging to provide widespread psilocybin treatment,” Hellerstein said. “How do you set up a clinic where people have to come in for eight hours every time they need a treatment?”

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