Confirmed: Psilocybin More Effective Than Traditional Antidepressant

Depression impacts over 280 million people worldwide. It is the leading cause of disability globally, affecting more than 3.8% of the population. Despite this, finding viable treatment options is difficult. While the antidepressants available work for some people, for a large percentage they are ineffective or cause unpleasant side-effects.

The race is on to find more effective, more holistic, and more affordable options. The current front-runner is psychedelics; a growing pile of research points to their potential as a therapeutic treatment for a whole host of mental health conditions, including, of course, depression. 

Comparative Studies Are Key

While psychedelics, such as psilocybin from magic mushrooms, have been shown to be effective in the treatment of depression, the real punch comes when their results are compared and contrasted with those of conventional depression treatments. Studies like this are currently less frequent, partially because of the hiatus psychedelic research was forced to take for much of the latter part of the 20th century. However, a review and meta-analysis, published this month in the BMJ has done just that, comparing the effects of psilocybin to the antidepressant escitalopram. 

The results of the review show that high doses of psilocybin were more effective than escitalopram in relieving depressive symptoms. This suggests that psilocybin may be (at minimum) comparable to established antidepressant treatment. 

Comparing Psychedelics to Other Depression Treatments

As we’re sure you know, (but incase of any newbies) psychedelics are psychoactive substances, some naturally occurring (psilocybin, ayahuasca), some synthetic (LSD, MDMA), that induce a psychedelic trip. As well as the recreational, spiritual, and mind-bending effects, they have the potential to treat numerous mental health conditions such as post-traumatic stress disorder (PTSD), eating disorders such as anorexia, addiction issues, as well as depression and many more. 

Despite how promising the results of psychedelic studies have been, it is always a challenge to carry out properly ‘blind’ studies due to the subjective effects of psychedelics. This means that placebo effects and possible bias may become more pronounced. 

How The Review Worked

The researchers of the new BMJ review wanted to compare monotherapy (one drug only) use of psychedelics with escitalopram, a common pharmaceutical antidepressant. To balance the potentially reduced placebo effects of psychedelic trials, the authors made a point to distinguish between the placebo response recorded in psychedelic trials, and the placebo response recorded in antidepressant studies. 

The researchers included randomized controlled trials with adult participants who had a clinical depression diagnosis. For all the data, they looked for changes in depressive symptoms as the primary outcome. In all, they were able to include data from 19 trials. These included 811 participants in psychedelic trials, and 1968 participants in escitalopram trials. On crunching the data, the researchers found that the placebo effect in psychedelic trials was lower than the placebo effect in escitalopram trials. 

Confirmed: Psilocybin More Effective Than Traditional Antidepressant

The study found that high doses (20mg or more) of psilocybin were slightly more effective than escitalopram.

“High-dose Psilocybin Shows Promise…”

David Merrill, MD, PhD, geriatric psychiatrist at Providence Saint John’s Health Center in Santa Monica, who was not involved in the study, had this to say to Medical News Today about the review’s findings:

“This study used meta-analysis techniques to compare the effectiveness of psychedelics and escitalopram (Lexapro) for depressive symptoms… High-dose psilocybin shows promise as a fast-acting, short-term treatment for depression. This is in comparison to antidepressants, which take weeks, if not months, to kick in and only continue to work with continued use,”

“Though not addressed in this study, the clinical consensus is that benefits of high dose psilocybin can last for months and potentially years after the acute episode of treatments. At times even only one treatment session is needed for otherwise chronic intractable depression. This is part of why psychedelic-assisted psychotherapy under safe, controlled professional settings is gathering such momentum and enthusiasm in the field of psychology and psychiatry,” 

How Could Psychedelic Trials Could Be Improved 

The study authors suggest that improving blinding methods and ensuring more standardized psychotherapies could help increase understanding of the effectiveness of psychedelics. Some researchers have criticized the findings, saying that the studies compared were too disparate to be relevant. 

The researchers from this study however, believe that these findings show that psilocybin has a real potential be used alongside psychotherapeutic support. David Merrill, MD, agrees stating; 

“These findings give hope to those with depression — especially those who find antidepressants to be ineffective or intolerable due to side effects. While there are always potential risks of using drugs to treat health conditions, this review shows that, with the proper mindset and treatment setting, high dose psychedelics can be used safely and effectively to treat depression, with results on par or better than seen with antidepressant medications.”

“Many in the field are working diligently to build a renewed evidence base to allow for the legalization and regulated approval of psilocybin and other psychedelic therapies for depression, PTSD, addiction, and other health conditions,” 

The Takeaway:

• Psychedelics have been shown to be effective in treating mental illness.
• Research that compares psychedelics to more traditional medications is currently relatively sparse. 
• Evidence from a new BMJ research review suggests that high doses of psilocybin are slightly more effective at treating depression than escitalopram, a common antidepressant.