Psychedelic therapy for depression still effective one year later

New research published in the Journal of Psychopharmacology has offered valuable insights into the long-term effects of psilocybin-assisted psychotherapy for depression. The study reports more than half the original cohort were still in remission 12 months after the acute psychedelic treatment.

Amidst the massive wave of stories reporting on groundbreaking psychedelic research it is easy to forget just how nascent the entire field actually is. Psilocybin research, for example, is still in its infancy. The most progressed area in the field is psilocybin psychotherapy for depression, and that only recently reported Phase 2 trial data late last year, encompassing just a couple of hundred participants.

One question yet to be clearly answered is exactly how long do the benefits of psilocybin psychotherapy last. Most current research rarely offers data longer than a few months following the acute treatment.

Up to now the longest psilocybin for depression follow-up study tracked patients for six months post-treatment. That study, an open-label trial involving 26 participants with treatment-resistant depression, saw persistent benefits six months later.

Another more recent study offered unique insights into the long-term effects of a single dose of psilocybin, in conjunction with psychotherapy, for patients with cancer-related existential distress. That study looked at participants up to five years after their psychedelic treatment and remarkably found more than two-thirds showed persistent clinically significant effects.

This new investigation has provided the most robust report to date on the long-term efficacy of psilocybin psychotherapy for major depressive disorder. The study followed up on 24 patients who participated in a trial involving two psilocybin sessions accompanied by pre and post psychotherapy.

At the 12-month follow-up, rates of response to the psychedelic treatment were remarkably stable, with 78 percent of the cohort showing persistent clinically significant reductions in symptoms and 58 percent presenting as still in remission. Natalie Gukasyan, a researcher from Johns Hopkins working on the project, does point out a number of subjects utilized other treatments to help control their symptoms over the course of the one-year follow-up.

“A third of participants began treatment with an antidepressant sometime during the course of follow-up, and about 42% received some form of psychotherapy outside of the study during that time,” Gukasyan reported on Twitter. “Overall it’s encouraging that remission and treatment response remained high through the 12 month follow-up, but for some participants part of that sustained improvement was likely also driven by other forms of treatment.”

Instead of interpreting the use of other therapies post the psychedelic sessions as a treatment failure, the study is a potent reminder that psilocybin is not a singular magic bullet or permanent cure-all. The rapid responses to psilocybin therapy in most of the participants suggest the treatment is helpful at quickly bringing a patient down to a more manageable baseline, from which longer-term work may still be needed to maintain remission.

On that note, Gukasyan does pointedly indicate the need to investigate safety and efficacy in repeated psilocybin sessions months, or even years, after the initial sessions. Could annual psilocybin sessions be helpful in maintaining ongoing remission?

“An important question moving forward: What are the risks/benefits of additional dosing for those who don’t respond, or relapse months after treatment?” Gukasyan asked.

Roland Griffiths, a pioneer of modern psychedelic science and founding director of the Johns Hopkins Center for Psychedelic and Consciousness Research, says the findings offer promising glimpses at the long-term persistence of psychedelic therapies.

“Psilocybin not only produces significant and immediate effects, it also has a long duration, which suggests that it may be a uniquely useful new treatment for depression,” said Griffiths, a co-author on the new study. “Compared to standard antidepressants, which must be taken for long stretches of time, psilocybin has the potential to enduringly relieve the symptoms of depression with one or two treatments.”

The researchers are cautious to note this is a small cohort of patients with no placebo control. So of course, there is a lot more work to be done to understand the persistent effects of psychedelic therapy, and discover the best ways to optimize any long-term benefits. Gukasyan also stressed that although these findings are positive, they were generated under research settings with lots of preparation and support for participants.

“Our findings add to evidence that, under carefully controlled conditions, this is a promising therapeutic approach that can lead to significant and durable improvements in depression,” Gukasyan said. “[However,] the results we see are in a research setting and require quite a lot of preparation and structured support from trained clinicians and therapists, and people should not attempt to try it on their own.”

The new study was published in the Journal of Psychopharmacology.

Source: Johns Hopkins University