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Psilocybin with psychological support for treatment-resistant depression: six-month follow-up

Authors
  • Carhart-Harris, R. L.1
  • Bolstridge, M.1, 2
  • Day, C. M. J.1, 2
  • Rucker, J.1, 3, 4
  • Watts, R.1
  • Erritzoe, D. E.1
  • Kaelen, M.1
  • Giribaldi, B.1
  • Bloomfield, M.5
  • Pilling, S.6
  • Rickard, J. A.7
  • Forbes, B.8
  • Feilding, A.9
  • Taylor, D.10
  • Curran, H. V.6, 11
  • Nutt, D. J.1
  • 1 Imperial College London, Psychedelic Research Group, Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, London, UK , London (United Kingdom)
  • 2 South London and Maudsley NHS Foundation Trust, London, UK , London (United Kingdom)
  • 3 King’s College London, The Institute of Psychiatry, Psychology and Neuroscience, London, UK , London (United Kingdom)
  • 4 South West London and St George’s Mental Health NHS Trust, London, UK , London (United Kingdom)
  • 5 University College London, Division of Psychiatry, University College London and Clinical Psychopharmacology Unit, London, UK , London (United Kingdom)
  • 6 University College London, Clinical Psychology and Clinical Effectiveness, London, UK , London (United Kingdom)
  • 7 the Royal London Hospital, Barts Health Pharmaceuticals, Barts Health NHS Trust, London, UK , London (United Kingdom)
  • 8 King’s College London, Institute of Pharmaceutical Science, London, UK , London (United Kingdom)
  • 9 The Beckley Foundation, Beckley Park, Oxford, UK , Oxford (United Kingdom)
  • 10 Pharmacy and Pathology, South London and Maudsley NHS Foundation Trust, London, UK , London (United Kingdom)
  • 11 University College London, Clinical Psychopharmacology Unit, London, UK , London (United Kingdom)
Type
Published Article
Journal
Psychopharmacology
Publication Date
Nov 08, 2017
Volume
235
Issue
2
Pages
399–408
Identifiers
DOI: 10.1007/s00213-017-4771-x
Source
Springer Nature
Keywords
License
Green

Abstract

RationaleRecent clinical trials are reporting marked improvements in mental health outcomes with psychedelic drug-assisted psychotherapy.ObjectivesHere, we report on safety and efficacy outcomes for up to 6 months in an open-label trial of psilocybin for treatment-resistant depression.MethodsTwenty 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.ResultsTreatment 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.ConclusionsAlthough 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 treatment-resistant cohort. Psilocybin represents a promising paradigm for unresponsive depression that warrants further research in double-blind randomised control trials.

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