Psilocybin for Depression: From Credibility to Feasibility, What’s Missing?

Abstract

Psilocybin has been suggested as a promising transdiagnostic treatment strategy for a wide range of psychiatric disorders. Recent findings showed that psychedelic-assisted/”psycholitic” psychotherapy should provide significant and sustained alleviation of depressive symptoms. However, to date, there have been several study limitations (e.g., small sample sizes, blinding, limited follow-up, highly screened treatment populations) and some health/political issues, including practitioners’ experience, lack of standardized protocols, psychedelics’ legal status, ethical concerns, and potential psychological/psychopathological/medical untoward effects. The focus here is on a range of clinical and methodological issues, also aiming at outlining some possible suggestions. We are confident that newer evidence, more precise protocols, and eventual reclassification policies may allow a better understanding of the real potential of psilocybin as a transdiagnostic therapeutic molecule.

Psychedelics and treatment of mental disorders: A survey of attitudes and knowledge among psychiatrists, general practitioners and psychologists in Iceland

“…Aukinn áhugi og kerfisbundnar rannsóknir á notkun hugvíkkandi efna í meðferð geðraskana er nokkuð nýr af nálinni, og bent hefur verið á þaetti sem þurfi að baeta úr í rannsóknum þessu sviði, meðal annars til að auka áreiðanleika og réttmaeti niðurstaðna. [20][21][22][23][24][25][26][27][28] Einnig er margt sem enn á eftir að upplýsa, svo sem virkni efnanna í fjölbreyttari og staerri hópum sjúklinga, mismunandi tegundum og alvarleika sjúkdóma, mögulegar aukaverkanir og áhaettuþaetti ásamt hugsanlegum langtímaávinningi eða skaða af notkun þeirra. Háskólar og fagfélög munu gegna mikilvaegu hlutverki í að koma niðurstöðum rannsókna á þessu til skila til verðandi heilbrigðisstarfsfólks og þeirra sem tekið hafa til starfa.…”

Editorial: What is up with psychedelics anyway?

“…Important discussions are emerging on how to integrate indigenous theoretical perspectives and approaches while reducing historically-rooted colonial assumptions prevalent in psychology-related fields (George et al, 2019 ; Williams and Labate, 2019 ; Ens, 2021 ; Hauskeller et al, 2022 ; Romero, 2022 ). Not only are there controversies within the scientific and therapeutic realm over the hype, methodologies, and feasibility of psychedelic-assisted therapies (Hendy, 2018 ; Michaels et al, 2018 ; Brody, 2022 ; Marseille et al, 2022 ; Munafò et al, 2022 ; Ona et al, 2022 ), but voters also show sharp rifts in psychedelic support. More counties in Oregon and Colorado recently voted “no” than “yes” on psychedelic decriminalization/legalization initiatives.…”

An Update on Psychoactive Substances: Pharmacology and Toxicology Issues

“…The six published articles highlight different aspects of the pharmacology and toxicology of several psychotropics; most of them are represented by opiates/opioids, e.g., tramadol [ 4 , 5 ], tapentadol [ 4 ], and fentanyl [ 6 ], but other categories here mentioned are selective serotonin reuptake inhibitor (SSRI) antidepressants [ 7 ], new psychoactive substances (NPSs) known as cathinones [ 8 ], and the hallucinogen drug psilocybin [ 9 ].…”

“…Further confounding issues have included the diversity of practitioner experience in the different studies, the lack of standardized protocols, differences in legal status of psychedelics between the different countries, and a range of ethical concerns and potential psychological/psychopathological/medical adverse effects. In the opinion article published here [ 9 ], a number of hypotheses concerning the mechanism of action of psilocybin are described. However, at this stage, it is not entirely clear which signalling pathways are predictive of the therapeutic effect.…”